Every child will have some illness during the first few years of life. There will be several occasions when your child doesn't "act right", and you will wonder whether or not he/she is getting sick. As you come to know him/her more and more, it will become easier to recognize the differences in behavior that mean he/she is sick or well. You will become the expert on your child.

We do not expect you to be an expert in the diagnosis of an illness. However, you will be an important asset to us by being able to give an early and accurate report of your impressions, and by being able to care for your child with our direction.

If problems or questions arise that cannot be solved with the help of this booklet, or with future printed material that you will receive, call the office between 9:00 a.m. and 4:00 p.m. Please limit routine questions to these times. If you have "caller ID", please disable anonymous call rejection (by dialing *87) when you request that a call be returned (whether during or after office hours). We have dedicated outgoing lines which cannot be unblocked, and we would like to avoid tying up our incoming lines. If your phone cannot be accessed from an anonymous line, your call cannot be returned. Questions concerning well child care and minor illness are best handled during routine office hours when your child can be readily seen if necessary, and your child's records are available. Please use after hours only for emergencies or urgent matters that cannot wait until regular office hours.

Most calls to the office will involve your concerns with your child's health: his/her eating, sleeping, crying, or symptoms of illness such as fever, cough, irritability, or rashes. When calling about your child, please try to be prepared to answer the following questions:

* What is your primary concern?

* When did he/she start to get ill?

* What were the first symptoms?

* What symptoms have developed since the illness began?

* What has been done for him/her?

* What medicines is he/she taking?

* Telephone number of Pharmacy if needed

Please have a pencil and paper available with which to write out instructions. When you call, if you know that you want your child examined, please tell the receptionist immediately. This will allow us to make the necessary arrangements to see your child promptly.

Back to Top

---

 COLDS IN INFANTS

An infant with a stuffy nose can be a difficult problem. Unlike his/her older brothers and sisters, an infant does not know how to breathe through his/her mouth. He/she must breathe through his/her nose no matter how "stuffy". Most "stuffy noses" and "colds" are caused by viruses -- small germs that are not killed by antibiotics. Viruses are passed from person to person by kissing, sneezing, breathing into another's face, or most importantly, by failure to wash hands. Certain things will make a person more likely to develop a cold such as hayfever, fatigue, air pollution (cigarette exposure), or anything that causes irritation to the lining of the nose. Some feel that vitamin C will prevent a cold. Vitamin C does not prevent a cold, but it may be helpful in alleviating symptoms of a cold, at least in adults. A small supplement of Vitamin C will not be harmful to your infant or child but is not necessary.

When your baby begins to develop a cold, he/she will be fussy and irritable. He/she may run a fever during the early stages. Usually, the runny nose or stuffy nose will start shortly afterwards. Occasionally, there will be a cough. Seldom will the fever last over 48 hours or will it be high. His/her appetite for solid foods will usually decrease more sharply than for the bottle or other liquids. The symptoms of the cold may last seven to ten days with occasional continued runny nose for two to three weeks. The other symptoms usually go away within a few days.

The color of the mucus does not indicate a more serious form of cold. Most colds start with a clear discharge that turns gray, yellow, or green. Occasionally, a small amount of bloody discharge will be seen representing irritation of vessels near the surface. Do not be overly concerned. Using a vaporizer and a small application of vaseline or antibacterial ointment to the inside of the nose will relieve the irritation.

Unfortunately, there is nothing to "make the cold go away" or to "cure it". You can, however, make the child more comfortable by following these directions:

(1) Use acetaminophen (Tylenol or Tempra are brand names) for fever over 101°F rectally. This will help only the fever, not the cold. You may give acetaminophen or ibuprofen according to the instructions on fever (see Fever section).

(2) Vaporizers are helpful in keeping the mucus loose and "runny". The safest is the "cool air" vaporizer (produces a cool, visible mist), and it should be used next to the crib, pointing directly at the child from three or four feet away (see Vaporizer section).

(3) A nasal bulb syringe, sometimes called an ear syringe, is useful in clearing the mucus by suction. When using a syringe, it should be placed firmly against the child's nostril and suction should be repeated three to six times repeatedly, yet gently, in each nostril.

