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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

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

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

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 Swimmer's Ear

1:30 to read

The entire country seems to be experiencing the “dog days of summer”.  That huge high pressure system has covered most of the weather map, so the only thing to do for the next month is to head to any water you can find…swimming pool, lake, ocean, river or fountain!  But, with swimming comes swimmer’s ear or otitis externa.

I rarely see a child with an otitis externa except during the hot summer months.  Swimmer’s ear is a frequent problem for children who “live in the water” all day long. They are just like a fish. They head to to the pool first thing in the morning and don’t come in until they are water logged…and their ears stay wet all day long and into the night….then back to the water again.  When the ear canal cannot dry out it becomes the perfect dark, damp breeding ground for bacteria to take root.

The most common complaint with swimmer’s ear is pain!! I have seen big stoic teenage athletes in tears from the pain when you just touch their ear.  The pain is due to the inflammation and infection of the ear canal..not the ear drum (an inner ear infection).  So, if you tug on the ear lobe or push the area in front of the ear at the jawline, this causes pain.  Rolling over in bed and laying on that ear will cause pain.  Many people also feel a fullness and complain that they don’t hear as well as the ear canal is so swollen.

The treatment for a swimmer’s ear is not an oral antibiotic, it is rather for ear drops that contain an antibiotic to treat the infection topically at the source. Many of the ear drops used to treat otitis externa also contain a steroid that will help with the inflammation (and swelling) of the ear canal.  Pain control is also important with a combination of acetaminophen and/or ibuprofen.   Keeping the ear canal dry is imperative in order that the ear drops stay in the canal and are not “washed out” right after you put them in the ear. I try to keep the patient’s ear canal dry for several days and have them pain free before getting their ear wet again.

BUT, the best treatment for swimmer’s ear is actually prevention.  Little children who are just learning to swim really do not spend enough time under water or during a bath to have their ear canals become infected.  It is typically seen in children over the ages of 5 or 6 who are now great swimmers and spend a great deal of time in the pool, lake or any body of water.  For these children I recommend putting in “home made” ear drops made with half alcohol and half white vinegar. It is easy to make a bottle and buy a dropper and leave it by the back door to the pool or by the dock…..in this way as the kids come in at the end of the day, everyone tilts their head and gets several drops instilled into both ears before heading inside for the night.  You can also buy “Swim Ear” over the counter if you aren’t “into” making the frugal ear drops.

On occasion, for an extremely swollen ear canal you may need to see an ENT to have the ear canal cleaned and treated…..but if treated early this is uncommon. 

Stay cool, hydrated and avoid swimmer’s ear by using those ear drops routinely!! I learned my lesson the hard way one year….prevention is the key to avoiding a painful otitis externa.

Daily Dose

A Germ-free Office?

To keep the germs at bay, it has been suggested to remove all toys & magazines from a doctor's office. Really? Aren't there germs on magazines in a lawyer, dentist or school office?I was just reading an interesting newspaper column in one of the advice columns carried in my daily newspaper. I just had to comment!  The writer had written in to suggest that doctor’s offices needed to change their practice of having magazines and toys for those in the waiting room.

Her feeling was that if doctors would discontinue having magazines in their offices, then patients would bring their own periodicals and that this would then reduce the spread of germs. The columnist also thought this sounded like a good idea and thanked the writer for such a great suggestion. I had to re-read the column as I really could not believe that someone would suggest that doctors should have empty waiting rooms!!!   Have we just gone overboard with “germ fears”?  I understand the need to wash your hands, and to try and keep your hands away from your face, to cover your mouth when coughing etc.  But taking magazines, newspapers, toys and books out of a waiting room seems a little extreme. There are also similar items in the waiting room of my dentist, lawyer, accountant, hairdresser etc.  I guess there could also be germs in those offices too, but no one is suggesting that these professions “sterilize” their waiting rooms and common areas. While I agree it is important to try and keep waiting rooms clean, especially in a doctors’ office (where not everyone is even sick), there is no way to keep any common area totally germ free. The magazines and books are not the only objects that may harbor germs. What about the chairs, the door knobs, the table tops, the counter tops, the fish tank glass, even the floor?  There is just not any way to keep the area entirely germ free, even with good cleaning. In my office we are very conscious about trying to keep the office clean to reduce the spread of germs. Our housekeeping staff that mop the floors and wipe the surfaces between morning and afternoon patients. To try and make an office germ free is as impossible as making a grocery store, a department store, a library or even a school germ free. It is just a fact of life that we will all be exposed to germs. To suggest that discontinuing the long standing tradition of having reading material in the waiting room of a doctor’s office in order to decrease the spread of germs just doesn’t seem to make common sense to me. If you (as a patient) are “afraid” to read a magazine at your physician’s office, then by all means bring your own. But to take away the books and magazines from everyone is just a bit too much. For many parents a trip to the pediatrician’s office is difficult enough without having to lug your own stash of toys and books. I have sweet moms who don’t even remember to bring diapers or wipes as they are just trying to get to their appointment.  Arriving to an empty waiting room to try and entertain 3 children waiting on their doctor seems like torture to me. Schools are full of germs too, but we send our kids there to learn (and occasionally get sick too). Getting sick is never fun, but germs are ubiquitous.  Don’t sweat the small stuff; remember there is a bigger picture. What do you think? I would love to hear from you! Feel free to leave your comments below.

