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Daily Dose

Too Sick To Go To School

1:30 to read

Now that we are really in the throes of sick season I am often asked…when should you keep your child home from day care or school?  I noticed a recent article in one of the pediatric journals on this topic…which emphasized that hand washing and vaccines are still the best way to prevent transmission of infectious diseases. 

 

But, with that being said, especially at this time of year when so may upper respiratory tract infections are circulating do you need to keep your child home?  The short answer is that most minor illnesses are not a sufficient reason to keep a child home. That includes most colds and coughs. But if your child is running a fever, or seems terribly uncomfortable or is ill enough to “require extra care” by a day care worker or teacher they need to stay home. A day at home for some TLC (tender loving care) is often the best medicine, especially for the first day or 2 of a viral upper respiratory infection when a child may have a fever.

 

I am also asked about GI illnesses and whether a child with diarrhea needs to stay home from day care. It seems that some day care facilities now exclude a child from care if they are having more than 3-4 loose stools/day, even if they are still playful, fever free and eating and drinking.  The recommendation by the CDC does not require a child with diarrhea to stay home, if the stools can be contained within the diaper.  This gets back to good hand washing!  A child with vomiting is a different story and should not be sent to school or day care.

 

I am seeing a lot of children with pink eye (conjunctivitis). Pink eye may be caused by both bacteria and viruses. Transmission occurs by direct contact with contaminated secretions from the eye or via respiratory droplets. Unless a child has other symptoms to keep them out of daycare they should be allowed to return to school once appropriate therapy has been started.   

 

Even with good hand washing it is not unusual for children who are crawling and walking to get up to 11-12 viral infections in a season! This is often difficult for a family with two working parents, as the decision is made whether a child can attend day care and who will stay home if the child needs to be home.  At the same time, young parents will often get several of their children’s viral infections as well- even with good handwashing. What parent has not had their child cough or sneeze directly into their face (this is not purposeful but age related), and within several days you find yourself sick! This is a hazard for us pediatricians as well.

 

Lastly, do not “try” to figure out “who got your child sick”. There are just too many places we all go on a daily basis where we are exposed to viruses and bacteria. Trying to “track down” the exposure for most of the common infectious diseases that children get is a big waste of time. Serious illnesses like meningitis, mumps, measles etc are a different story…but fortunately, because of vaccines this is rarely the case.

 

So keep up hand washing and hope for the best during this time of year.

Daily Dose

More Flu Cases

1:30 to read

If you read this blog often you know I have been writing about the upcoming flu season since the vaccine was released this summer.  The predictions were that it might be a “bad” flu season due to the fact that Australia had had a severe flu season, and the United States often sees the same influenza strains that were previously in the southern hemisphere.

 

The predominant strain in Australia was an influenza A virus (H3N2 strain) which seemed to have caused outbreaks with more serious illness. The H3N2 strain was also the one that was included in this years (2017-2018) influenza vaccine currently being given.

 

Preliminary studies from Australian data analyzed the effectiveness of the influenza vaccine against H3N2 and found that it was only about 10% effective in preventing this type of flu. This is not great news for the impending flu season in the U.S.

 

At the same time we are already seeing early flu cases in several states including Oklahoma and Louisiana as well as increasing activity in several other states. As I noted in an earlier post, Dallas has been seeing some early flu activity as well. I have already seen two doctors who were immunized succumb to influenza A with classic symptoms of fever, body aches, chills, sore throat and cough….and indeed sick enough to be home from work for several days, where I assure you they were missed! 

 

If indeed flu season continues to increase in the next weeks it could potentially be a busy Christmas season….and not just for Santa. The more we “gather together”, whether at a party, church, on an airplane or in a mall shopping, the more likely you are to be exposed to the flu and to infect others. 

 

So, the best way to try and prevent getting the flu is to still go ahead and get vaccinated, despite the question of how effective the vaccine may be. Any protection is certainly better than none. Other ways to ward off the flu?  Continue good hand washing and observe respiratory and cough hygiene. When possible stay away from large groups of people and this is especially important for very young children, under 6 months of age who cannot receive a flu vaccine and who also have more complications with the flu.

 

Lastly, if you are sick and have flu like symptoms, stay home!  Do not send your child to day care or school. If you the parent get sick you also need to stay home and not go to work, or host the Christmas cookie exchange etc. etc…..and risk exposing others as well. 

 

i am working over the Christmas holidays and continue to pray that all of the above predictions are WRONG!! Stay tuned for further updates.

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Daily Dose

How to Treat A Vomiting Child

We are definitely in the throes of "sick season" in our office and with that comes a lot of kids with vomiting. I remember the first time that one of my own children vomited.

