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Daily Dose

School & Infectious Disease

1:30 to read

I received an email this week from a patient…subject line: “potential exposure to Herpangina”.  In the body of the email was the following:

Dear Parents,

We want  to inform you that a case of Herpangina disease has been reported for a child at ….. room #112.  This is a contagious disease that  is spread by direct contact with another person or contaminated objects.  Herpangina is an illness caused by a virus, characterized by small blister-like bumps or ulcers that appear in the mouth, usually in the back of throat or the roof of the mouth. The child often has a high fever with the illness. We have attached further information about this common childhood illness published by Children’s Hospital in Boston. Our teachers are carefully disinfecting their room to help prevent further spread of the disease.

The mother of the child that sent me the email was “freaked” out and “worried” about  sending her child back to pre-school.  

My question is this, when did it become a “rule” to notify parents in a pre-school or day care setting that there were viral illnesses circulating?  It certainly seems unnecessary to me to send notification of EVERY childhood illness that occurs and for most of my families only serves to cause anxiety.  Some of the schools in our area post a sign on the entry that says something to the effect:  “there are cases of diarrhea, RSV, hand foot and mouth and fevers being reported in children that attend this school.”  Really, is it that surprising or necessary? Seeing that many of the numerous viral illnesses that children get these days are spread via respiratory droplets and contact with surfaces, such as toys and tables that everyone touches (computers too), children are exposed to things all of the time.  Do you go to work and ask your co-workers in a conference room..have you had diarrhea, a cough or a sore throat in the last day?

I understand notifying parents of illnesses, such as meningitis, measles, mumps…even chickenpox that are infectious and may be serious or life threatening. Thankfully, there are very few cases of these illnesses to report, now that the MAJORITY of children receive vaccines to these diseases. 

By putting these emails, texts and notices out for every parent to become alarmed about…and then to come to the doctor out of concern that their child  “may get sick….even before they have a symptom”,  serves no purpose. Herpangina and Hand Foot and Mouth are very similar viral illnesses, and both are caused by enteroviruses. It is at times hard to distinguish one illness from the other. But, with that being said, the treatment is solely symptomatic. In other words, treat the fever, make your child comfortable and don’t let them go back to school until they are fever free for 24 hours.  

Lastly, your child is going to catch a lot of these viruses, no matter what you do when they go out to play, shop or go to school. Each time they catch a viral illness it actually helps them to build antibody in order that their immune system may get stronger and stronger. I think the better note is….as winter comes children will get more coughs, colds and viral infections…if you think you child is not feeling well or running a fever, please keep them home from school for the day.  It is just a normal part of childhood…we don’t need any more anxiety in this world.   

 

Daily Dose

Home From School

1:30 to watch

I continue to talk about it being  the “sick season” and thankfully it is now February!  Parents are all tired of having sick children and I can now at least assure them that we are halfway to the end of upper respiratory and flu season.

 

But, with that being said that means I am still seeing children with RSV, Flu and every other virus I can think of. Remember, the majority of the illness I see every day in my office is VIRAL.  It really doesn’t matter if you can put a name to the virus, as the treatment is the same. Rest, fluids, fever control and watch for any respiratory distress or symptoms of dehydration. As I told one young mother who said that her other child had been tested for RSV (by another doctor), testing the child I was now seeing will not make any difference in how we treat the illness. So, why make the child uncomfortable when doing the swab and also drive up health care costs, for no change in treatment recommendations.  I think people are confused about what the test actually does….it does not change how a child is treated, and it also causes a lot of “alarm” as the mother of one patient goes home to tell her friends that her child has RSV and then the school starts sending out emails and parents become more anxious and alarmed that they may have been exposed….as they are every day all over our city.

 

So…when do you know it is time to keep your child home from day care or school as we all know these viruses are spread at home, school and work as well.  

 

If your child has a fever over 100.5 degrees (by any method of taking their temperature) they should not go to day care or school for at least 24 hours after becoming fever free (without fever lowering medication).

 

If your child is vomiting, 2 or more times in the last 24 hours, they should stay home. Some young children may vomit after coughing as well, but if infrequent they may attend school. 

 

Diarrhea as defined by two or more loose, watery stools that are “out of the ordinary stool pattern” for your child. Any child having diarrhea that does not stay contained within a diaper should stay home. A child who has blood in their stool should not attend day care or school (and should see the doctor).

 

Children with strep throat may return to school after 24 hours if they are fever free and have received the appropriate antibiotic therapy.  (Newer article suggests 12 hours if they are feeling well).