(4) Elevate the head of the bed, or put your baby to sleep in the infant seat. This promotes drainage.

(5) Saline nose drops may be useful for short-term treatment. Ayr, NaSal, Ocean, and other infant saline nasal drops may be obtained at the drug store. Use 2-3 drops in each nostril every 2-4 hours as needed for congestion and to promote drainage, followed by suction. Do not use the nose drops just because the baby "sounds stuffy" or is making a lot of noise with breathing.

(6) Continue to offer a regular diet even though the appetite is decreased.

(7) Cold medications are discouraged due to the potential for side effects. Do not use without specific instructions on dosage based on weight. Refer to the section on cold medications on this website or call.

(8) For children over 12 months of age, Children's cold medication may be helpful. Again, these are controversial with limited effectiveness. Dosage is based on weight, not age. Refer to section on cold medications on this website.

Arrange an appointment in the office if:

(1) Fever lasts more than 48 hours (if 48 hours are up in the evening, please call earlier -- always try to call during office hours).

(2) Fever develops after the cold has been established for several days.

(3) He/she seems to be in pain.

(4) You hear a "wheezing" or "crackling" cough.

(5) He/she has chest pain, or is breathing rapidly and deeply as if he/she has been running or exercising vigorously.

(6) He/she seems "sicker" than we have described. Ear infections are a common complication of colds in many infants and young children. Fever, extreme fussiness, poor sleep, mattering of the eyes, or pulling the ears may be a sign of ear infection. Children with these symptoms should be examined.

Back to Top

---

FEVER

FEVER is an important defense against infection and disease. Contrary to popular belief, it is not dangerous. A "high" fever does not necessarily mean a serious infection, nor does a "low" fever insure that a serious infection is not present. When your child is ill with fever, direct your efforts at determining the cause of the fever, not at heroic measures to bring it down. Fever causes discomfort, requires a great deal of the child's energy, and occasionally indicates an illness requiring medical attention. This section will discuss what you should do, when you should call and safe measures to make your child comfortable.

PRESENCE OF FEVER is sometimes difficult to define. In children, temperatures vary rapidly and widely, even in health. The "normal" temperature is influenced by activity, eating, emotion, and environment. Body temperature is normally higher in the evening than in the early morning. Following afternoon play activity, a child's temperature would be expected to be over 100°F.

MEASURING A FEVER has become more complex with increasing technology. However, the older methods are still quite accurate. We recommend a rectal temperature in children under the age of two, using a simple digital rectal thermometer. An oral or otic temperature may be measured in older children. Ear (otic) thermometers are quite inaccurate, especially under age 2 years and are not recommended under age 2. Forehead or temple scanning thermometers seem to be reasonably accurate. Under the arm (axillary) temperatures are inaccurate and not usually recommended at any age. Once you know your child has a fever, repeated measurements are usually unnecessary, as treatment will be dictated by the appearance of the child, not the actual temperature. Fevers between 101°F and 106°F are treated the same, so the exact number is typically meaningless. It is also not necessary to "add a degree", or any amount for that matter, to a measured temperature - simply let us know what temperature was measured and where.

SYMPTOMS OF FEVER include loss of appetite, fatigue and irritability. Headache, other aches and pains, and nausea are also common. Chills occur as a means of elevating temperature, and delirium may occur with fevers above 104°F. Breathing rate and heart rate will be elevated with fever. Sleeping habits are altered with some children sleeping more and others sleeping fitfully and for shorter periods of time than usual.

THE DANGERS OF FEVER are much exaggerated. Children are able to tolerate temperatures of 104°F and above with much greater ease than an adult. Fever alone will not damage a child's brain. Even convulsions with fever, which occur in 3% of all children regardless of measures taken to control fever, are relatively harmless, especially if of short duration as they usually are. More children are harmed by excessive measure to control fever than are harmed by fever itself. Temperature approaching 107°F, especially in an adolescent, may be a sign of heat stroke and those children should be seen in the Emergency Room immediately.