We were in Target, he was about two and he had said he "was sick". Now, seeing that he was not very specific and did not elaborate, I just went on shopping. Several minutes later, as he sat in the cart (with seat belt fastened), he just looked at me wide eyed and suddenly vomited. This is the moment as a parent that you understand the difference between babies that "spit up", and true, projectile vomiting! Now what do you do once your child has vomited (besides rush out of Target as fast as you can)? Once a child has vomited it is important not to give them anything else to eat or drink, for at least 30 to 45 minutes. That means even if they are "begging" for a drink, as you will probably see it come right back at you if you do. After waiting, you want to begin re-hydrating with clear liquids. Not a good idea to pull out the milk or food yet. In an infant you can use Pedialyte, which is an oral electrolyte solution, and instead of breast milk or formula you can try feeding your infant about an ounce of Pedialyte every 10 to 15 minutes and see if they can keep Pedialyte down. In toddlers and older children I use Gatorade, as it is not quite as "salty" and kids seem to take it better. Again, frequent small sips of Gatorade while you wait to see if the vomiting is persistent. Don't go too quickly on giving them larger volumes. The key is small amounts, frequently, which are easier to handle. As your child keeps down the Pedialyte or Gatorade you can increase the volume that they are taking and decrease the frequency. The main thing you are trying to do with a child of any age is to keep them from getting dehydrated and their vomiting is typically due to a viral illness affecting their GI tract. Because it is typically a virus that is the culprit for nasty vomiting, it just takes time to get through the illness. There is no "miracle" cure, and watching your child vomit, or cleaning up the vomit that invariably is usually not in the toilet, is one of the worst parenting jobs. That being said, there are very few children who will not experience vomiting at least once or twice during their childhood, so you need to keep "clear liquids" on hand in the pantry. Having powdered Gatorade around is a lifesaver at 2 a.m when your four-year-old wakes up and throws up. If you are giving the clear liquids, and your child tolerates larger volumes, but then vomits again later on, you just back up and start all over with smaller amounts more frequently. It is somewhat like a "balancing act" to give enough that they are hydrated, but at the same time to not give too much at one time that they vomit again. Slow and steady is the mantra. You should always be looking for your child to have tears, a wet and moist mouth (put your finger in there, it should come out with some saliva on it), and urine. It is often hard to tell if a child in diapers has had a wet diaper as they will not be "soaking" the diaper and smaller amounts of urine are "wicked" with the new super absorbent diapers. Children will also be pitiful after vomiting and may seem "lethargic" to you, but if they are an infant and can smile and make good eye contact or they are an older child who can tell you they feel terribly and don't want to drink Gatorade or play with their blocks they are probably not dehydrated. If in doubt, give your doctor a call to discuss what is going on. After using Pedialyte and Gatorade, and your child has not vomited for six to eight hours you can try adding some formula or breast milk, or other liquids such as chicken soup or a Popsicle. I still would not start solid food until the child has kept down other liquids. We parents all worry if our children don't "eat" but the fluids are the important part, and as we all know, a day without out chicken nuggets or peanut butter will be okay. Keep up the fluids!! If your child continues to vomit despite your best efforts with "slow and steady" fluids you need to call the doctor. We have plenty of patients that we see everyday to make sure they are hydrated, and to even watch them while they take fluids in our office. Occasionally, when all else fails we will have to hospitalize a child for IV hydration. Oh yes, remember to wash your hands frequently as these nasty viruses are contagious and parents will often find themselves getting sick after their children. That’s your daily dose, we’ll chat again tomorrow.

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

The Difference Between A Viral Sore Throat & Strep Throat

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

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

Daily Dose

What's making Your Child Sick?

1:30 to read

As our office is getting ready for the onslaught of “sick season” I am already getting numerous phone calls from concerned parents about illnesses in their schools.  One thing that is the same each year….once kids go back to school, whether it is daycare, preschool or elementary school, young children start to get sick.  Parents wonder why this is the case and is it REALLY normal?

 

It is very normal for otherwise perfectly healthy little children to catch just about everything that is “going around”. Once a child is a toddler they play in close contact with their friends and put “germy” hands and toys into their mouths, so a younger child catches more viral illnesses than a 5 or 6 year old.  In fact, it is not uncommon for a toddler to catch 10 -12 viral illnesses in one year. That means they are sick at least once a month if not more. But, the good news is most of the illnesses are self limited and resolve with minimal treatment with over the counter fever control medications, fluids, rest and a lot of tender loving care!

 

But, with the advent of many rapid in office tests that allow a doctor and parent to know within hours which virus is causing their child’s  cough and cold, I am actually seeing more and more worried parents. I got a call yesterday from a mother who had gotten a “note/email” from her child’s school that there was a child who had rhinovirus.  Rhinovirus is just one of many viruses that cause the common cold!!  There is really no need for a school to let parents know that there is a child who has a cold.  But if you hear the words rhinovirus, metapneumovirus, adenovirus, or parainfluenza virus (which has nothing to do with the flu), it sounds pretty scary.

 

Although being able to swab a child’s nose to determine which virus is causing their fever, cough and runny nose is fairly easy, and it may be helpful in certain situations (such as a child who has a compromised immune system, or a premature baby with lung problems), for the “normal healthy child” identifying the name of the virus is not necessary, and most importantly it typically does not change how the doctor or parent will care for the child.  

