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Daily Dose

Cough and Cold Medicine

1:30 to read

My husband has a cold (I have been fortunate not to have one) and he decided he needed some over the counter (OTC) “cold medicine”, despite the fact that I told him they don’t work!  At any rate, I stayed in the car while he went in to buy “some things.”  It wasn’t too long before he was back empty handed…..and asking for some help in deciding what to buy!  It seems that he was overwhelmed and confused by all of the different choices….so I thought this was a good time to review all of the “ingredients” in OTC cough/cold medications. But remember, OTC cough and cold products are not recommended AT ALL for children under the age of 4. 

Most of the products that are advertised and sold for treating coughs and colds contain either a decongestant, antihistamine, expectorant, or anti-jussive (for cough).  But many of the OTC medicines contain some combination of these ingredients and there are many similar products with different brand names. Just gazing at the row of choices is enough to confuse anyone….even a doctor.

The most common decongestant used in OTC products is phenylephrine but its effectiveness in reducing nasal congestion from the common cold has been inconclusive. Another decongestant, pseudo ephedrine (Sudafed) is available, but has become restricted (it is a precursor in the manufacturing of methapmphetamine) and is now found behind the counter. Both of these drugs are often found in combination with other ingredients.

Antihistamines are also in many products. First generation antihistamines include diphenhydramine (Benadryl) and chlorpheniramine and are known for their tendency to be sedating. Second generation non sedating antihistamines such as loratadine (Claritin), fexofenadine (Allegra) and cetirizine (Zyrtec) are also found in some preparations ( typically with wording “daytime”) and are not sedating. In either case antihistamines do not seem to help the common cold.  Antihistamines do help allergies which are histamine mediated while a cold is not.

Anti-tussives or cough suppressants are commonly found in OTC cold medications, as cough is one of the most irritating aspects of a cold.  Dextromethorphan acts on the cough center in the brain to suppress coughing. It is the main ingredient in many OTC cough syrups but may also be found in many cough and cold combos in either liquid or pill form.

Guaifenesin is an expectorant and is found in many products, but again has not been found to have a measurable effect on mucous production from a cold.

Lastly, there are many products that are advertised to help with the “aches and pains” of a cold including acetaminophen and ibuprofen which may be found in combination with some of the above ingredients.

So…you have to read labels and make sure you “know” what you are getting. Too many people do not realize that they may be taking the same medicine but with different brand names, and this could cause an overdose.  

But the take home message is that “we” spend billions of dollars on these OTC products with continued studies showing minimal if any effect on the common cold when compared to placebo!  

I would spend my money on some Vicks, honey, and chicken soup and forgo the confusion on the cough and cold aisle.

Daily Dose

Got a Lip Licker?

1.45 to read

Just back from an evening call night in the office and it was like dermatology clinic!  But the funniest thing was that 4 of the children I examined, all of different ages, had the same thing: Lip Lickers Dermatitis.

It is beginning to be the time of year when the weather gets cooler, the humidity drops and children who are in the habit of licking their lips develop dry cracked and chapped lips. Not only do children lick their lips, they also tend to lick the skin around their lips which results in more chapping and irritation, and the cycle begins. One little girl I saw could actually lick all of the way up to her nostrils!! She had to show me for me to believe that this is why her nose was chapped, I foolishly thought it was from blowing her nose.

Every one of the kids habitually licked their lips while I examined them, even before telling them of their diagnosis. Several of the concerned parents “doubted” the diagnosis of lip lickers dermatitis, but I pulled out a derm book and proudly showed them pictures that looked just like their child. The rash can get quite raw and inflamed and if irritated and rubbed enough may even get secondarily infected.

The problem with lip lickers dermatitis is that it is a habit, just like thumb sucking, nail biting and hair twirling. As you know habits are hard to break, even when they cause discomfort. It is so hard not to moisten you lips when they are dry and are becoming drier. Licking your lips seems to improve the dryness but only for a moment.

The treatment of choice is to try and break the habit as well as to use a protective barrier on the lips and around the mouth. This is best accomplished with a thick layer of Aquaphor or Vaseline that must be reapplied quite frequently. For an older child you can give them a pocket tube to carry so that they may apply the moisturizer as often as need be, even every 30 minutes to an hour.

To aid in the treatment the thicker the layer of Aquaphor the better, so once they are heading to bed I would GLOB on  enough that they couldn’t possibly lick it all off before falling asleep. It might be prudent to apply once last coat to their mouths after the child is already sleeping as well.

