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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

Treating Motion Sickness

With spring break under way, I seem to be getting some phone calls from patients of mine who have been on the road travelling and dealing with a child with motion sickness.Many areas around the country are enjoying spring break. What's interesting this time of year and during the summer months, is the amount of calls I receive from patients of mine who have been on the road travelling and dealing with a child with motion sickness. Whenever I get calls like this it brings back memories of my own children and episodes of throwing up in many different locales, YUCK!  

So, maybe this will help you be better prepared than I was when this first happened to our family while riding in the infamous minivan. The most common cause of motion sickness is car sickness, but children may get sick while on airplanes or boats too. It seems that about 58% of children between the ages of four and 10 experience the symptoms of car sickness. Younger children are also affected, but may not be able to verbalize the sensations of motion sickness. It seems to be due to an increased sensitivity to the brain’s response to motions. The brain receives signals from the motion-sensing parts of the body (the eyes, the inner ear, and the nerves in the extremities), and in most situations all three areas respond to any motion. When the signals the brain sends and receives are in conflict, (typically between the ear which senses movement, while the eye does not), the symptoms of motion sickness occur. The signs of motion sickness usually start with a slight feeling of queasiness: “I have a stomachache” is heard from the backseat of the car. Dreaded words to any parent. In some cases children can be sick before you have even gotten out of town and on the highway. The initial nausea is then followed by a cold sweat, fatigue and loss of appetite. A younger non- verbal child may just become restless, pale, sweaty and cries. At some point these symptoms are usually followed by vomiting. By then you have figured it out! The best treatment for motion sickness is like many things: prevention! If you have already experienced motion sickness with your child plan ahead for trips. If your child is over the age of two, place them in their carseat in the middle of the backseat and face them forward. Provide a small nutritious snack prior to the trip rather than a big meal, and avoid dairy (there is nothing worse I can assure you from personal experience). Open the windows to provide fresh air. Do not let your child play video games or read while the car is in motion, Try to distract them by singing or talking. Sleeping may also be helpful, so at times you may plan your trip around naps and bedtime. Frequent stops for a child who is feeling sick are a necessity. Letting them lay flat for a few minutes while the car is stopped and even applying a cool rag may make them feel better. Try small sips of carbonated beverages or crackers to help the nausea. Some children who have a tendency to get sick may do well if they are pre-medicated for a trip with either Dramamine or Benadryl. Although these medications typically cause drowsiness, some children may have the opposite reaction and become agitated. You might want to try them prior to a trip. Check with your doctor about dosages. Lastly, be prepared and have zip lock bags and hand wipes available in case of emergency. This will make everyone in the car a little happier. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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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

Ear Infections Can Develop Quickly

1:15 to read

One of the things that I sometimes see in my practice, which is interesting to me as a pediatrician, and was equally interesting when I had young kids, is how quickly a child's ear exam can change.

You are taught that in medical school, but when you really see it happen it with your patients or your own child you become a real believer. As the saying goes, seeing is believing. I can remember checking one of my boy's ears for an ear infection early in the morning before heading out to work, and declaring, "his ears are perfectly clear". How could it be, my husband would inquire, "that they seem worse after we have been at work all day" and lo and behold, I would re-check their ears and a normal morning ear is an abnormal evening ear. What a difference 12 hours can make! Not a very good warranty on ears and infections.

I was reminded of this yesterday when a patient called and said that her little boy had developed "disgusting" eye drainage which was worsening since I had seen them in the office a few days ago. They had just returned from taking both of their young children to Disney World, and she "couldn't believe they came home sick!" That's a whole 'nother column. At any rate, seeing that they lived fairly close I told them to swing on by and let me look at him again. I think she was just hoping I would call in eye drops. The two precious boys arrived at my doorstep on Saturday night and lo and behold after looking in the youngest child's ears, both of his ears were so infected. So, once again I was a believer in ears changing, and he did not need eye drops he needed to have oral antibiotics to clear up his ears (and subsequently his eyes). There are several lessons from all of this. Ears can change quickly, eye drainage in a toddler with a cold may often really indicate that their ears are infected, and house calls are a good thing.

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

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

The Luxury of House Calls

A quick visit to a family down the street made me realize the luxury of "the olden days" of house calls.I went down the street today to see a family of mine who had just had their second your-baby. I saw the stork sign in her front yard, announcing the birth of their second son, and thought I would "pop" in to take a peek at the your-baby and see how things were going.

