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Daily Dose

Update on Flu Season

1:30 to read

Flu vaccine is still available throughout the country and it is never too late to get a vaccine.  But, with that being said, our office has very few vaccines for children over the age of 3 years and there is no more vaccine being produced for this flu season.  Because the vaccine is “seasonal”, meaning that a new vaccine with different strains of flu is made each year, manufacturers stop producing vaccines in anticipation of flu season slowing down and ending….in fact, they will begin discussions about next years flu vaccine in the next several weeks.

 

I continue to have parents explain to me “why they don’t get fu vaccines”, yet they are concerned that their child has the flu. They tell me, “why should I get a shot, that hurts, if it doesn’t even work?”. Even though the vaccine effectiveness is less than had been hoped for, any protection is better than none!  There are studies every year that show that people who have been vaccinated have less severe illness, less secondary infections, fewer hospitalizations and lower mortality rates.  Knowing that, why would you “skip” the vaccine, while at the same time be anxious about your child’s illness being the flu?

 

I am also seeing many other viral illnesses right now that have very similar symptoms as the flu. Not every child who has a fever, runny nose, congestion, sore throat and cough has influenza. We have had kids test positive for all sorts of different viruses including coronavirus, adenovirus, parainfluenza virus, and rhinovirus.  This also means that all of these viruses are circulating in the community….and you are pretty much exposed to these viruses wherever you go.  Although a few schools in our area have closed due to Influenza, these kids are still exposing one another to viral infections as they head to the movies, the gym, swimming lessons, dance class and sports events. It is impossible to “hide” from the germs, even when you don’t go to school.

 

Lastly, several parents have told me that their child “did not feel well, but did not have a fever” so they went ahead and sent them to school or day care, only to be called a short time later that their child is at the nurse complaining of being sick and now have a fever. During this epidemic it would probably be better to err on the side of caution, and if your child is “under the weather”, keep them home for a day and make sure that they don’t develop a fever or become more ill. Remember, you are shedding virus and are contagious before you even get the fever.

 

So…get your vaccine if you have not yet gotten it. Wash hands, cover mouths when coughing or sneezing, and stay home if you or your children are sick!!!

 

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This Year's Flu Season

Daily Dose

Flu Season

1:30 to read

While I do appreciate the need for media coverage of this years flu epidemic, I am a bit dismayed by the “scare tactic” information that is constantly leading the headlines, and in my opinion causing anxiety rather than educating and informing the public (of all ages).

 

I am continually reassuring parent after parent (and even grandparents) that although there are so many people who are getting the flu this year (big denominator), for the majority of people the flu is not a deadly disease. But, watching the news makes everyone feel as if they “might die within hours” if they do not seek “immediate medical care”. I have seen worried parents who are coming in within 2 -3 hours after their otherwise healthy child comes home from school with a fever. In many cases they have not even treated the fever. These are not infants under 6 months of age who are too young to immunize against the flu, but children of all ages from 1 - 21 years of age.

 

I have also conducted a biased, non scientific and not statistically significant study among the doctors I see while making hospital rounds, within other pediatric and emergency medicine groups or even socially. “We docs” in Dallas have been BLESSED that “we” feel as if the children are actually not as sick this year as in many previous years and that “we” have not had to hospitalize large numbers of patients due to secondary flu complications….yet. Continuing to pray that this continues. (My group has not put one child in the hospital with flu).

 

So….I went back to look at “real” data that is statistically significant and is available for anyone to see on the CDC website.  Looking retrospectively at pediatric deaths due to influenza: 

 

2014-2015:   148 deaths

2015-2016:   92 deaths

2016-2017:   110 deaths

2017-2018:   30 deaths to date (and we had an early start to this year’s flu season)

 

-In all of these years the male:female ratio was about 1:1

-In 50% (sometimes slightly more) of the deaths there was an underlying medical condition putting the child at greater risk. These included in descending order of prevalence: neurological disorders, pulmonary disease, and cardiac disease.

-In >60% of the deaths a child had been admitted to the hospital for days to weeks before dying and less than 20% occurred in the ER. ( It seems that media reports make parents feel as if children were all dying within hours of becoming ill). 10-20% of pediatric deaths did occur outside of the hospital but I did not see any data as to whether they had previously seen a doctor.

-45% of the deaths occurred due to a secondary bacterial infection

 

It is tragic that there will be deaths in “otherwise healthy children” due to influenza, but sadly this occurs every year. Even with the best care in the world, viruses do kill people. But, while we may be in a flu epidemic (which also occurs every year when enough flu tests are positive) we are NOT seeing alarming numbers of pediatric deaths which should cause parents to have sleepless nights and worry if their child gets a fever. You still have a much greater chance of your child dying in an accident.

