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Daily Dose

Strep Throat

1:30 to read

During the “sick season” a common complaint among children (and their worried parents) is that a chid has a sore throat. While all children will at some point complain of a sore throat, most sore throats are due to a virus and are often the first sign of a cold.  

 

Many parents worry that their child may have strep throat which is a bacterial infection and requires treatment with antibiotics.  In fact, only about 10-20% of children with a sore throat will have strep.  More and more parents are bringing their children in to the office right after they “hear” that someone is their child’s class has strep (thank you social media).  In fact, their child may have not even complained about their throat until they were asked, “does your throat hurt”, or they may have only been sick for an hour or two.

 

How can you decide if your child might need to be seen at the pediatricians office if they have complained of a sore throat?

 

Strep throat is most common in school aged children 3-14 years of age.  It it typically not seen in young children (who cannot even tell you that they have a sore throat) or in adults over the age of 45.  With the advent of urgent care centers on every corner I am hearing more and more parents tell me “I have strep throat so I am worried about my child”, but when asked if they the parent are better on their medicine the majority say “not really”, and I am coughing and congested and not getting better. Their “strep throat” is more likely to have been the beginning of a cold. 

 

Children with strep throat typically do not have a cough, but do have swollen or tender lymph nodes in their neck (just under their jaw), have a temperature over 100.4 and have swollen inflamed tonsils that may or may not have exudate (white patches), and are between 3 - 14 years of age. 

 

By using these guidelines which are called the Centor Criteria your doctor is also deciding which patients should have a rapid (in office) strep test. Over testing (swabbing) with an in office rapid strep screen may lead to false positive results due to picking up the bacteria in a child’s (or adult’s) throat when they are simply carriers and do not have strep throat. Why is this important?   Over testing, may lead to over prescribing antibiotics and no one wants their child to be taking antibiotics unnecessarily. 

 

So, it is typically best to wait 24 hours or so after your child complains of a sore throat to take them to the pediatrician.  History of the illness and clinical findings are the two things that will determine if your child needs a “strep test” and should not be decided simply because “there is strep in their class”. In our office all children are examined by the physician prior to having a throat swab.

 

 

 

 

 

 

 

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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.

 

 

 

 

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Daily Dose

Treating an Upper Respiratory Infection

1:30 to read

With so much illness circulating right now (not all of which is flu) parents continue to ask what is the best way to treat their child’s cold and congestion?

 

Despite so many advances in medicine the treatment of viral respiratory illnesses has not changed that much over the years. But, we have become smarter and know that over the counter cough and cold medications are not recommended for children under the age of 6 or 7 years and may have side effects. Personally, I don’t recommend these products for older children or adolescents and don’t even take them when I get a cold.

 

The treatment of congestion and runny noses is symptomatic. You actually want your child’s nose to run and have them blow their noses once they are old enough to figure out how to “blow out rather than sniff in”. This keeps the upper airway and sinuses clear and also will help to prevent ear infections. Young children when congested, are more prone to ear infections for several reasons including the fact that their eustachian tubes don’t drain as well and that they cannot blow their noses which helps to keep the eustachian tube open and clear. It is a myth that green or yellow nasal discharge means you have a bacterial infection and need antibiotics. During most upper respiratory infections the color of the mucous will change from clear, to yellow/green, to cloudy before resolving….which usually takes a good 10-14 days. Green runny nose does not necessarily mean a trip to the pediatrician.

 

I like to have children of all ages take a steamy bath or shower to keep the nose running and then use a cool mist humidifier in their rooms at bedtime. I do not recommend running a humidifier continuously for weeks as this may promote mold growth, but use it while your child is ill.  I don’t recommend warm vaporizers either as they may cause burns in children. 

 

Nasal suctioning is also a good way to clear a baby or young child’s nose which will help them breathe more easily.  My patients parents LOVE the NoseFrida and many are “obsessed” about suctioning their child - even when they don’t have a cold.  I think our new grandson has a “NoseFrida” experience daily.  You really cannot “over suction” but if your child starts to dislike the nasal suctioning/bulb that you use and they cry constantly while suctioning their nose, especially children over 12-15 months of age, they will actually make more mucous and the whole suction experience may be counter productive. I also use a nasal saline like Little Remedies® Nose Drops or Spray, which helps to loosen and thin the mucous before I suction.  

 

I am also a big fan of Vicks or Mentholatum, which has been shown to relieve congestion. I remember my grandmother rubbing my chest and neck with Mentholatum and then putting a warm washcloth over it before I went to bed. It brings back memories of lots of “TLC” and also of feeling less congested before heading to bed. Many of my patient’s parents also like to put Vicks on their children’s feet and then put their socks on before bedtime.  

 

If your child’s nose is “stopped up” if may make it seem like they are having trouble breathing as it “sounds funny”. Look at their chest if you are concerned and make sure that they are not having any distress, with their ribs pulling in and out as they breathe or using their tummy muscles. Any labored breathing requires immediate evaluation!  In many situations all of those upper airway noises may go away after you suction their nose.  You should also watch your child’s overall color, they should be nice and pink and look comfortable despite all of the congestion in their nose. 

 

 

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

Too Sick To Go To School

1:30 to read

Now that we are really in the throes of sick season I am often asked…when should you keep your child home from day care or school?  I noticed a recent article in one of the pediatric journals on this topic…which emphasized that hand washing and vaccines are still the best way to prevent transmission of infectious diseases. 