It was such a delight to get the opportunity to see the family (now four rather than three), at home with their newborn and almost 2-year-old son, relaxed and happy. What a difference to have the chance to visit with them and do a cursory exam on the four-day-old, in the comfort of their home, rather than the chaos of a busy pediatricians office in the winter. It was easier for them I am sure, rather than having to bundle the your-baby up, drive to the office, sit in a waiting room etc. We sat together while I had the pleasure of holding their precious newborn and talked about bringing home a new your-baby and questions or concerns that they had. We had the time to talk about breastfeeding, jaundice and newborn stools, all the while watching the toddler show me his puzzles and new toys. It was a wonderful visit. This 20-minute visit made me realize the luxury of "the olden days" of house calls, when you had the chance to see a family in their surroundings. I am sure that a doctor could gain a lot of insight into family dynamics by making house calls, as there are many times I think, "I wish I was a fly on the wall to watch this family at home". That may be my next life, pediatrician on call, only going to a few houses a day to do home visits. In the meantime, back to the office tomorrow, but one less patient to see as I have already taken him off my schedule! That's your daily dose, we'll chat again tomorrow.

Daily Dose

Is the Weather Making You Sick?

1.15 to read

The weather has been up and down all over the country with some unseasonably hot days, followed by cold days and then warm days in between.  At the same time lots of people are experiencing the first colds of the fall season.  Funny, I continue to hear “the reason I am sick is this weather, hot and cold, up and down, just makes you sick!” 

But, I am sure that you really do know that the weather change does not “make you sick”.  That seems to be a long-standing old wives tale that my grandmother used to tell us as well. She would also say, “don’t go to bed with a wet head or you will catch a cold”.  

The change in weather does not cause illness. It may mess up your wardrobe choices, or cause a last minute change in birthday plans when your outdoor party is moved indoors due to a 30 degree drop in temperature, but it will not “cause” an illness. 

The truth is that viruses live better in cooler weather. Children are spending more time in together in a classroom sharing knowledge and germs. As the weather turns cooler, wetter and gloomier, we all tend to move from outdoor activities to indoor activities. The combination of all of these factors suddenly converge and viral upper respiratory season arrives. 

Bottom line:  it is not the change in weather that is making you catch a cold, but rather the usual respiratory viruses that are back as the seasons change.  It is just the beginning of the cold season, so despite ups and downs with temperatures, the best protection is not a coat, but rather good hand washing and covering those mouths when you cough. Personally, I love this weather; every day is different!

Daily Dose

Bug Spray & Bug Bites!

2.00 to read

What's the best way to keep the bugs away? With the holiday weekend approaching, many families will celebrate outdoors and with all the rain some areas received, bugs may be a few uninvited guests crashing your party. In fact, I have been seeing (lately) a lot of children who are suffering from uncomfortable bug bites.

The best way to prevent bites from the myriad of insects including mosquitoes, mites, chiggers, flies and fleas is by using an insect repellent. Insect repellents do not prevent bites from stinging insects such as bees, hornets and wasps. The AAP recommends using bug sprays in children who are older than 2 months of age when necessary for preventing insect bites during outdoor activities. The most common insect repellent is DEET, a chemical that has been studied for over 50 years. Most of the OTC bug sprays contain DEET in different strengths. The higher the concentration of DEET, which typically ranges from 5 – 30 %, the greater the protection and length of effectiveness. I usually recommend starting with the lowest concentration of DEET, which typically provides protection for 1-2 hours, and use a higher concentration as needed for longer protection. The number of bites a child receives and their reaction to bites are different in all children, so each child may need a different concentration of DEET to be effective. With concentrations of DEET above 50% (not recommended for children), the effectiveness and duration of protection actually plateaus, so there is really no benefit from higher concentrations. Another product approved for use in the U.S. about 5 years ago is picardin. Picardin provides similar protection in both duration and effect to DEET. Cutter, Skin So Soft and Off all have some products containing 7-10% picardin. The advantage to picardin containing products is that they are odorless (unlike DEET) and do not feel as greasy on the skin and are less likely to cause skin irritation and damage to fabrics . With all products you must read the labels to see what you are getting. There has been some recent data on the use of natural products such as oil of eucalyptus which the CDC has found to be comparable in its duration of effectiveness in preventing mosquito bites, to lower concentrations of DEET. It may also work well against ticks (Repel). Eucalyptus oil may be poisonous if ingested in large quantities and should not be used in children younger than 3 years of age. Other studies have found that 2% soybean oil (Bite Blocker for Kids) has similar levels of protection to products containing 5-15% DEET, and may provide up to 90 minutes of protection from mosquitoes. This may be a useful product for short term exposures. Chemical repellents containing permethrin kill ticks on contact but should never be applied to the skin, but may be applied to clothing. Insect repellents should not be reapplied throughout the day, as is sunscreen. Parents should be instructed to spray the insect repellent on their hands first and then apply to their child and do not apply to the areas around the nose and mouth.  It is a good idea to wash the repellents off with soap and water at the end of the day. That’s your daily dose for today. We’ll chat again tomorrow.

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