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Daily Dose

Summer Viruses

1:30 to read

June….now seems like officially summer, although there are still some schools around the country in session, and even a couple in Dallas.  So, with summer here it is check up time in my pediatric office.  That means most days I am seeing very few sick patients, and most of the patients who come in for a visit other than a check up have a rash, a bug bite or maybe a swimmer’s ear.

 

But, with that being said there are also always some of those pesky summer viruses hanging around and many of them appear with just a fever. Many of the “sick” children I am seeing only have a fever, some of whom have a temperature as high as 103-104 degrees, with very few other symptoms.  Although these kids have a significant fever, once they are given an over the counter product like acetaminophen or ibuprofen they feel pretty well and even play for awhile. 

 

Fever is often just a symptom of a viral infection and these summer viruses have names…enterovirus, adenovirus, and even some left over parainfluenza virus.  We are definitely out of flu season….at least till next year.

 

Some of these summer viruses may have associated rashes which are more common with summer viral infections than winter viruses.

 

I have seen some kids with these summer viruses with prolonged fever, even 5-7 days which is a bit longer than a pediatrician and a parent want to see. But, with that being said, when I have seen these children they appear to look well and have not had any other physical findings.  I have often seen them again after having 5 or more days of fever, and it seems that many of them have adenoviral infections.  Adenovirus may also cause a myriad of other symptoms than just fever, including pink eye, sore throat, abdominal pain and vomiting and diarrhea and tummy cramps.  Rarely, some children will develop blood in their urine without having a urinary tract infection. 

 

Parents often ask me….where did they catch this? Remember that these are just viral infections and that there is not a vaccine for adenovirus. Once we see one virus in the community I know I will continue to see more and more children as it is “passed around”.  Best thing to do is to keep up good hand washing and keep your child home from the pool or summer activities if they have a fever.  

 

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.

 

 

 

 

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Daily Dose

Your Child's Check Up

1:15 to read.

How many times have I talked about my clever patients. I continue to be amazed at how smart my patients are…and how much they teach me….as well as how they make me laugh.  

I was seeing a young lady the other day who was complaining of a cough. She was about 11 years old. She was not one of my regular patients, as she was a patient of a partner of mine who was out of town, so she came to see me about her cough.  

So..I started asking her and her mother about her cough and quickly realized that she was more than capable of answering my questions ( the best kind of patient to have).  Her mother was great and deferred to her, as her daughter was doing such a good job with her history.  I asked her if the cough was problem during the day or night or both? She replied “during the day”. I asked her if the cough was worse when she was playing or exercising during the day? The answer was “no”.  I then started asking her about the quality of the cough…(I also had the benefit of hearing her cough while I was getting her history).  I then asked her if the cough was dry or if it was wet and “gunky”?  I was not sure if the would understand if I asked her if it was “productive”?  

Surprisingly , she looked at me and said , “do you mean do I produce phlegm?”.   There are many parents that don’t understand that word!!  Then realizing that she was quite bright and knew words that I swear I learned in med school (okay maybe undergrad biology?), I asked her if she could spell phlegm. Of course, she immediately spelled the word correctly!!  

She was delightful patient and is another example of “kids say the darnedest things”.  We had a great conversation and it was so helpful to be able to get a good history from her. The history is just as critical as the physical exam in diagnosing a patient… so a good communicator makes a doctor’s job a lot easier.

The only time she was not communicative…when I told her she needed her flu vaccine, and YES it was a shot! Sorry, but this is to keep you healthy.

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

Vomiting Kids

1:30 to read

Pick a virus ….and it is probably circulating in your area!  Seems we are at the peak of upper respiratory season, influenza like illness season and also vomiting and diarrhea season. In other words, lots of sick kids right now.

 

I just started seeing a lot of vomiting again!!  It is the worst for both the child and the doctor’s office where it seems many a child has vomited either in the car, coming up the elevator or in the exam room.  YUCK for all.

 

Remember, norovirus is the most common virus that causes vomiting and diarrhea and it is VERY contagious. Not only via “dirty hands” but it is also airborne…so in other words, those standing near by a child who is vomiting (parents, other sibs) are probably being exposed as well. That is the main reason you probably see an entire family who gets sick almost simultaneously.  

 

If your child vomits….DO NOT give them anything to eat or drink for at least 30 min. I know that is hard as they are asking for a drink,  but you need to give their tummy a minute to “recover” before challenging them with a few sips of Pedialyte or Gatorade.  A SIP is the key word too….tiny amount to start in hopes that they do not vomit again.  

 

I just saw a 6 year old little boy who had been vomiting several times during the night.  His Dad said that he had given him Zofran to help stop the vomiting (this is a prescription).  I use a lot of Zofran in children who are vomiting as it can go under the tongue.  But after the Zofran his son felt better….so he gave him strawberries and a waffle!! Surprise? He vomited again!!

 

Don’t be fooled and start trying to feed your child too quickly after they are vomiting. I know parents worry that “their child is not eating”, but fluids are the important part of staying hydrated. As one little boy told me, “ it feels like there are grasshoppers in my tummy”!! So well put. I grumbling tummy needs time to heal and frequent sips of clear liquids (no dairy) are the best way to prevent dehydration. As your child tolerates a small volume you can go up a bit and gradually increase the amount that they take.  I usually wait a good 4-6 hours after a child has successfully tolerated fluids before I even consider giving them food. Then I start with crackers, noodles or something bland (that I also don’t mind cleaning up) in case they vomit again.  