 

Your child does not need to stay home due to a cold, cough, runny nose (of any color) or scratchy throat if they do not appear ill and do not have a fever. Look at how your child is behaving…some times a day of rest may be needed (even when you get sick, right?) 

 

Most importantly, it is not necessary to name the virus that your child might have, but to follow the guidelines for keeping them home (as well as out of stores, church, and after school activities) until they are feeling better. Wash hands, cover coughs and yes….still get the flu vaccine. It is not too late…the ground hog even said we still have a lot of winter left.

 

 

 

Your Teen

Concussions May Affect Kid’s Academic Performance

2:00

Can a concussion affect your child ‘s academic performance? According to a new study it might, depending on two factors - the severity of the concussion and the grade level of your child.

A concussion is a brain injury caused by a fall or blow, jolt or bump to the head that causes the brain and head to move back and forth rapidly. While most recover from mild concussions quickly, the young and the elderly can have symptoms that last for days or weeks.

Researchers from the Children's National Health System, George Washington University School of Medicine and Brody School of Medicine at East Carolina University studied 349 students ages 5 to 18 to find out what happened to their academic performance after concussions. They divided the students into those who were continuing to experience problems following head injuries and those who were fully recovered, and asked the students and their parents to fill out questionnaires about their academic performance.

The study found that the severity of the concussion symptoms was directly related to the degree of academic problems among all grade levels. Eighty-eight percent of the children who were not fully recovered still had problems with concentration, headaches and fatigue. Seventy-seven percent of those same children had problems taking notes and found themselves spending more time on homework and having problems studying for exams and quizzes.

High school students reported having the most learning problems, significantly more than middle or elementary school children.

The authors say that their findings suggest that school systems and medical professionals should be working together to support students who are still in the recovery phase.

"Our findings suggest that these supports are particularly necessary for older students, who face greater academic demands relative to their younger peers," the study's authors say.

The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Symptoms can last for days, weeks or even longer.

The Mayo Clinic says that common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia, which may or may not follow a loss of consciousness, usually involves the loss of memory of the event that caused the concussion.

Signs and symptoms of a concussion may include:

•       Headache or a feeling of pressure in the head

•       Temporary loss of consciousness

•       Confusion or feeling as if in a fog

•       Amnesia surrounding the traumatic event

•       Dizziness or "seeing stars"

•       Ringing in the ears

•       Nausea

•       Vomiting

•       Slurred speech

•       Delayed response to questions

•       Appearing dazed

•       Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

•       Concentration and memory complaints

•       Irritability and other personality changes

•       Sensitivity to light and noise

•       Sleep disturbances

•       Psychological adjustment problems and depression

•       Disorders of taste and smell

Symptoms in infants and toddlers can be difficult to recognize because these little ones are unable to communicate how they feel. However, there are nonverbal clues of a possible concussion. These are:

•       Appearing dazed

•       Listlessness and tiring easily

•       Irritability and crankiness

•       Loss of balance and unsteady walking

•       Crying excessively

•       Change in eating or sleeping patterns

•       Lack of interest in favorite toys

Concussions should always be treated seriously even when a child doesn’t seem to be showing physical or mental symptoms. If you suspect your child may have a concussion seek a professional diagnosis to make sure.

Sources: Sandee LaMotte, http://www.cnn.com/2015/05/11/health/concussions-academic-problems/index.html

http://www.mayoclinic.org/diseases-conditions/concussion/basics/symptoms/con-20019272

Your Child

Your Child’s First Day at School

1:45

While I may have forgotten a lot of things in my life, I remember my first day of school. I was so excited because I actually recognized someone. Her name was Donna. We’d met in a department store a week earlier. We had both picked out the same umbrella, but there was only one – she said I could have it. We’ve been friends for life.

When my daughter began school, she experienced all the same emotions I had those many years ago; scared, excited and uncertain where to go and what to do next. She found a friend also and they wandered the halls together.

Some school districts have already begun their new school year, but for many kids - the bell will ring in the next couple of weeks.

Children aren’t the only ones that are anxious as the first day rolls around – parents can get quite nervous and have that feeling that their little one is growing up so fast- trust me I know. It’s a normal “things are about to change” emotion.

One tip I’d like to suggest before your little one starts school is to share your own first day memories with your child as well as pictures. It’s amazing how comforting it is for a child to know that their parents did the same thing at their age and lived to tell about it!