 

The BEST prevention continues and will always be GET A FLU VACCINE!! Surprisingly, there are still patients who are coming in to be tested for the flu and don’t want to be vaccinated, despite data to show that immunized children have fewer complications, lower hospitalization rates and few deaths. I don’t understand?? Wouldn’t that knowledge alone help you feel a bit better about being exposed to flu everyday…no matter what you do. We also have at least 4-10 weeks of flu season left so you would still benefit from a vaccine, and fortunately there is NOT a vaccine shortage. 

 

Lastly, if your child has ANY respiratory distress, prolonged fever over 72 hours, a fever late in  their illness, issues with dehydration or seeming to get sicker, they NEED to be examined by their doctor or urgent care. This advice has also been the standard of care for all flu seasons, but really pertains to any illness.

 

 

 

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Daily Dose

Treating an Upper Respiratory Infection

1:30 to read

With so much illness circulating right now (not all of which is flu) parents continue to ask what is the best way to treat their child’s cold and congestion?

 

Despite so many advances in medicine the treatment of viral respiratory illnesses has not changed that much over the years. But, we have become smarter and know that over the counter cough and cold medications are not recommended for children under the age of 6 or 7 years and may have side effects. Personally, I don’t recommend these products for older children or adolescents and don’t even take them when I get a cold.

 

The treatment of congestion and runny noses is symptomatic. You actually want your child’s nose to run and have them blow their noses once they are old enough to figure out how to “blow out rather than sniff in”. This keeps the upper airway and sinuses clear and also will help to prevent ear infections. Young children when congested, are more prone to ear infections for several reasons including the fact that their eustachian tubes don’t drain as well and that they cannot blow their noses which helps to keep the eustachian tube open and clear. It is a myth that green or yellow nasal discharge means you have a bacterial infection and need antibiotics. During most upper respiratory infections the color of the mucous will change from clear, to yellow/green, to cloudy before resolving….which usually takes a good 10-14 days. Green runny nose does not necessarily mean a trip to the pediatrician.

 

I like to have children of all ages take a steamy bath or shower to keep the nose running and then use a cool mist humidifier in their rooms at bedtime. I do not recommend running a humidifier continuously for weeks as this may promote mold growth, but use it while your child is ill.  I don’t recommend warm vaporizers either as they may cause burns in children. 

 

Nasal suctioning is also a good way to clear a baby or young child’s nose which will help them breathe more easily.  My patients parents LOVE the NoseFrida and many are “obsessed” about suctioning their child - even when they don’t have a cold.  I think our new grandson has a “NoseFrida” experience daily.  You really cannot “over suction” but if your child starts to dislike the nasal suctioning/bulb that you use and they cry constantly while suctioning their nose, especially children over 12-15 months of age, they will actually make more mucous and the whole suction experience may be counter productive. I also use a nasal saline like Little Remedies® Nose Drops or Spray, which helps to loosen and thin the mucous before I suction.  

 

I am also a big fan of Vicks or Mentholatum, which has been shown to relieve congestion. I remember my grandmother rubbing my chest and neck with Mentholatum and then putting a warm washcloth over it before I went to bed. It brings back memories of lots of “TLC” and also of feeling less congested before heading to bed. Many of my patient’s parents also like to put Vicks on their children’s feet and then put their socks on before bedtime.  

 

If your child’s nose is “stopped up” if may make it seem like they are having trouble breathing as it “sounds funny”. Look at their chest if you are concerned and make sure that they are not having any distress, with their ribs pulling in and out as they breathe or using their tummy muscles. Any labored breathing requires immediate evaluation!  In many situations all of those upper airway noises may go away after you suction their nose.  You should also watch your child’s overall color, they should be nice and pink and look comfortable despite all of the congestion in their nose. 

 

 

Daily Dose

Does the Color of Mucus Really Matter?

1.30 to read

It is that time of year and everyone seems to have a cold, including me!! I am actually “on” my second cold of the month, so I am feeling like a toddler who gets sick every two to three weeks.  

This is really a good time to talk about mucus. I wonder how many people will keep reading now? But I do get lots of questions and comments from parents who are worried about the color of their child’s mucus. Runny noses and mucus color are discussed as often as color of poop. And just like poop, the color of your nasal mucus is usually not terribly significant. 

If you happen to have a cold yourself, you probably notice that your nasal discharge changes throughout the day, that is unless you are a teenager, and they swear they never look at mucus or stool color!! I think we notice “green snotty noses” among children between the ages of six months and four years, when they typically don’t blow their noses and many times the mucus is either wiped off of their face or they wipe it themselves on their shirt sleeve, (which then leaves a telltale sign of the color of the mucus). Once a child can blow their nose and dispose of the Kleenex, the color of the mucus does not seem to be a hot topic of discussion.

