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Daily Dose

Why Fever Is Your Child's Friend

Every parent is concerned about fever and why their child is running a fever. During the "sick season" I see 20 - 30 patients a day with a fever. Every parent is concerned about the fever and why their child is running a fever. Fever is one of the most common symptoms of childhood. Younger children run fevers quite frequently when they are sick. As we have talked about before, that may be four to eight times during the fall and winter season.

"Fever is our friend" has been one of my mantras for years. It is comforting for parents to understand that fever is a symptom that the body is fighting an infection. That is usually a viral infection that only lasts a few days, and lo and behold the fever is gone. The biggest myth is that fever, in and of itself, causes brain damage. Remember again, fever is simply a symptom.

The height of a fever does not correlate with severity of illness. Once again, higher fever does not necessarily mean you are sicker. Your child may feel awful with a fever of 101 or 104 degrees. Typically, once given either acetaminophen or ibuprofen for their fever, the temperature comes down a little and they symptomatically feel better for a while. Once the anti-pyretic (fever reducing) medications wear off, the fever will often return.

Children typically have more fever in the night, seems like darkness brings out the fever monster (that is the mother in me, but it was always true at my house) and those nights of fitful sleep, and hot little bodies seem very long. The other thing I have noticed, why do children who have had little sleep due to fever, coughs etc get up in the morning and do not long for a nap like their parents?

The other thing you need to keep in mind is that the higher the fever, the faster your child's heart will beat and the higher respiratory rate they will have. It is easy to climb into bed with your "hot" two year old and feel their heart pounding away, and know they have a high fever, even before the thermometer is out. This is the body's natural way of expending heat. Once the fever comes down you will notice that they are breathing less rapidly and their heart rate has come down too. Remember to offer plenty of fluids to a child with a fever, as they need extra fluids. They can eat too, but if not interested, a Popsicle or jell may be a good alternative. Just keep chanting, "fever is our friend." 

That's your daily dose, we'll chat again tomorrow.

Daily Dose

How to Treat Hyperventilation

It is not uncommon for someone to hyperventilate when they are in pain.I saw a child today who had been injured in a soccer match when he was accidentally kicked in the chest. He had shortness of breath and then became uncomfortable and started to breath rapidly and get upset about "feeling light headed" and anxious. Because he had a history of asthma his Mom brought him straight to the office for fear that he was having an asthma attack.

But he was not having any real respiratory distress and his oxygen levels were normal and his lungs were clear. The problem was that he was hyperventilating. It is not uncommon for someone to hyperventilate when they are in pain. When you hyperventilate and disturb your CO2 and O2 levels, you will have a feeling of lightheadedness, and often tingling in your arms and hands. That seems even scarier, so you then breathe faster and faster and the cycle continues. The best thing to do if you think someone is hyper-ventilating, have them re- breathe into a paper bag. By re-breathing your CO2 it will slow down your breathing and within several minutes they will be feeling much better, less anxious and light headed. If you don't happen to have a paper bag, have them follow your lead as you slow their breathing down and reassure them that their symptoms are going to improve as they take slow deep breathes. A bit of TLC for the little guy today, slow breathing exercises, a Sprite and a note for school sent him on his way! That's your daily dose, we'll chat again soon!

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Daily Dose

Migraines in Children

1.15 to read

I received an email via our iPhone App inquiring about migraines in children. Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches which include migraine headaches. 

Migraine headaches are best diagnosed by obtaining a detailed history and then a thorough neurological exam. There are several characteristics of childhood migraines that are quite different than adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population. 

Childhood migraines often are shorter in duration than an adult migraine and are less often unilateral (one sided) than in adults. Only 25-60% of children will describe a unilateral headache while 75-90% of adults have unilateral pain.  Children do not typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise or loss of appetite proceeding the headache.  About 18% of children describe migraine with an aura and another 13% may have migraines with and without auras at different times. When taking a history it is also important to ask about family history of migraines as migraine headaches seem to “run in families”. 

Children who develop migraines were also often noted to be “fussy” infants, and they also have an increased incidence of sleep disorders including night terrors and nightmares. Many parents and children also report a history of motion sickness. When children discuss their headaches they will often complain of feeling dizzy (but actually sounds more like being light headed than vertigo on further questioning). 