To help make the first day of school a little less scary for your child, here are some other tips from https://www.healthychildren.org:

•       Point out the positive aspects of starting school: It will be fun. She will see old friends. She will meet new friends. Refresh her memory about previous years, when she may have returned home after the first day with high spirits because she had a good time.

•       Remind your child that he is not the only student who is a bit uneasy about the first day of school. Teachers know that students are anxious and will be making an extra effort to make sure everyone feels as comfortable as possible.

•       Talk about the kinds of interesting things he will learn in the months ahead.

•       Buy him or her something (perhaps a pen or pencil) that will remind her you are thinking of them while they are at school, or put a note in their lunch-box.

•       Reassure your child that if any problems arise at school, you will help re­solve them. (If problems do occur, get involved as soon as possible.)

•       Find another child in the neighborhood with whom your youngster can walk to school or ride with on the bus. If your child is not going to ride a school bus and you feel it is appropriate, drive your child (or walk with her) to school and pick her up the first day.

•       Encourage him to look for new students in his classroom or in the play­ground, invite them to join the group for a game, and ask them about their interests.

•       After school, show your child some special attention and affection. Give him or her a hug and ask what happened at school. Did she have fun? Did he make any new friends? Does she need any additional school supplies (notebooks, rulers, erasers) that you can shop for together?

In addition to the suggestions listed above, your child may need some extra support if he or she is starting school in a new location. Here are some suggestions to make the transition easier.

•       Talk with your child about his or her feelings, both their excitement and their con­cerns, about the new school.

•       Visit the school with your child in advance of the first day. Teachers and staff are usually at school a few days before the children start. Peek into your child's classroom, and if possible, meet the teacher and principal. You might be able to address some of your child's concerns at that time. She may have no questions until she actually sees the building and can vi­sualize what it will be like. (When you formally register your child in the new school, bring her immunization record and birth certificate; usually school records can be sent directly from school to school once you sign a "release of information" form.)

•       Try to have your child meet a classmate before the first day so they can get acquainted and play together, and so your child will have a friendly face to look for when school begins.

•       Do not build up unrealistic expectations about how wonderful the new school will be, but convey a general sense of optimism about how things will go for your child at the new school. Remind him that teachers and other students will be making an extra effort to make him feel welcome.

•       If your child sees another student or a group engaged in an activity she is interested in, encourage her to ask if she can participate.

•       As soon as you can, find out what activities are available for your child in addition to those that occur during school itself. Is there a back-to-school picnic or party planned? Can he or she join a soccer team? (For community sports programs, sign-ups often begin weeks or even months before the start of the season.)

It’s been many years since my first day at school but I remember it well. Your child’s life is about to change forever, but that’s a good thing-another milestone in life’s progression. Give him or her a hug, wipe away the tears and smile a big smile. Let them know you trust them and are proud of them. Then go ahead and shed a few tears of your own when you’re back in the car. Yes, they are growing up fast. 

Story source: https://www.healthychildren.org/English/ages-stages/gradeschool/school/Pages/Making-the-First-Day-of-School-Easier.aspx

 

Daily Dose

Healthier School Lunches

1.00 to read

With everyone back in school after a nice summer break, what better time to discuss school lunches, especially as they relate to healthy choices.  The USDA (Department of Agriculture) has just issued new national guidelines for school lunches which will begin this school year.  The new guidelines include calorie and sodium limits for foods served on the school lunch line and are age dependent.   

The new guidelines also include the recommendation for more whole grains, and dark green, orange or red vegetables (color on the plate). Students buying school lunches must choose at least one fruit or vegetable at every meal.  Portion sizes may also be smaller as well. 

These changes are all geared at helping students understand the importance of healthy eating and making good nutritious food choices.  It is hoped that as students get “used” to seeing and eating healthier school lunches, the choices that they make at home may become better as well.  

Students will also be able to choose from fat-free, low-fat and lactose-free milk and will be required to have 1 serving a day.  Flavored milk will be required to be fat free. 

Lastly, half of the grains served in a school lunch must be whole grain and by 2014 school year all grains must be whole grain rich. 

So, if you are planning on packing your child’s lunch this year, remember these guidelines as well. I think that a combo of packing healthy lunches on some days, while letting your child buy a school lunch on other days seems to be the perfect balance.  Let your children help pick out healthy food choices to put in their packed lunch and they might even pick up a few ideas from the new school lunches this year too. 