 

You are just wanting to make sure your child stays hydrated…tears, saliva and urine!  Keep washing those hands. 

Daily Dose

Summer and Fall Viruses are Here

We talk about viruses throughout the year, but certain viruses do tend to occur seasonally and in the summer and early fall that means enteroviral infections.We talk about viruses throughout the year, but certainviruses do tend to occur seasonally and in the summer and early fall that means enteroviral infections. Enteroviruses are a large group of viruses that include Coxsackie viruses (that we have discussed as the most common cause of Hand-Foot and Mouth disease), polio viruses (now eradicated in the U.S., secondary to vaccines) andechoviruses. Most enteroviral infections occur in young children and I have been seeing a host of illness in the office most likely related to enteroviral infections. Enteroviruses are hardy viruses and can live for several days on surfaces etc

Daily Dose

Strep Throat

1:30 to read

During the “sick season” (fall and winter) a common complaint among children (and their worried parents) is that a chid has a sore throat. While all children will at some point complain of a sore throat, most sore throats are due to a virus and are often the first sign of a cold.  

 

Many parents worry that their child may have strep throat which is a bacterial infection and requires treatment with antibiotics.  In fact, only about 10-20% of children with a sore throat will have strep.  More and more parents are bringing their children in to the office right after they “hear” that someone is their child’s class has strep (thank you social media).  In fact, their child may have not even complained about their throat until they were asked, “does your throat hurt”, or they may have only been sick for an hour or two.

 

How can you decide if your child might need to be seen at the pediatricians office if they have complained of a sore throat?

 

Strep throat is most common in school aged children 3-14 years of age.  It it typically not seen in young children (who cannot even tell you that they have a sore throat) or in adults over the age of 45.  With the advent of urgent care centers on every corner I am hearing more and more parents tell me “I have strep throat so I am worried about my child”, but when asked if they the parent are better on their medicine the majority say “not really”, and I am coughing and congested and not getting better. Their “strep throat” is more likely to have been the beginning of a cold. 

 

Children with strep throat typically do not have a cough, but do have swollen or tender lymph nodes in their neck (just under their jaw), have a temperature over 100.4 and have swollen inflamed tonsils that may or may not have exudate (white patches), and are between 3 - 14 years of age. 

 

By using these guidelines which are called the Centor Criteria your doctor is also deciding which patients should have a rapid (in office) strep test. Over testing (swabbing) with an in office rapid strep screen may lead to false positive results due to picking up the bacteria in a child’s (or adult’s) throat when they are simply carriers and do not have strep throat. Why is this important?   Over testing, may lead to over prescribing antibiotics and no one wants their child to be taking antibiotics unnecessarily. 

 

So, it is typically best to wait 24 hours or so after your child complains of a sore throat to take them to the pediatrician.  History of the illness and clinical findings are the two things that will determine if your child needs a “strep test” and should not be decided simply because “there is strep in their class”. In our office all children are examined by the physician prior to having a throat swab.

 

 

 

 

 

 

 

Daily Dose

RSV

1:30 to read

Flu season seems to be winding down but RSV (respiratory synctial virus) season is still here and actually arrived a bit later than usual this year. RSV is a common upper respiratory infection that causes cold symptoms with cough, runny nose, congestion and in some cases wheezing.  

But when new parents hear that there is RSV in their day care or school they often “freak out”. While RSV may cause cough, wheezing and respiratory distress in some young children (more commonly in those with underlying lung or cardiac disorders), thankfully for most it is just a really bad cold!

Statistically, 2% of infants less than 12 months of age are hospitalized for RSV each year.  But, that also means that 98% of infants do not require hospitalization!!  Much better odds that your child will be okay than if you play the lottery, right?

It really doesn’t make much of a difference as to which virus causes your child’s (or your) cold.  What is more important is how your child is breathing!!  Because a baby’s nostrils and airways are smaller, it is not uncommon for parents to be concerned that their child sounds noisy when they are breathing. I think it is more important to look at how your child is breathing rather than listening to their stuffy nose and coughing. This means that you need to take off their t-shirt or jammies and actually look at their chest, and make sure that you cannot see their ribs pulling in and out, or see their abdominal muscles doing work of breathing. You should also not see your baby’s nostrils flaring or see any change in their color...always pink, never dusky or blue!  The cough with RSV is horrendous and sounds terrible as well, but look at how they are breathing and their color when coughing.

It is also important that your child stays hydrated, even though they may not take their bottle or fluids as well as usual. You should always see “spit” in their mouths and tears when they cry and wet diapers (may not be sopping, but wet).  Remember, you probably don’t want to eat as much when you are sick yourself. Offer more frequent feedings. No schedules when your child is sick.

Best treatment, suck the mucous out of your baby’s nose and turn on a cool mist humidifier. They may also feel better when more upright, that is probably why there are many nights with a baby spent rocking on your shoulder when they are sick.

If you have any concerns about how your child is breathing you should always contact your doctor...better be safe. 

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