They may also complain of associated blurred vision, abdominal pain, nausea and vomiting, chills, sweating or even feeling feverish. A child with a migraine appears ill, uncomfortable and pale and will often have dark circles around their eyes. It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep as wells as stress. But stress for a child may be positive like being excited as well as typical negative stressors. 

Children will also tell you that their headaches are aggravated by physical activity (including going up and down stairs, carrying their backpack, or even just bending over). They also complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms. 

Children with migraines do not watch TV or play video games during their headaches. They are quiet, and may not want to eat, and may just want to rest.  Nothing active typically “sounds” like fun. To meet the diagnostic criteria for childhood migraine, a child needs to have at least 5 of these “attacks” and a headache log is helpful as these headaches may occur randomly and it is difficult to remember what the headache was like or how long it lasted, without keeping a log. 

There are many new drugs that are available for treating child hood migraines and we will discuss that in another daily dose.  Stay tuned! 

Daily Dose

Keep Your Athletes Hydrated On and Off the Field

With summer heat in full swing all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 3,442 deaths between 1999-2003 due to heat and exposure to elevated temperatures, while children under 15 years of age accounted for approximately 7% of the total deaths. Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.) The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used. Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

Daily Dose

Fever Frenzy

1.30 to read

More about fever and all of those fears and myths.  

Treating the symptom of fever simply makes your child feel a bit better, it does not make them get better faster nor does it mask other symptoms. I see many parents not treating their child’s fever before bringing them to the office as they “want me to see how sick they are”.  Giving your child acetaminophen or ibuprofen will make them feel better and in turn “not look quite as sick”, but your doctor wants to see this behavior as it is reassuring. I promise you, I believe the mother who says to me, “his temp was 103.8 an hour ago!”. But seeing that child now playing with their parent’s cellphone  and eating one of those pouches (another topic), reassures me that this child is most likely not extremely ill.  Treating a fever does not mask the symptom of meningitis, or appendicitis, you have to trust me on that. 

Some parents have been told by grandparents and others that a fever means that your child can’t have milk or dairy products.  Again, if the only thing your child wants when they have a fever is a milk shake, let them have it. I am just concerned that a child is getting fluids when they have a fever, and it really doesn’t matter what that fluid is.  Food when you have a fever?  Sure, if your child wants to eat, great!  But, remember how your own appetite usually diminishes when you are sick (sad but true, good for quick weight loss).  Your child can go days without eating and be just fine as long as they are drinking.  Push popsicles, jello, juice, ginger ale, etc.  No rules about “healthy” when your child is sick....back to healthy eating rules once they’re child well.  

Lastly, you cannot feel your child’s head or chest and know what their body temperature is.  I can often tell a child has a fever by their heart rate, which goes up as your body temperature goes up, but even after more than 25 years of practice and raising 3 kids I cannot feel a forehead and be accurate.  So.....go buy a thermometer. I still like the “cheap’ digital ones, but you can buy the temporal thermometers or otic ones, whatever you prefer.  If your child is sick and you think they have a fever, take their temperature to document fever. You don’t need to do it all day long, or wake them up at night, but it is important to document at least once a day.  

Lastly, no school, day care or going places when your child has a fever. Please keep them home for 24 hours fever free, to help not spread their illness.  This is fact!

Daily Dose

Zika Virus

1:30 to read

If you are pregnant or planning on becoming pregnant in the near future you need to be aware of the Zika virus.  This virus is spread via the Aedes mosquito (as is West Nile Virus, Dengue fever and Chikunguyna), and has been found in Africa, Southeast Asia, the Pacific Islands , South America and Mexico.  The Zika virus was also just confirmed in Puerto Rico and the Caribbean in December.  There are new countries confirming cases of Zika virus almost every day, as the Aedes mosquito is found throughout the world.  

When bitten by a mosquito that has the Zika virus, only about 1 in 5 people actually become ill.  The most common symptoms are similar to many other viral infections including fever, rash, joint pain and conjunctivitis.  For most people the illness is usually mild and lasts for several days to a week and their life returns to normal.  Many people may not even realize that they are infected. 