You can find the new guidelines at http://1.usa.gov/Qzd5Z7

 

 

Daily Dose

Lice is Tough to Treat

1:15 to read

What are kids bringing home from school besides their homework? Lice! The good news is: lice are obligate parasites and don’t jump, or fly…they are transmitted by direct contact.  But, the smart louse has found another way to drive parents crazy…they are becoming more and more resistant to all of the over the counter products containing permethrin. 

A recent study has shown that 25 states now have a big problem with lice and permethrin resistance.  It seems that the lice are smart and they have developed “genetic mutations” which has made them drug resistant. Texas has had a problem for several years and I have had many patients coming into the office with bags full of “stuff” that they have used to treat their children’s head lice to no avail!!!  Many a mother has told me she is ready to try anything…including some things that might be considered unsafe, but you know a desperate mother.

While about 12 million children a year get head lice, the louse itself does not cause any disease, but just uncomfortable itching.  Parents spend multi millions of dollars each year trying to eradicate head lice. In states like Texas, California, Florida and Virginia the lice are immune to over the counter products, while in New York, New Jersey and several other states they are partially resistant. 

But don’t despair, despite the resistance to the over the counter products such as Nix, there are other prescription products available. Products such as benzoyl alcohol (Ulesfia), ivermectin (Sklice), malathion (Ovide), and spinosad (Natroba), may all be used to treat a case of head lice, but will require a prescription to obtain them.  Although prescription drugs typically are more expensive, treating head lice with an over the counter product may be an exercise in futility. It is likely to be more cost and time effective to start with a prescription product if you live in one of the 25 states which has shown drug resistance.

So, if you get a note that your child has head lice, pick up the phone and call your doctor’s office to see what advice they give you. 

Daily Dose

Parent-Teacher Conference Time

It is that time of year when parents have the privilege of meeting with their children's teachers to discuss academic progress and the fall semester.Now that I have finished doing homework with the younger set, I have returned to the office and ALL of my 27 messages are related to school conferences. It is that time of year when parents have the privilege of meeting with their children's teachers to discuss academic progress and the fall semester. From preschool through high school, conferences are in full swing. I loved getting to sit down with my children's teachers to discuss their progress and really to compare notes, parent to teacher, as to how our boys were progressing in school. You may have heard me say that I believed in the "no news is good news" perspective, and did not call the school etc, unless summoned.

But conferences really are a time of gathering information and discussing this information with your children, whether there is good news or "bad" news to discuss. This is the time of year when attention issues seem to become evident. It may be inattention, impulsivity, excessive talking, lack of focus or incomplete work, but all of these problems deal with attention. Many younger children may be in their first classroom and are still adjusting to a full day of school, following directions, and completing work. But, if you child has been in school and is not showing maturation on these fronts, and teachers continue to discuss your child's attention, focus and concentration, it is important to follow up with your pediatrician. Attention Deficit Hyperactivity Disorder (ADHD) is common in up to 10 - 15% of children of school age and is usually diagnosed in elementary school. If your child has symptoms suggestive of attention issues, call your pediatrician to discuss further workup and evaluation, beginning with teachers and parents rating scales. It is important to note any concerns with your doctor and to continue evaluating your child as needed. Remember, there are more conferences in the spring, and this is a good time to set goals with your child. That's your daily dose, we'll chat tomorrow.

Daily Dose

Tummy Aches

1:30 to read

I am getting a lot of phone calls and texts with concerns about  tummy aches. I have even started seeing patients in the office with complaints of “my tummy hurts”, and we are just in the first week of school. I know that school nurses are dealing with this common complaint as well.   Amazingly, I don’t see very many complaints of tummy aches during the “lazy days of summer”…but once school starts they seem to become more prevalent.

Don’t get me wrong…while the tummy aches are real and painful, they are usually not due to anything serious.  In many cases I see,  the abdominal discomfort may be due to a bit of anxiety and stress that often comes as children get back into the classroom.  While the child may not be aware of “stress”,  their body does sense it and the gut responds with abdominal pain. 

The children that I am already seeing are all healthy and growing well. They do not appear to be “ill” when I see them, but will complain that their tummy hurts. When I have them point to where the pain is, they typically point right around their belly button (periumbilical).  If asked to point to the one place where it “hurts the most”  they typically still cannot localize it…it’s just all over! Having generalized pain is typically a good sign, rather than having point tenderness in one area.  Upon further questioning they do not have a fever, have not had vomiting or diarrhea, DO NOT wake up in the middle of the night with abdominal pain and often cannot remember if they “pooped“ today or yesterday but usually swear that their “poop” is “normal” . (I am not always sure about that - stool history in kids is quite hit and miss!) 