WHAT TO DO FOR FEVER: For the child who does not act ill and who has a temperature below 102°F, no treatment is necessary. For children who are acting ill with a temperature above 101°F, dress lightly (DO NOT bundle up or try to "sweat it out"). Follow the instructions in the table for use of medications. Offer cool liquids. Although rarely necessary, a bath in tepid or lukewarm water will usually help bring a temperature down, or using lukewarm water for sponging the face and neck. Do not use alcohol for sponging - this causes shivering which will then increase the temperature.

POINTS TO REMEMBER:

1) Fever is not harmful. It is the body's means of combating infection.

2) The height of fever alone is not an indication of the severity of illness.

3) Judge the severity of illness by all the signs and symptoms, not the fever alone.

4) Fever in an infant under four months of age (even with no other symptoms) and fever of 105°F or greater in a child under 2 years of age may indicate potentially serious disease and warrants an immediate call.

FINALLY, children frequently will have fever during the first two to three days of a cold, and may be "watched" at home without any specific treatment. However, if symptoms such as a sore throat, ear ache, severe headache, or stiff neck develop, then the child should be evaluated. If fever persists over three days without an adequate explanation for its presence, call for an appointment. If your infant is under four months, or "acts sick" with fever (refusal to eat or drink, weak cry, pain on movement, etc.) call immediately. If you are unsure, call!

Back to Top

---

Cough and Cold Medications

There are many different cold and allergy medications available without prescription. It can be quite confusing to choose which (if any) to buy when your child is ill. In general, infants under 6 months should not take any medications other than acetaminophen (Tylenol™). There are no studies showing a benefit to using cold or cough medication under 6 years of age, and therefore we discourage them. These medications can have side effects if dosed incorrectly. Many infant cold remedies have appropriately been removed from the market due to the potential for side effects if used incorrectly. In certain instances, we may still recommend a cough or cold medication. It is important to follow any directions regarding dosing that are on the package. If the package does not list a dose for your child's age or weight, refer to the chart below, or call us for directions. Also, check the ingredients, since many combinations may already contain a fever reducer, or products designed for adults may contain alcohol or aspirin, which should never be given to children. If you are unsure, do not give the medication. Please call us during regular office hours for proper instructions. Cold medications may contain some or all of the following ingredients:

Antihistamines (brompheniramine, chlorpheniramine, pyrilamine, diphenhydramine) are supposed to dry a runny nose. They are more effective for allergies than colds. They may cause drowsiness, dry mouth, or a "stuffy" feeling.

Decongestants (pseudoephedrine, ephedrine) are designed to relieve nasal or sinus congestion. They can cause a rapid heart rate, jitteriness, sleeplessness, or cause your child to be temporarily hyperactive.

Cough Suppressant (dextromethorphan) is designed to suppress coughing. Cough is the body's protective reflex and should only be suppressed if cough is interfering with sleep. Avoid this during the day.

Mucous Thinner (guaifenesin) is supposed to thin secretions to help nasal drainage or make a cough more productive. Plenty of fluids and moist air are probably more effective.

Nasal spray decongestants such as Afrin, NeoSynephrine, Sinex, etc., may be used sparingly for nasal congestion in children over age 2. They can cause a stinging sensation and should not be used more than 3 days in a row since they are irritating and may cause "rebound" congestion when stopped. Salt water or saline drops are also helpful, have no side effects, and may be used in infants. There are several brands available, or you can make your own with 1 teaspoon salt in 1 cup water. Instill 2-3 drops in each side of your child's nose and then remove the loosened mucous with a bulb syringe.

Dosages of cold medications are generally the same as Tylenol™ (based on the child's weight). If you are unsure of the dosage, less is better. The chart below is a general guide only. Please call the office if you have questions about the dosage of a specific medication.

Dosages listed are the acceptable maximum dosages; less may be just as effective with fewer potential side effects. Children over 90 lbs may take 1 tablet of most adult cold remedies. Medication may be given every 6-8 hours as needed.