Unfortunately, if a pregnant mother is infected with the Zika virus, the virus may be transmitted to the baby.  It seems that babies who have been born to mothers who have been infected with the Zika virus may have serious birth defects including microcephaly (small head) and abnormal brain development. There have been more than 3,500 babies born with microcephaly in Brazil alone…and just recently a baby was born in Hawaii with microcephaly and confirmed Zika virus. In this case the mother had previously lived in Brazil and had relocated to Hawaii during her pregnancy.  The virus to date has not been confirmed in mosquitos in the United States.

Because of the association of the Zika virus and the possibility of serious birth defects, the CDC has announced a travel advisory stating, “until more is known and out of an abundance of caution, pregnant women in any trimester, or women trying to become pregnant, should consider postponing travel to the areas where Zika virus transmission is ongoing”.  

Should pregnant women have to travel to these area they should follow steps to prevent getting mosquito bites during their trip. This includes wearing long sleeves, staying indoors as much as possible, and using insect repellents that contain DEET.

Researchers are continuing to study the link between Zika virus and birth defects in hopes of understanding the full spectrum of outcomes that might be associated with infection during pregnancy. There will be more data forthcoming.

At this point the safest way to avoid being bitten is to stay away from the countries who have had confirmed cases of the Zika virus.  But as the weather warms up in the United States and mosquitos become more abundant there is concern for Zika virus to be found here.  It only takes one infected mosquito to bite one person who then contracts the virus….should that person be bitten by another mosquito, that mosquito may acquire the infection and so it spreads.  There is not known to be human to human transmission of the virus.

Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

Daily Dose

Enterovirus Continues to Spread

1.15 to read

Enterovirus infections are in the news and are causing a lot of parental anxiety. While enterovirus D-68 has caused some serious illness in children, especially in the midwest and now spreading to the northeastern states, you have to remember that there are many other children who handle this virus just like a bad cold.

Enteroviruses have been around for a long time...in fact polio is an enterovirus. But thankfully there is a vaccine for polio.  The hundreds of other enteroviral infections continue to cause upper respiratory symptoms, viral meningitis, as well as vomiting and diarrhea.  In most cases when you have many of these symptoms you don’t even think to “name the virus”.

Enterovirus D-68 was first reported in 1968 (so the name) but it was in 2008-2012 when it again began to be identified and was reported in the literature.  Enteroviruses typically peak in late summer and early fall, so this is the time of year that we expect to see a peak in these infections.

The typical symptoms with a  D-68 infection are upper respiratory with sore throat, runny nose, and a cough. Only about 25% of patients are even reporting a fever. In some cases, especially in children who have an underlying history of asthma or wheezing, there have been more severe symptoms with difficulty breathing, wheezing, and respiratory distress. In these instances the children have been admitted to the hospital for supportive care, which includes IV hydration, bronchodilator therapy, and supplemental oxygen.  In some cases a child may require intensive care. Fortunately, there have not been any deaths associated with enterovirus D-68. 

The bottom line? This is yet another respiratory illness that may cause more severe symptoms in some children. We also see this with other viruses such as RSV and flu which will be circulating later this fall and winter.  What parents do need to know is that if your child is sick and seems to be having ANY difficulty breathing you need to call your doctor or go to the ER. 

If your child is sick, keep them home from school. If you are sick don’t go to work or volunteer in the school cafeteria. To stay healthy over the ensuing “sick” season promote good hand washing and cough hygiene. Lastly, everyone over the age of 6 months needs a flu vaccine.

 

 

 

Daily Dose

The Difference Between A Viral Sore Throat & Strep Throat

It only takes getting the kids back in school for the pediatrician’s office to see an upswing in illness. But this year it came on particularly early and we are definitely seeing more illness in the first week of fall than is typical.

Most of the illness being reported around the country is due to Influenza A, H1N1 (swine flu) and the majority of cases seem to be occurring in the five to 24 year old age group, in other words the school aged, elementary through college aged kids. To review again, flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12 – 24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. As we get into winter there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats as we get into winter. But in the meantime, get those flashlights out and start looking at throats. That’s your daily dose, we’ll chat again tomorrow.

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DR SUE'S DAILY DOSE

Can you use homeopathic products to relieve your child's illness?

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Can you use homeopathic products to relieve your child's illness?

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