 

But, with that being said, especially at this time of year when so may upper respiratory tract infections are circulating do you need to keep your child home?  The short answer is that most minor illnesses are not a sufficient reason to keep a child home. That includes most colds and coughs. But if your child is running a fever, or seems terribly uncomfortable or is ill enough to “require extra care” by a day care worker or teacher they need to stay home. A day at home for some TLC (tender loving care) is often the best medicine, especially for the first day or 2 of a viral upper respiratory infection when a child may have a fever.

 

I am also asked about GI illnesses and whether a child with diarrhea needs to stay home from day care. It seems that some day care facilities now exclude a child from care if they are having more than 3-4 loose stools/day, even if they are still playful, fever free and eating and drinking.  The recommendation by the CDC does not require a child with diarrhea to stay home, if the stools can be contained within the diaper.  This gets back to good hand washing!  A child with vomiting is a different story and should not be sent to school or day care.

 

I am seeing a lot of children with pink eye (conjunctivitis). Pink eye may be caused by both bacteria and viruses. Transmission occurs by direct contact with contaminated secretions from the eye or via respiratory droplets. Unless a child has other symptoms to keep them out of daycare they should be allowed to return to school once appropriate therapy has been started.   

 

Even with good hand washing it is not unusual for children who are crawling and walking to get up to 11-12 viral infections in a season! This is often difficult for a family with two working parents, as the decision is made whether a child can attend day care and who will stay home if the child needs to be home.  At the same time, young parents will often get several of their children’s viral infections as well- even with good handwashing. What parent has not had their child cough or sneeze directly into their face (this is not purposeful but age related), and within several days you find yourself sick! This is a hazard for us pediatricians as well.

 

Lastly, do not “try” to figure out “who got your child sick”. There are just too many places we all go on a daily basis where we are exposed to viruses and bacteria. Trying to “track down” the exposure for most of the common infectious diseases that children get is a big waste of time. Serious illnesses like meningitis, mumps, measles etc are a different story…but fortunately, because of vaccines this is rarely the case.

 

So keep up hand washing and hope for the best during this time of year.

Daily Dose

Winter Clothes Season

1:30 to read

Winter weather has been marching across the country with new LOWS being posted in so many cities.  Not only do flu viruses prefer cold, less humid temperatures, but the cold weather often makes us stay indoors where we are also more likely to come into contact with other sick people.

 

But, cold weather doesn’t always mean you have to stay inside.  If the temperatures are not bitter cold, you can dress for the weather and still get outside. The AAP just released tips for dressing your child in cold weather. Winter activities are often a great way to enjoy snow and cold temperatures and also encourage some exercise (and less screen time). 

 

When dressing your child for outdoor activities use layers…as several thin layers keeps them dry and warm. There are so many new products to “wick” moisture and ensure warmth.  Children need to wear warm boots, gloves and always a hat. Keeping the head warm is so important as children lose a great deal of heat if their heads are not covered. I found this it for myself when we all started wearing helmets for skiing….so much warmer!

 

Parents often worry about taking an infant outside when it is cold, but some fresh air is also good for this age group. Remember to dress them in one more layer of clothing than and a adult would wear in the same conditions. It is funny to hear parents say to me “ it is too cold to take a walk with my baby”, but it is 40 degrees and sunny outside….we southerners don’t know cold weather! A cold sunny day is perfect time for a short, brisk walk and some fresh air. I would prefer my “babies” are dressed appropriately and out in the fresh air than being around crowds in malls where mothers like to walk.

 

One of my patients parents was concerned because her 2 year old son would wake up crying in the middle of the night, (at about the same time each night) and she was convinced that he had hypothermia as his temperature would be 97 degrees every time she took it. He was talking to her and wanted to go sleep in her bed. He had NOT been outside or exposed to extremely cold temperatures and was wearing pajamas in a heated house. I think he was probably having nightmares or awakenings not related to hypothermia which occurs when children are left playing outside in very cold weather without wearing proper clothing or when their clothes get wet. It does occur more quickly in children than adults.  A child with hypothermia may shiver and become lethargic or have slurred speech. Hypothermia is a medical emergency. Call 911 and while waiting take off any wet clothes and wrap the child in warm blankets if possible.

 

Frostbite may also occur on exposed areas when the skin and outer tissue layers become frozen. This typically occurs more often on the extremities like fingers, toes, ears and nose -(wear that hat). Children may complain that their fingers or toes feel numb or may burn. Make sure to immediately bring the child inside and warm the frostbitten parts in warm but NOT hot water - usually about 104 degrees F (like a hot tub).  You may  use warm washcloths for nose and ears.  After warming then cover with warm clothes or blankets and give the child something warm to drink. (this may be why they invented hot chocolate). The numbness should subside in a few minutes. If there is no improvement you should seek medical care.

Lastly, if putting infants and children in car seats it is preferable that they wear thin, snug layers rather than thick bulky coats…you may need to warm the car before putting your child in their carseat. A thick bulky jacket does not allow the carseat harness to fit tightly enough against your child’s chest. You may take off the jacket and put their arms thru it backwards on top of the harness or use a blanket over the carseat harness…but never under the child.  

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