So, what does color of mucus mean? When you have a cold, the nasal discharge associated with that viral infection typically begins as a clear discharge, that changes over several days into a thicker and more purulent (green) discharge. The color may be due to the white cells that are in the mucus that are producing antibodies to fight the cold. 

As a cold progresses the green mucus then changes back into a more clear discharge and eventually goes away, but that is usually after a seven to 10 day course. It is also common to see thicker “booggers” in the nose in the morning or after your child’s nap as the dry air they are breathing makes the mucus thicker and they are not wiping or blowing their noses so the mucus is thicker. Same for us, we also usually have thicker greener nasal discharge in the morning, while the “snot’ has been sitting overnight. The best way to clear out any color mucus is by using saline nasal irrigation. It works great for all ages. By clearing the nasal passages, it will prevent a secondary bacterial infection which and cause a sinus infection.   

Most doctors use length of time of nasal discharge as more indicative of an infection than color of mucus. Typically in a pediatric patient an antibiotic for a “presumed” sinus infection is not even considered until a child has had over 14 days of a “gunky” green nasal discharge. Remember too, that the nose can clear up and the cold can go away, only to be followed in another week or two by another cold. It is the season. With that being said I am off to blow my nose again and wash my hands! 

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

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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

Winter Clothes Season

1:30 to read

Winter weather has been marching across the country with new LOWS being posted in so many cities.  Not only do flu viruses prefer cold, less humid temperatures, but the cold weather often makes us stay indoors where we are also more likely to come into contact with other sick people.

 

But, cold weather doesn’t always mean you have to stay inside.  If the temperatures are not bitter cold, you can dress for the weather and still get outside. The AAP just released tips for dressing your child in cold weather. Winter activities are often a great way to enjoy snow and cold temperatures and also encourage some exercise (and less screen time). 

 

When dressing your child for outdoor activities use layers…as several thin layers keeps them dry and warm. There are so many new products to “wick” moisture and ensure warmth.  Children need to wear warm boots, gloves and always a hat. Keeping the head warm is so important as children lose a great deal of heat if their heads are not covered. I found this it for myself when we all started wearing helmets for skiing….so much warmer!

 

Parents often worry about taking an infant outside when it is cold, but some fresh air is also good for this age group. Remember to dress them in one more layer of clothing than and a adult would wear in the same conditions. It is funny to hear parents say to me “ it is too cold to take a walk with my baby”, but it is 40 degrees and sunny outside….we southerners don’t know cold weather! A cold sunny day is perfect time for a short, brisk walk and some fresh air. I would prefer my “babies” are dressed appropriately and out in the fresh air than being around crowds in malls where mothers like to walk.

 

One of my patients parents was concerned because her 2 year old son would wake up crying in the middle of the night, (at about the same time each night) and she was convinced that he had hypothermia as his temperature would be 97 degrees every time she took it. He was talking to her and wanted to go sleep in her bed. He had NOT been outside or exposed to extremely cold temperatures and was wearing pajamas in a heated house. I think he was probably having nightmares or awakenings not related to hypothermia which occurs when children are left playing outside in very cold weather without wearing proper clothing or when their clothes get wet. It does occur more quickly in children than adults.  A child with hypothermia may shiver and become lethargic or have slurred speech. Hypothermia is a medical emergency. Call 911 and while waiting take off any wet clothes and wrap the child in warm blankets if possible.

 

Frostbite may also occur on exposed areas when the skin and outer tissue layers become frozen. This typically occurs more often on the extremities like fingers, toes, ears and nose -(wear that hat). Children may complain that their fingers or toes feel numb or may burn. Make sure to immediately bring the child inside and warm the frostbitten parts in warm but NOT hot water - usually about 104 degrees F (like a hot tub).  You may  use warm washcloths for nose and ears.  After warming then cover with warm clothes or blankets and give the child something warm to drink. (this may be why they invented hot chocolate). The numbness should subside in a few minutes. If there is no improvement you should seek medical care.

Lastly, if putting infants and children in car seats it is preferable that they wear thin, snug layers rather than thick bulky coats…you may need to warm the car before putting your child in their carseat. A thick bulky jacket does not allow the carseat harness to fit tightly enough against your child’s chest. You may take off the jacket and put their arms thru it backwards on top of the harness or use a blanket over the carseat harness…but never under the child.  

Daily Dose

Strep Throat

1:30 to read

During the “sick season” 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.

 

 

 

 

 

 

 

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