OTITIS MEDIA means inflammation of the middle ear. It occurs as a result of an infection in the middle ear, and may occur in one or both ears. Otitis media is very common in young children, rare in adults, and is seen most frequently from late October through early May. Otitis media is not serious if treated promptly and effectively. However, if not treated properly, it can cause immediate problems of infection (even involving the coverings of the brain itself) and the long term problems of hearing loss and impaired speech. Thus, it is important to learn to recognize the symptoms of otitis media in your child, to get medical attention promptly, and to continue with treatment until the problem has resolved completely.

THE CAUSES of otitis media are surprisingly difficult to pinpoint. We know that abnormal functioning of the eustachian tube is involved. This tube is the narrow passageway which leads from the middle ear to the back of the throat. Its purpose is to equalize the air pressure between the middle ear and the air outside of the body. With a "cold" (upper respiratory infection, URI), or allergic reaction (hayfever, allergic rhinitis), or chronically swollen lymphoid tissue in a portion of the throat, the opening of the eustachian tube may become blocked. This results in fluid accumulating within the middle ear which may become infected and produce pus, pressure, and severe pain.

Part of the abnormal function may be an insufficient antibody response locally (secretory antibodies). There is good evidence that otitis media "runs in families" and that heredity plays some role. Parental cigarette smoking (or anything that chronically irritates the air passages) also increases the frequency of otitis media, as does bottle feeding in the child who is laying flat instead of sitting up. However, the most significant "culprit" is the common "cold" and anything that can be done to reduce the exposure of a child with recurrent ear infections to "colds" in others will reduce the number of bouts of otitis media.

SYMPTOMS of otitis media consist of a feeling of pressure or blockage in the ear, and ear pain. Children may, or may not, pull at their ear. Fever (to 105°F), nausea, vomiting, and diarrhea are frequently seen as well. Hearing is muffled, and may be a symptom of persistent fluid in the middle ear after the pain of infection has resolved. This fluid prevents the normal movement of the ear drum (the tympanum) and both muffles and distorts the sounds heard. Properly treated, this hearing loss is temporary, though with inadequate follow-up, may become permanent.

PROPER MEDICATIONS ARE ESSENTIAL to the treatment of otitis media. These medications will most likely include an antibiotic to help eliminate the infection, and may include a decongestant depending on the type of otitis media present. The symptoms of otitis frequently disappear very rapidly. However, the infection itself will need a substantial time to clear up. Therefore, be sure your child takes the prescribed medications as directed for the FULL TIME indicated. This is typically 10 days, but may be longer.

Ear pain may be relieved by acetaminophen (Tempra, Tylenol, Panadol, etc.), or ibuprofen (Advil, Motrin, etc.) as directed for temperature control. In addition, warmth may be applied with a heating pad or hot water bottle (BE CAREFUL NOT TO CAUSE BURNS. DO NOT LET YOUR CHILD SLEEP ON A HEATING PAD). A solution of water and salt is always available and very effective (it works by "pulling" fluid from the middle ear and relieving the pressure). This salt water solution is made according to the following instructions:

To two ounces of lukewarm water add one heaping Tablespoon of salt. Mix well and allow the nondissolved salt to settle to the bottom. Using a dropper, remove some of the salt-water from near the surface and place it in the ear canal. Allow this salt water to remain in the ear canal for several minutes. This may be repeated every 10 to 20 minutes until pain is relieved.

A NOTE ABOUT ANTIBIOTICS. The antibiotic chosen for your child is determined by recent antibiotic use in your child, characteristics of the infection, allergies or prior medication reactions, and (all else equal) cost. An antibiotic that has "not worked" in the past may control the current infection very well. Whether or not an antibiotic works is determined by the bacteria causing the infection, not by the patient.

Activity and care at home should be determined by the child. Allow opportunity for rest. Forcing a child to rest is not necessary (and is nearly impossible). Elevating the head of the bed when your child is sleeping will relieve pressure and reduce pain.

Additional treatment is sometimes necessary for otitis media. Most episodes will clear with antibiotics (and occasionally decongestants). However, occasionally, the surgical placement of ventilation tubes (commonly referred to as P.E. tubes) is necessary. This is usually recommended for the child with chronic accumulation of fluid in the middle ear, or the child who gets recurrent ear infections without "clearing" between episodes. Rarely, chronic antibiotics (referred to as prophylactic antibiotics) are prescribed prior to placement of P.E. tubes.