Daily Dose

Wheezing & Respiratory Distress

2.00 to read

What is that hissing noise in the air? Plenty of wheezing and coughing ushering in upper respiratory season.  With all this noise, I’m on the lookout for respiratory distress. As I start to see more and more sick kids, my office becomes a cacophony of coughing.  While many of the coughs sound horrible, fortunately most of the children I will see do not have any real respiratory distress.

I will spend a lot of time this respiratory season talking to parents about respiratory distress and what to watch for. Just like so many things in parenting, observation is the key. Watching your child’s breathing when they are coughing or even wheezing is the most important thing you can do. But knowing what is “distress” or “shortness of breath” really often means you need to know what to look for.  

I just saw a precious little girl in the office, my first patient of the morning. She had a history of a few episodes of wheezing, and did have a nebulizer and medications at home. She had been well all summer and the mother hadn’t thought about wheezing, but noted that her daughter started to cough over the weekend and had then gotten worse and had coughed all night, which made her come to the office bright and early the following am.

When I walked into the room I immediately could see that the little girl was in a bit of respiratory distress. Not only was she coughing (which every other patient seems to be doing), she was also retracting or “pulling”.  She was still happy and playing but you could see that she was “working” to breath. Her tummy was moving in and out and you could see her ribs pulling in and out a bit. She was still well oxygenated and pink.  

Her mother had not looked at her chest and had forgotten about her daughter’s nebulizer (you know, out of sight out of mind), as she had not used it for 6 months and was not “clued” back into coughs and respiratory season.

A quick review and she remembered what we had discussed last winter and realized that she should have pulled out the nebulizer over the weekend. It is repetition that makes you remember “the home wheezing action plan” and if you only do it once a year it is easy to forget.

Any time your child is coughing, whether they are 2 days or 20 years old, you want to look at their color (pink, not blue) and at their chest. You want to see if they are using their ribs or tummy to breathe. The sound of the cough is not as important as LOOKING at their chests. Whether it is during the day or the middle of the night, take off their shirts, (turn on a light) and look. That is what your pediatrician is doing throughout the season.

Any type of retractions, pulling, or respiratory distress means a phone call and visit to the doctor or ER.  Coughs are usually okay, but never respiratory distress.

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

Daily Dose

Earaches Are Painful

1:30 to read

I just managed to catch yet another cold from my cute, little patients who felt that they could “squeeze in” one more cold before officially closing out the sick season!  Parents are so SICK of their children being SICK and I must agree...it is time for everyone to stop coughing and sniffling and get well, and that means fewer ear infections as well.

Ear infections are one of the most common reasons that a parent brings a child to their pediatrician.  But, not every child that has a runny nose, cough, fever, or pulls on their ear will have an ear infection. In fact, most will not.  

Several important facts about an ear infection: a child’s ears typically do not get infected on the first day of a viral upper respiratory infection, most ear infections occur between day 3-7 of a cold. Most children who will develop an ear infection will have a runny nose, congestion, cough and often develop a fever.  It is not unusual for a child to have a fever for the first few days of a cold, but a fever that develops 3, 5, 7 days after the beginning of a cold may be a red flag for an acute ear infection.

The newest guidelines on ear infections are quite clear and state that the pediatrician needs to distinguish between an acute otitis media (AOM), with a bulging and opaque ear drum versus those children who simply have serous otitis media (fluid behind the ear drum).  Antibiotics are only recommended for those children with and acute ear infection who are symptomatic.   

For children under the age of two years, especially those in day care or school situations who have a first AOM, amoxicillin is still the recommended drug of choice. It is inexpensive and well tolerated (and tastes good too). For children with recurrent ear infections second line drugs will be used.

