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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

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

Airborne & Your Kids

1.45 to read

It’s cold & flu season and I have already been receiving emails from parents asking what works/doesn’t work.  I reviewed a recent note from a well-meaning dad asking if he could give his 3 year old son Airborne to help “offset colds”. 

I myself have just recovered from my first cold of the “season” and have looked high and low for ANYTHING that might prevent or treat the common cold. As I tell my own patients on a daily basis, if I had the “magic pill” I would certainly not only manufacture it to distribute to everyone, but I would also be getting ready to accept Nobel Prize in medicine for solving the mystery of preventing the common cold!!  Airborne is NOT the magic potion and I see no reason to use it period.

I recently did an extensive review of complementary and alternative medicine for the common cold (selfishly trying to cure myself) and once again came up empty handed for any proven remedies. There are still a lot of ongoing studies (someone will win the Nobel Prize one day), but nothing so far has really proven to be the panacea.

Many people “swear” by Airborne.  I am just not sure what they are thinking it does. If you read their website it states, “there are scientific studies that the ingredients in Airborne have been shown to support the immune system”. I can’t find those studies anywhere. 

In 2008 a class action suit against Airborne resulted in a $23 million dollar fine for “misleading consumers and making false claims”, when Airborne claimed to “ward off colds”. They have now changed their advertising to the wording, “boosting the immune system” which also seems like deceptive advertising to me. Regardless, they continue to make millions (despite that huge fine).  My mother even called to say she thought she might take some before flying to visit at Thanksgiving asking, “did I think that would help her from getting sick?” OMG!

The ingredients in Airborne include Zinc, ginger, Echinacea, vitamins, minerals, and herbs.  This is what I commonly call “hocus pocus”.  Many of the ingredients in Airborne have been studied for use during a cold, without a lot of success.  Zinc is still being studied with varying outcomes, but there are still no definitive guidelines on using Zinc for a cold. Stay tuned for more as more studies are completed.

In the meantime, the answer to the email is NO; I would not give a 3 year old Airborne. What I would do is make sure that your child is getting nutritious meals, adequate sleep and that they learn to wash their hands and cover their mouths when they cough (hand hygiene). I would put the money you would spend on Airborne in their piggy bank for future college expenses.   I would also make sure to get your child their Flu vaccine. We do have data that vaccines work!

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

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

Asthmatic Kids & Colds

2.00 to read

Cold season continues to hang on and for anyone who has a child with asthma, you are aware that wheezing will often accompany winter colds.

I have spent a lot of time in the last week listening to wheezy chest, lots of coughing and seeing many children who need to be using their asthma medications. After a quiet summer of no coughing it is a good time to review asthma and the medications to use to treat as “wheezy season” is here!

Many children will wheeze once in their lifetime and I tell parents, “everyone gets one free wheezing episode”. But if a child wheezes on several occasions and responds to bronchodilators they probably have asthma. If you throw in a positive family history of wheezing as well as wheezing that begins each time a child gets a cold it is time to discuss the diagnosis of asthma and the treatments that go along with the diagnosis.

The good news about asthma is that there are a lot of great medications available for treatment. With that being said I think it is important to teach parents about the pathophysiology of asthma and then talk about treatment. I tell my patients/parents that understanding wheezing is somewhat analogous to being a medical intern. You have to see the symptoms for a while and then you finally “learn it, and know it” and then can begin to understand treatment.

For a parent with a child with asthma it is the same process. Each repeated wheezing episode should get easier for a parent to know what they are dealing with and when and how to start treatment. Many times they will not need the doctor to be involved once they are comfortable with the medications.

In fairly simplistic terms, there are really two components to asthma, airway narrowing (brochospasm) and airway inflammation. In most cases it is important to be treating both symptoms. The most common trigger for asthma in children is a viral upper respiratory infection. When you get a viral upper respiratory infection the virus causes airway inflammation and irritation in all of us. That is one reason we all cough with a cold.

For an asthmatic child it also causes bronchospasm and resultant wheezing. By the time you audibly hear your child wheezing they are what we pediatricians refer to as “being tight”. The goal is therefore to treat the asthmatic episode early and aggressively; you never want to hear audible wheezing.

An asthmatic cough is often short, frequent, non productive and occurs throughout the day and often all night long. I love to walk into a room and hear a child with a productive, “phlegmy” cough, as these children are typically not wheezers but are good coughers! It is that dry little recurrent pesky cough that occurs incessantly that is often the hallmark of a child who is wheezing.

In severe cases of wheezing and bronchospasm the child will also show signs of respiratory distress, where their chest may show retractions (pulling in between ribs) or using their abdominal muscles to help them breath. These children look uncomfortable and are usually not running around the exam room as they are having a hard time getting air exchanged.

Some other children may not be in any respiratory distress but when listened to with the stethoscope you can hear the high pitched noise on expiration and sometimes on inspiration as well. You just have to get used to listening. Practice, practice and then a parent with a stethoscope gets better at understanding asthma.

When a child is actively wheezing it is time to start medications to relieve their symptoms. More on treatment coming.  Stay tuned.

Daily Dose

Colds & Suctioning Your Child's Nose

1:30 to read

I am beginning to sound like a broken record, but we are in the throes of cold and flu season and unfortunately there are a few more months of this.  As every parent knows, colds (aka upper respiratory infections) are “age neutral”. 

In other words, there is not an age group that is immune to getting a cold and for every age child (and adult for that matter), the symptoms are the same. Congested nostrils, scratchy sore throat, cough, and just plain old feeling “yucky”. When an infant gets a stuffy nose, whether it is from “normal” newborn congestion, or from a cold, they often have a difficult time eating as an infant is a nose breather.  When they are nursing and their nose is “stopped  up”, they cannot breath or even eat, so it is sometimes necessary to clear their nasal passage to allow them to “suck” on the bottle or breast. 

