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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 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

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

Hurricanes & Your Health

1:30 to read

The last week has been a tough one for Texans, and especially for those who live in Houston and along the Texas Gulf Coast.  Having my son, brother and mother all with houses in Houston, I have been watching the “Harvey” situation quite closely. Fortunately, my family is lucky enough not to have flood damage and they have not had to leave Houston.  But, too many other families have suffered flooding and have been forced to evacuate their homes and seek refuge in shelters not only in Houston, but in Dallas where I live as well. 

 

There are many families who are now living in very close quarters where they may be for sometime…as it will take weeks and months if not years to recover from this disaster and to rebuild the homes, schools, churches and businesses that have been either damaged or destroyed. 

 

The necessary relocation of families and children into shelters is also “a perfect storm” for the possibility of the spread of infectious disease. This is an important time in which managing the spread of illness and infection is paramount. What this means is that EVERYONE needs to be up to date on their immunizations to prevent the spread of vaccine preventable diseases. 

 

If you have ever “skipped” a vaccine by choice or missed a vaccine, now is the time to get your child’s vaccines updated. This is not only for those who have had to evacuate, but for everyone, as infectious diseases are spread outside of the shelters and as well.  We pediatricians are working in the shelters to try and make sure that everyone is vaccinated as they arrive, but there are those who are too young to be vaccinated and others who do not have their medical records to ensure accuracy of their vaccines. It is an arduous process.

 

But, for the public health system which will be stretched even more so during the flood recovery, vaccines are one of the most important ways to protect people. It only takes one person who might get mumps, measles or whooping cough to spread it to hundreds of others….all living in close proximity. These people will then also leave their shelter to go to school, church the store or even a temporary job where they may put others at risk, you never know if you might be exposed.

 

Lastly, it is really time to get those flu shots!!! The last thing we need is an early flu season with a large group of un-immunized people…and most doctors have already received shipments of flu vaccine.

 

Please please pray for these families who have lost so much and protect everyone by immunizing your children (and yourself).  

 

 

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

More on Ear Infections

1:30 to read

It is winter and fortunately while there is not much flu to date, there are certainly colds and coughs throughout the country.  It seems that every child I see has a runny nose.  Remember, a toddler will get anywhere from 5-10 colds a year for a couple of years as they start to have playmates and pass those pesky viral upper respiratory infections back and forth.  But for some young children, (especially those in daycare) those frequent colds may lead to recurrent ear infections (otitis).

Otitis media is an infection of the middle ear. In children, an ear infection typically follows a common cold, which may be caused by a plethora of viral illnesses. It seems that the virus changes how the middle ear “functions” (lots of complicated science about cilia, and mucous and eustachian tube function) which then leads to secondary bacterial infection and an acute ear infection.  It typically takes a few days to weeks of a cold, before developing an ear infection. I tell my patients, “you don’t usually see an ear infection in a young child on day 1 or 2 of a cold”.  If everything else seems okay, you might want to watch your child for a few days before having their ears checked.

The guidelines for treating acute otitis media (AOM) changed several years ago after studies showed that not all ear infections were caused by bacteria, especially in older children, and that with “watchful waiting” many ear infections would improve on their own.  So, for children between the ages of 6 -23 months of age with bilateral or unilateral ear infections and signs and symptoms of pain (tugging on the ear, rubbing the ear, irritability and sleep interruption) and fever the recommendation is to treat the infection with antibiotics.  The recommendations get a bit trickier for children who do not have bilateral infections and who are considered to have “non-severe” AOM, in which case the doctor and parent may discuss the pros and cons of antibiotic therapy and in some cases may decide to defer the use of antibiotics for 48-72 hours and observe the child for worsening of symptoms or failure to improve at which time an antibiotic may be started.  “Watchful waiting” has helped to decrease the number of antibiotics prescribed for children.

For the younger children 6 - 23 months who are more likely to be “sicker” than an older child with AOM,  the first line antibiotic to be prescribed is still Amoxicillin (unless the child is known to be penicillin allergic). Amoxicillin is the gold standard , “pink medicine” that many parents remember from their childhood…..tastes like bubble gum and needs to be refrigerated.  For children who have had recurrent ear infections other antibiotics know as “second line” drugs may be used.  Again, there are pros and cons to many antibiotics as well in terms of taste, how often they need to be given and side effects….so discuss this with your own pediatrician.   

For children 2 and older I am a big believer in “watchful waiting” and pain control.  So many of these children will do well with over the counter acetaminophen and ibuprofen as well as topical ear drops for analgesia.  I would guess that in my practice (not a valid scientific study) about 80% of my older patients do not fill a prescription for antibiotics….which as you know is a good thing (no one wants to be on an unnecessary antibiotic).  