For a child over the age of two years who is not running a high fever or in exquisite pain, the newer guidelines advise “watchful waiting” with treatment beginning with topical ear drops for pain and acetaminophen or ibuprofen.  In the older child the infection is less likely to be bacterial and more likely viral and therefore will not respond to antibiotics.  I will give the parents a prescription for an antibiotic with instructions to begin it if the child seems to be worsening over several days, and to call me to let me know they started the antibiotic. In over 75% of my patients, they never begin antibiotics and the symptoms improve and the ear infection resolves on its own.

Discuss options for treatment with your own pediatrician and remember, judicious use of antibiotics is very important.  Not every child who pulls on their ear or who has a “bad night” of sleep will require an antibiotic. All children must be seen to decide who has an ear infection. it is not a telephone diagnosis!

 

Daily Dose

Baby's First Cold

I find myself in the office each day amid a host of babies who are finally succumbing to their first colds. I walk into the room and see their little runny noses, their red rimmed eyes and hear their frequent coughs, while simultaneously see them sitting on their mom or dad's laps, playing with a toy and making good eye contact with the parent.

The parents of course are "worried sick" but I am immediately reassured as I watch their bright-eyed, runny nosed your-baby interact with me. So it goes in the winter.... No one is immune to those nasty cold viruses and many of these babies have managed to ward off illness for months, but are finally battling their first cold. The babies actually are fairing pretty well, but the parents are both worried about the cold and sleep deprived, because one thing about most kids with colds whether they are four months or 15 months, they just don't sleep as well. Colds are an unfortunate fact of life and each cold that a your-baby suffers through actually makes them a little stronger. Their bodies are making antibodies to that virus and helping to shore up their immune system. Small victories amid the myriad of viral infections they get in those six to 24-month period. There is still no real treatment or cure for the common cold. The recommendations for a your-baby are fairly similar to the rest of us. Hydration (milk is okay), fever control if they need it, and TLC and tincture of time. The first cold is the hardest, at least for the parent. You can try putting a humidifier in their room and irrigating their noses with saline to help clear the mucous and make it easier for them to breathe. Tylenol for fever, which is common in the first several days, may also make them more comfortable. After several days, the worst of the cold is over and they should feel a little better. Watch for fever that re-occurs or worsening of their sleep habits or mood which my signal an ear infection. Most ear infections don't occur on the first day of the cold, so give it a little time and if they are not improving it warrants a trip to the pediatrician. Best news, I saw very few ear infections today, but lots of colds. That's your daily dose, we'll chat again tomorrow.

Your Child

Measles Vaccine May Help Prevent Other Diseases

2:00

The measles vaccine may provide additional benefits beyond protecting children from the highly contagious and sometimes fatal disease.

According to a new study, by blocking the measles infection the vaccine may also prevent measles-induced immune system damage that makes children much more vulnerable to other infectious diseases for two to three years after immunization.

The immune system has the advantage of having “cellular memory” for previous infections to help fight invading microbes.

The study focused on a phenomenon called "immune amnesia" in which the measles infection destroys cells in the immune system that remembers previously encountered pathogens.

Prior research had suggested that “immune amnesia” typically lasted a month or two. The new study, based on decades of childhood health data from the United States, Denmark, England and Wales, showed the measles-induced immune damage persisted on average for 28 months.

Because of the long-term damage to the immune system by the measles infection, children that were not vaccinated and got the measles were more likely to die from other infections.

"The work demonstrates that measles may have long-term insidious immunologic effects on the immune system that place children at risk for years following infection," said Princeton University infectious disease immunologist and epidemiologist Michael Mina, whose study appears in the journal Science.

"The work also demonstrates that, in these highly developed countries prior to the introduction of measles vaccine, measles may have been implicated in over 50 percent of all childhood infectious disease deaths."

Measles was declared eliminated in the United States in 2000, but increasing numbers of cases have been reported in recent years, as more people remain unvaccinated. Last year's 668 U.S. measles cases were the most since 1994, the Centers for Disease Control and Prevention said.

"Our work reiterates the true importance of preserving high levels of measles vaccine coverage as the consequences of measles infections may be much more devastating than is readily observable," Mina said.

The study provided data showing that measles prevention through vaccination lowered childhood deaths from the pathogens that cause conditions such as pneumonia, sepsis, bronchitis, bronchiolitis and diarrheal diseases.

The study comes as many parents opt out of the measles, mumps and rubella (MMR) vaccine for their children based on discredited claims about the vaccine's safety or for religious and other reasons.

The MMR vaccine has been thoroughly studied by scientists around the world and has been found safe for children. This new study shows that its benefits may last much longer than previously thought.

Source: Will Dunham, http://www.reuters.com/article/2015/05/07/us-health-measles-idUSKBN0NS23N20150507

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