A few of the children say that eating makes their tummy ache worse while others report it feels better if they eat. They typically are not having issues with a specific food.  (It also depends what they are given to eat - often they will eat their favorite food if given the opportunity).  

For some of the children the pain is “bad enough” that they come home from school, but once home their parents report that after an hour or so they seem better.  Other children stay in school, but the minute a parent picks them up they start saying “my tummy hurt all day at school”!  

I remember that one of my sons often had tummy aches during the school year and we were talking about it the other night (he is now an adult).  He says he remembers being worried about school and “hiding” in the morning when it was time to go to school (I would be looking all over for him as his older brother was already out the door, and anxious that he would not get to school on time,  while I had the younger brother on my hip as I searched the house).   Talk about getting a stomach ache…mine was in knots by the time I would get to work.  It would only be several hours later when I would get the phone call from the school nurse that he was there with a tummy ache.  He now says that he remembers that by the time he was 8 years old it all just changed and it went away. 

Many times all it takes is a little reassurance that the tummy ache is not serious. I tell the children that everything on their exam is normal which is a good thing. Sometimes it seems to help a tummy ache if I prescribe the child some extra fiber and maybe a Tums  a good source of calcium too). Who knows if it is placebo effect… but just by doing something they feel a bit of relief. The one thing I do know…they need to keep going to school and it usually gets better once they are settled back into a school routine.  

 

Daily Dose

Viruses Linger During End of School Year

Viruses linger during end of school year and disrupt many events. Dr. Sue explains what parents can do to keep their kids healthy.Well, it seems all students, from preschoolers through those in high school and college, are in full end of the school year mode. Graduations are ahead, from kindergarten through college, and of course there also seem to be several spring/summer viruses lurking around that are disrupting students (and parents) end of year plans.

Just like we have influenza during the winter months (and over the Christmas and New Year’s holidays), we also see other viruses that cause fever, myalgias (muscle aches), cough, congestion and sore throat, that are equally bothersome at this time of year.  While it is not influenza, other viruses such as  adenovirus, enteroviruses and parainfluenza virus (just to name a few), can make you run fairly high fever, feel horribly, have a sore throat and congestion and eventually a cough. Most viruses last anywhere from 7 -14 days, and for the first 2-4 days it is not unusual to see kids running fever, which only makes them feel that much worse.  Something about having a 103 degree fever, while the weather is in the 70’s to 90’s around the country, just doesn’t seem right! Unfortunately, these viruses don’t really care what we all have happening in our lives, and so you may find your child trying to wrap up end of school activities, but really needing to stay home for a few days due to illness. I am writing this as I have seen dozens and dozens of sick kids in the last few weeks with a litany of things to “do” before school ends. Parents bringing their sons and daughters in to my office for “the cure” so that they may attend the end of preschool party, or the field trip, prom or graduation.  I only wish that I had “the cure”. As we have discussed so many times, viruses are bigger and brighter than the best minds, and they cannot be cured in 12 hours with a magic shot of penicillin (although I must say some doc in the boxes still do this).  Despite my best efforts as a physician (and a mother too), the only thing that really cures a viral illness is “tincture of time”, which no one seems to have any more. I am not pointing fingers, because I am guilty of feeling like that too.  I only wish that I could get everyone, including my own children, better in time to attend all of these important functions!!  Viruses always occur at the most inconvenient times. One mother has brought her son to see me both in my office and by my house in hopes of finding “something” that we can treat. She has thrown out options like “antibiotics, inhalers, vitamins and steroids” in hopes of getting him better faster. Now throughout this illness, he like many others has “drug” his sick body out of bed to attend “special” events, all the while running fever and coughing. So, he is indeed contagious and might spread the virus to others. Whether intentional or not, viruses are spread very easily, especially in the close contact that our adolescents all have. I LOL when a parent says “my child has not been around anyone that is sick”!!  But of course they have.  The viruses are at  school, at  after school activities, while sharing water bottles on the sports field, or sandwiches at lunch, our children are exposed. Then throw in all of the parties going on now and it is perfect storm for germs to spread. So bottom line, if your child has a fever, they should stay home.  Rest, fluids, fever control and time are really the only cures.  But thankfully, I feel certain that one of these bright students will one day find the “CURE” for the viral illnesses that we all dread, and they will be a Nobel Prize winner. Not only that, they will be loved by all parents who want to figure out how to  “fix” their child in time for  the next party or event! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue now!

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