Lip Lickers Dermatitis is definitely a diagnosis and is quite common. I am taking the camera back to the office to grab a few pictures to post at a later date, as it is only the beginning of the dry, chapped and crack lip season.

That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Plenty of Colds Going Around

1.30 to read

I have been looking at the data from the Center for Disease Control and Prevention and it looks like flu season has made an early exit from many parts of the country. That would be a welcome blessing. But cold season is still in full swing and so many of the parents I am seeing in the office continue to say, “it just seems impossible that my child can have this many colds in one year!”.  If you have a child between the ages of 6 months and 3 years of age, and they go to school, you are probably one of these parents.

The first several winters that you child starts day care or pre-school are pretty tough....not only in terms of “being away from your child”, but also for the number of viral illnesses they get. Many a parent has called me “CRAZY” when I tell them that it is not unusual at all for your child to get 7-10 viral infections during the first fall/winter season that their child is around other children. In fact, I know that there have been several families over the years that changed pediatricians just because the parent felt certain that their child had an “immune problem” due to their frequent coughs and colds. True problems with immunity do exist in pediatrics but they don’t typically present with recurrent coughs and colds, but rather with far more serious illnesses.  Thankfully these are rare.

Parents with younger children know their pediatrician far better than they really want to during those first several years. That is another reason that you want to find a pediatrician that is not only close to your house but that you really get along with!

So with all of that being said, hang in there for about another 6-8 weeks and the winter viral season truly will be exiting and children (and their parents) will all start to be healthier for the rest of spring.  I promise once your youngest child reaches 3 years of age your visits to the pediatrician during the winter months become less and less frequent.

Daily Dose

Do Essential Oils Boost Immune System?

1:30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

Daily Dose

Cold Weather & Colds

1.15 to read

It has been bitterly cold across the country including my home state of Texas. We have survived “icemageddon” which is finally starting to melt and kids around here are back in school. 

But one theme I keep hearing from parents is that this cold weather causes colds. NOT TRUE!  MYTH!   Viruses are the cause of most of the colds that are making both children and adults sniff and cough.  What does happen during the winter months is that we all tend to spend more time indoors and this is where it starts. Cold weather is not typically conducive to outdoor activities like the playground or bike riding. (but for some ice skating and sledding). In other words, we spend more time inside, gathered together in enclosed spaces. (malls, movies, house)  

But, when we all head indoor, the coughs and colds don’t stop, and the germs are easily spread from person to person. The more time we spend inside, whether we are in a mall shopping or in school, it makes it easier to catch a cold. 

Children are great at spreading germs, and not purposely. While they are learning to share at pre-school, this sharing also includes their viruses. Younger children are just learning to cover their mouths when they cough and they touch their noses and face all day long.  They also put everything in their mouths and then set it down for their friends to “share”.  It is not unusual for children between the ages of 1-3 years to get 5-6 colds during the winter months alone.

So....in reality, being outside, even in cold weather does not cause a cold. Rather,  it is that we spend more time inside sharing our germs. So, just bundle everyone up appropriately and do get some fresh air during the winter months. Remember cough hygiene and those flu vaccines as well.  Viruses do like cold, dry weather, but they love us being cooped up in the house even more.

Daily Dose

Recurrent 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

Do Essential Oils Boost Immune System?

1.30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

 

Daily Dose

Cold & Cough Relief!

1:30 to read

Although it is just getting really cold across the country, it feels as if we have been in full cold and cough season for awhile.  The office sounds like what I call “kennel cough” as every child seems to be coughing…. even those who are just coming for check ups.

Parents often ask, “what is the best way to keep from catching a cold?” and the answer continues to be, “wash your hands and try not to touch your hands to your eyes, nose and mouth”.  Easy enough for an adult (well maybe not), but trying to tell your toddler not to put their hands in their nose or mouth is nearly impossible! That is one reason that children get so many colds in the first several years of life. Toddlers typically get the most colds as they have just started having playmates with whom they share not only toys but their germs…all part of growing up.

I remind parents that coughs are there for a reason. While they are a huge nuisance, and cause a lot of sleepless nights for both the child and parent, a cough is there to keep the lungs clear, and a cough is actually protective. In other words, coughing helps you clear the lungs of mucus that comes with a cold and helps to prevent pneumonia and secondary infections.  But, with that being said, learning to cover your mouth when you cough is not only polite, but it is also protective for others. It is a big day when your children learn to cover their mouths with the crook of their arms (better than the hand). Who knew as a parent this would be a milestone for your child?