Of course it is self evident that an infant cannot blow their nose, or rub or pick their nose so they must either be fortunate enough to sneeze those” boogers” out or have another means to clear the nose.  This is typically accomplished by using that wonderful “bulb syringe”. In our area they are called “blue bulb syringes” and every baby leaves the hospital with one tucked into their discharge pack.  As a new parent the blue bulb syringe looked daunting as the tip of the syringe appeared to be bigger than the baby’s nose.  But, if you have ever watched a seasoned nurse suck out a newborn’s nose, they can somehow manage to get the entire tip inside a baby’s nose. For the rest of us the tip just seemed to get inside the nostril and despite my best efforts at suctioning nothing came out. Once a nurse showed me the right “technique” I got to be a pretty good “suctioner”.  With the addition of a little nasal saline, which you can buy in pre made spray bottles, or which may be made at home with table salt and warm water, the suctioning gets a little easier as the nose drops helped to suction the mucous.

Now, I have become a firm believer that there is a place for suctioning a baby’s nose, but once a child is over about 6 months of age they KNOW  what you are getting ready to do. I am convinced that a 6 month baby with a cold sees the “blue bulb syringe” approaching their face and their eyes become dilated in fear of being suctioned!!  Then they begin to wail, and I know that when I cry I just make more mucous and the more I cry the more I make. So a baby with an already stuffy nose gets even more congested and “snotty” and the bulb syringe is only on an approach to their nose. It also takes at least two people to suction out a 6 – 12 month old baby’s nose as they can now purposely move away , and hit out to you to keep you away from their face and nose. It is like they are saying, “ I am not going to give in to the bulb syringe” without a fight! I swore I would not have a child with a “green runny nose” that was not suctioned.

As most parents know, don’t swear about anything, or you will be forever breaking unreasonable promises to yourself!  I think bulb suctioning is best for young infant’s and once they start to cry and put up a fight I would use other methods to help clear those congested noses.  Go back to the age old sitting in a bathroom which has been steamed up with hot water from a the shower. Or try a cool mist humidifier with some vapor rub in the mist (aroma therapy).  Those noses will ultimately run and the Kleenex will come out for perpetual wiping. Unfortunately, it takes most children many years before they learn to blow their nose, but what an accomplishment that is!!!  An important milestone for sure.

That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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

Dealing With A Baby's First Cold

1:15 to read

With the "sick season" upon us, I'm starting to see more babies with cold symptoms and their concerned parents wondering "what can I do to help their precious bundle of joy?"

In pediatrics, we often say “children are not little adults” but in the case of the common cold, they really are. They have the same symptoms, runny nose, red-rimmed eyes, cough and they just FEEL YUCKY! With those symptoms most babies are fussier than usual and don’t sleep well at night, which is just like an adult with a cold (or maybe just me). One of the main differences is that an adult cannot wake up off and on all night and have someone really “care” that you can’t sleep because you are so congested, or your throat hurts. As much as your spouse loves you, the most common response is “just deal with it” and go back to sleep. Not so for an infant, they are usually up and down all night, don’t feed as well, and just want to be held a little more. We the parents are also up and down with the baby with a cold and so it goes as a parent. When an infant get’s a cold it is not uncommon for them to run a fever along with the cold symptoms. This usually only lasts a day or two and then resolves, but the other common cold symptoms may last from seven to 10 days.

The first several days of a cold usually begin with a runny or congested nose and a cough. With a cold they may not want to nurse or drink their bottle as well as they have a hard time breathing and sucking. These leads to a cranky baby, who may take less with each feeding, but will need to eat more often. It is important to make sure that they stay hydrated. Contrary to popular myth, drinking formula or breast milk does not make a cold worse, and fluids are the most important thing. If your baby is having difficulty taking the bottle or latching on due to the congestion, you may use the “bulb syringe” that is sent home with the baby after birth. Place the tip of the bulb syringe inside the baby’s nostril to remove mucous and help them breath and eat. You may also use a little salt water nose drops to squirt up their nose to help the mucous come out. It also helps to get a cool mist humidifier to place in the room at night to help put some moisture in the air while the heat is running and the air is dry. The cool mist will also help alleviate some of the thicker mucous and also help the cough that accompanies the cold.

The most important thing to watch for is any sign of respiratory distress. A child’s breathing may “sound noisy” but it is important once again to look at their chest to make sure that they are not using those muscles between the ribs and “pulling” when they are breathing. They may also have a congested cough and it can sound “junky” but they should still not be showing any signs of difficulty with breathing. Coughs are also protective in that they help move mucous and keep the airway clear to prevent pneumonia. Lastly, your child should look a little better after the first several days of their cold. They should not develop fever later in the cold, and if they do it would be worth a pediatrician visit to check their ears. Not every baby with a cold gets and ear infection and they usually develop after they have had several days of cold symptoms, and not on the first day of a cold.

The only way to diagnose an ear infection is for the doctor to visualize your child’s eardrum, even with email, and phones, you just can’t get a picture down the ear canal! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

It's Cold Season!

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 mucous 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 child learns to cover their mouth with the crook of their arm (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. 

 

The best treatment for a cold and cough continues to be the tried and true…saline and suction to clear the nose of the mucous and make it easier to breath, a warm bath or shower before bed to loosen up the mucous, a cool mist humidifier in the bedroom and honey for the cough. Remember, you cannot use honey in a child under the age of 12 months! 

 

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 they don’t get a cold every other week and also seem to handle the viruses a bit more easily.

 

If your child has any difficulty breathing you need to call your pediatrician!

 

 

 

 

 

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