Unfortunately, there seems to be a “group” of children (typically the younger ones) who get recurrent AOM and spend many of their winter months in the pediatricians office.  More about those infections in another post.

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. 

Daily Dose

Summer Viruses

1:30 to read

June….now seems like officially summer, although there are still some schools around the country in session, and even a couple in Dallas.  So, with summer here it is check up time in my pediatric office.  That means most days I am seeing very few sick patients, and most of the patients who come in for a visit other than a check up have a rash, a bug bite or maybe a swimmer’s ear.

 

But, with that being said there are also always some of those pesky summer viruses hanging around and many of them appear with just a fever. Many of the “sick” children I am seeing only have a fever, some of whom have a temperature as high as 103-104 degrees, with very few other symptoms.  Although these kids have a significant fever, once they are given an over the counter product like acetaminophen or ibuprofen they feel pretty well and even play for awhile. 

 

Fever is often just a symptom of a viral infection and these summer viruses have names…enterovirus, adenovirus, and even some left over parainfluenza virus.  We are definitely out of flu season….at least till next year.

 

Some of these summer viruses may have associated rashes which are more common with summer viral infections than winter viruses.

 

I have seen some kids with these summer viruses with prolonged fever, even 5-7 days which is a bit longer than a pediatrician and a parent want to see. But, with that being said, when I have seen these children they appear to look well and have not had any other physical findings.  I have often seen them again after having 5 or more days of fever, and it seems that many of them have adenoviral infections.  Adenovirus may also cause a myriad of other symptoms than just fever, including pink eye, sore throat, abdominal pain and vomiting and diarrhea and tummy cramps.  Rarely, some children will develop blood in their urine without having a urinary tract infection. 

 

Parents often ask me….where did they catch this? Remember that these are just viral infections and that there is not a vaccine for adenovirus. Once we see one virus in the community I know I will continue to see more and more children as it is “passed around”.  Best thing to do is to keep up good hand washing and keep your child home from the pool or summer activities if they have a fever.  

 

Daily Dose

Fever

1:30 to read

It’s starting….fever, fever, fever season and lots of concerned parents, so figured it was a good time to talk about fevers….AGAIN.  

 

Remember that fever is simply a symptom that your body’s immune system is working, and in most cases, in children, it is fighting a viral infection.  We docs call a fever a temperature above 100.4 degrees…but I do realize that day care and schools will send your child home when they have a temp above 99.5 degrees ( in some cases even lower). Some parents “explain” to me that their child’s body temperature is always lower than 98.6 degrees so a 99.9 degree temperature is abnormal for them….I’m just saying. 

 

The first thing to try and remember is that the thermometer is simply showing you a number and that the number should not scare you…it is only a number and a higher number does NOT necessarily mean that your child is any sicker.  Some children do tend to have a higher temperature with an illness than another, and even in the same family.  Again, the number should not make you concerned that one of your children is sicker than another…it is still just a fever.

 

Parents always ask…”what degree of fever is dangerous, and when do I go to the hospital?”  The number that registers on the thermometer should not be the deciding factor as to how sick your child is. They will look and feel worse with a higher temperature ( as do you when you are sick), but the important thing is to always look at their color (never dusky or blue), how they are breathing (you do breath faster and more shallow with a higher body temperature, but do not appear to be in any distress), and if they are hydrated (you do need more fluids when you are running a fever).  If all of this seems to be okay, the best thing to do is treat the fever with either acetaminophen or ibuprofen.  Once their temperature comes down a bit, and that may not be 98.6, look at your child again…children with lower temperatures typically “perk up” for a bit and may play or eat and drink for awhile, until their fever returns and they look pathetic again.  I would always check with my doctor before heading to the ER just because of a fever.

 

Parents also worry about their child having a seizure due to a fever…and this is true some children may have a febrile seizure. But, they can have a seizure with a temperature of 100.8 or 104.2…it does not seem to be the higher the temperature causes a febrile seizure. Febrile seizures do seem to “run in families” and they are also most common during the toddler years. (see another post on this).

 

So… as we are getting into sick season make sure you have an acetaminophen and ibuprofen dosing chart handy and always dose your child’s medications based on their weight and not age. I would also make sure to have a “working” thermometer, and I prefer a rectal thermometer for children under 12 months of age. Rectal temps are really easy to take and in my experience far more accurate (when I am really concerned if a child has a fever) than a tympanic or temporal thermometer. 

 

Be ready and relax….it is just a fever and having an anxious parent is not going to make your child feel better any faster.

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