Whenever your child is sick and has a cough and cold it is important to not only listen to their cough but to actually observe how they are breathing.  Parents send me videos or voicemails of their child coughing, but I am usually more interested in seeing their chest and watching their breathing. Your child may have a huge productive cough and sound terrible, but have no respiratory distress. With that being said, your child may also have a tiny little non-productive cough and be struggling to breath. In most cases the visual is more important than the audible.

To help symptoms like stuffy noses, try irrigating your child’s nose with Little Remedies® Sterile Saline Nasal Mist and then suctioning his or her nose to clear the mucus and make it easier for him or her to breath, a warm bath or shower before bed to open up airways and a cool mist humidifier in the bedroom.

Don’t panic if your child gets sick, as each time they fight off a cold and cough they are actually boosting their immune system…small victories.  It is not unusual for a toddler to get 6 - 7 colds in one season (and their parents get half as many as that from them). Once your child turns about 3 you will see that he or she doesn't get a cold every other week and also seems to handle the viruses a bit more easily.

If your child has any difficulty breathing you need to call your pediatrician! For more information on these products visit www.littleremedies.com.

 

 

 

 

Daily Dose

The Best Cold Treatment

1.30 to read

Alright, enough is enough! How could I possible have another cold?  I routinely tell patients with children that it is not unusual for kids to get 8-10 colds a year which seems like once a month from September through April!

If you also think that the average cold lasts anywhere from 7–14 days, then it seems like a child has a cold that lasts most of the year. That is how I am feeling right now.

A cold usually starts off with a little “sniffles” and maybe a sore throat, and you pray that it is just your imagination, and then over several days you  realize that you now feel “yucky”, have more congestion, the sore throat is still there and you are coughing. That is a cold!!!! That is not allergies, nor is it flu. It is that pesky cold virus of which there are an infinitesimal number, and you have succumbed once again. That is my story!

So, with those symptoms AGAIN, and a day in the media research office, I went back to the literature to see if I could find ANYTHING that might lead me to preventing  a cold, curing a cold or making this nasty thing go away any faster. I mean, I am a busy woman and like everyone else, “I really don’t have time for this!” There have been thousands of studies done over the years looking at cold symptoms and their prevention. Studies on Vitamin C from the days of Linus Pauling, to more recent studies for prevention and treatment of upper respiratory infections have really found no benefits to taking vitamin C.

There was one study that showed taking vitamin C might reduce the duration of cold symptoms if taken before a cold begins.  My question is, how do you know that you need to start Vitamin C in anticipation of a cold?  Also, too much vitamin C may cause an upset stomach and diarrhea.

How about Echinacea?  I have been taking Echinacea for years in hopes of “warding off colds”, but the review of the data  showed that Echinacea had no effect in preventing the common cold, studies did show that it might reduce cold symptoms in adults, but studies in children did not produce the same results.  It was also found to increase rashes in those who had eczema (atopy), and allergies to ragweed. I am still taking it, but personally “can’t tell a difference”. You do realize that my opinion alone is not statistically significant. Then there was the whole zinc movement and there are numerous studies that show conflicting results. Some studies did show that those who took 15 mg of zinc daily had a lower mean number of colds and also a shorter duration of cold symptoms.

Other studies did not find a statistical significance for either reducing the number of colds or decreasing symptoms. I have tried all sorts of zinc preparations over the years (even when it was such a hot item I had to order lozenges off of QVC-should I admit that?) and besides tasting horribly I think my cold lasted the same number of days.  Another study of one (not significant), and most would say that the data is still inconclusive.

The hottest new topic is vitamin D.  A study published in the Archives of Internal Medicine in early 2009, analyzed information on vitamin D levels in adult and adolescents.  The results showed that those people with the lowest vitamin D levels (less than 10 ng/ml) were 36% more likely to report having upper respiratory infections that those with higher vitamin D levels (above 30 ng/ml).

Vitamin D is also important for bone and general health, so it is a good idea to be making sure that you are getting adequate vitamin D. The AAP increased the recommended daily intake of vitamin D to 400 IU. I am currently taking a vitamin D supplement in hopes of boosting my immunity as well as keeping my bones healthy.

If you have any ideas or PROVEN remedies, potions, concoctions please send them my way. In the meantime, I continue to drink lots of herbal tea, take hot showers and baths to help the congestion, go to bed earlier than usual, suck on my honey throat lozenges and pray. I also wash  my hands incessantly and even resorted to wearing a mask over the last several days in hopes of warding off germs. My patients think I am playing dress up!

That's your daily dose for today.  We'll chat again tomorrow (cough)! 

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