 

So… I would encourage doctors to be judicious in ordering these tests and parents to understand why they are NOT routinely done.  The social media chain of identifying which child has which virus is not helpful and may make an already anxious parent, even more anxious. 

 

Bottom line, wash your hands, get a flu shot and get ready for a lot of coughs and colds in the next few months!

 

 

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Daily Dose

Flu is Here!

1:30 to read

Well, I knew that it would happen sooner or later…that is when would I see my first case of Influenza 2017-2018?  Unfortunately, it is it happening sooner than later as I am seeing more than a handful of children with classic flu like symptoms that come on quickly including high fever, body aches, chills, sore throat and cough. The few children that I have seen have looked like “flu victims” as they are laying down on exam table with a coat or blanket over them despite having a fever and say “they feel terrible”. Their flu tests have been positive for influenza!

 

To remind you there are two types of influenza: A and B. The patients that I have been seeing have had Influenza A which is typically the more “severe”  illness than Influenza B.  The flu vaccine (all of which is injectable this year) is a quadrivalent vaccine, which means it contains 2 influenza A viruses and influenza B virus.  The vaccine components are selected each season based on the worldwide surveillance of flu activity and specifically what have been the prevalent viruses in the southern hemisphere in the months prior to our flu season.

 

The CDC tracts flu activity around the country every year, and they are currently reporting very little flu based on tests from surveillance sites throughout the U.S (only about 2.9% of tests are positive for flu this week)  The Dallas County Health Department also tracts influenza activity and are reporting that 4.7% of their tests were positive for influenza, most of which is influenza A. 

 

The CDC is predicating that is may be a “tough” flu season based on the most recent data from Australia.  They are just wrapping up their flu season as it is early spring there now. Australia has had one of their worst flu seasons in recent years with the predominant strain being an influenza A - H3N2 virus, which typically causes more severe illness. Fortunately, this years flu vaccine contains the H3N2 virus.

 

Many people (including my patients and their parents) ask “why get the vaccine if it is not 100% effective?” The vaccine typically is between 40 - 60 % effective in preventing flu and if you are unlucky enough to get the flu after being vaccinated you typically have a less serious illness, are less likely to have complications and to require hospitalization. Seems like an easy choice to me. 

 

So….it is really important to get that vaccine now…if indeed we are gong to have an early and severe fu season you don’t want to wait. It takes about 2 weeks post vaccine to develop antibodies and protection too…it is not immediate.

 

Parents with babies under 6 month of age also need to make sure they are immunized as well as anyone that cares for the baby.  Babies under 6 month of age cannot get flu vaccine, so they need to be protected by having everyone around them vaccinated. 

 

Our son and his wife just had their first baby a few weeks ago…a BOY!! So I assure you everyone in our family has already been vaccinated to protect that precious new grandson of ours. Welcome Stewart Wilson! 

 

  

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Daily Dose

Coronavirus

1:30 to read

Coronavirus is here…does that cause you concern?  It is causing a lot of concern among mothers in my practice and community as they are posting “my son has coronavirus”. Of course that leads to a Google search and the next thing you know I have parents calling concerned about SARS! (a rare complication).

 

Coronavirus (which is named for the crown like shape of the viral particles under a microscope) is just another fall and winter virus that typically causes cold like symptoms with a scratchy throat, congestion, runny nose and cough. It may also cause several days of fever.  Coronavirus “acts” like many of the other viruses that we are seeing now, including rhinovirus and parainfluenza.

 

While most everyone gets a  coronavirus infection in their lifetime, knowing the name of the virus really doesn’t change anything about the treatment. Having your child’s nose or throat swabbed and sent for a fairly expensive test so that “you may have peace of mind” does not dictate any different treatment than that of any other respiratory virus.  Symptomatic relief has been the advice for treating all of these upper respiratory infections….long before we could test for them in an office setting. 

 

How do you treat it?  Treat the fever if there is one and do not send your child to daycare or school until they have been fever free for 24 hours (you also need to stay home if you have a fever). Use over the counter saline nose drops to help suction your child’s nose or to help thin the mucous so that they can “blow” more effectively. Take a steamy shower to relieve the congestion and loosen the cough. Use a cool mist humidifier in your child’s room (especially if you have the heat running). Make sure to teach your children how to “cough into their elbow” rather than their hands. 

 

I am continuing to hold a lot of hands as parents worry about all of these different respiratory viruses….but naming them is not going to change treatment in the otherwise healthy child. Making sure your child washes their hands and try to teach your older children to keep their hands away from their eyes, nose and mouth will serve you better than worrying about which virus they may have been exposed to. 

 

In the case of any illness, if you become concerned about how your child is breathing and respiratory distress, you need to place an immediate call to your pediatrician or a visit to the ER.  Do not be soconcerned about naming the illness. 

 

 

 

 

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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.

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DR SUE'S DAILY DOSE

When should you keep your child home from school?

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