Back to Top  

---

ANTIBIOTICS AND YOUR CHILD

Unnecessary Antibiotics CAN be Harmful!

Antibiotics are among the most powerful and important medicines known. When used properly they can save lives, but used improperly, they can actually harm your child. Antibiotics should never be used to treat viral infections.

Two main types of germs -bacteria and viruses- cause most infections. In fact, viruses cause most coughs and sore throats and all colds. Bacterial infections can be cured by antibiotics, but common viral infections never are. Your child recovers when the illness has run its course.

New strains of bacteria have become resistant to antibiotics. These bacteria are not killed by the antibiotic. Some of these resistant bacteria can be treated with more powerful medicines, which may need to be given by vein (IV) in the hospital, and a few are already untreatable. The more antibiotics prescribed, the higher the chance that your child will be infected with resistant bacteria.

Each time we take antibiotics, sensitive bacteria are killed, but resistant ones may be left to grow and multiply. Repeated use and improper use of antibiotics are some of the main causes of the increase in resistant bacteria. These resistant bacteria can also be spread to others in the family and community.

When are antibiotics needed, and when are they not needed? This complicated question is best answered by your doctor, and the answer depends on the specific diagnosis. Here are a few examples:

Ear infections: There are several types, most need antibiotics, but some do not.

Sinus infection: Most children with thick or green mucus do not have sinus infections. Antibiotics are needed for some long lasting or severe cases.

Cough or bronchitis: Children rarely develop bronchitis, and nearly all cases are viral.

Sore throat: Most cases are caused by viruses. Only one main kind, "strep throat," requires antibiotics. This kind must be diagnosed by a laboratory test.

Colds: Colds are caused by viruses and may sometimes last for 2 weeks or more. Antibiotics have no effect on colds, but your doctor may have suggestions for comfort measures while the illness runs its course.

Viral infections may sometimes lead to bacterial infections. But treating the viral infections with antibiotics to prevent bacterial infections does not work, and may lead to infection with resistant bacteria. Keep your doctor informed if the illness gets worse or lasts a long time, so that proper treatment can be given, as needed.

(From American Academy of Pediatrics, Centers for Disease Control and Prevention, and American Society for Microbiology, 1997)

Back to Top

---

 CHICKENPOX (Varicella)

Chickenpox is a common childhood disease nearly all of us had as children. The incubation period is approximately two to three weeks from the time of exposure. The illness consists of many small, itching blisters that quickly scab over. Chickenpox usually begins with scattered red spots that have tiny "water blisters" in the center. They spread rapidly over the next several days. There may or may not be fever. Chickenpox usually lasts one to two weeks and is contagious for the first six days or until all of the "pox" have dried scabs. Most children are out of school for a week and their skin lesions have pretty well cleared within one month. Occasionally, one or two pox will leave a scar.

Treatment consists of acetaminophen or ibuprofen for fever and discomfort, and measures to control itching such as Calamine lotion applied as often as necessary, antihistamines such as Benadryl which is available without a prescription, and corn starch or oatmeal (Aveeno) baths.

The Chickenpox vaccine, Varivax, arrived in 1995, after over 30 years of development and testing. It is 88 percent effective in preventing Chickenpox after the first vaccine dose, and 99 perecent effective after the second dose. A small number of vaccinated children will still get Chickenpox if exposed to the "wild" virus, but their illness will be milder than if they had not received the vaccine. The vaccine is recommended for all susceptible children over 12 months of age by the American Academy of Pediatrics and the Advisory Committee on Immunizations Practices of the Center for Disease Control. The vaccine consists of a modified, weakened Chickenpox virus which will multiply and stimulate the immune system. Occasionally, if a Chickenpox like rash develops, there can be transmission of the vaccine virus to susceptible individuals who are in close contact with the vaccinated child.

Back to Top

---

CONJUNCTIVITIS (Pink Eye)

Conjunctivitis (pink eye) is an inflammation or infection of the inside of the eyelid and the "white" of the eye. Watery, itchy eyes may be due to allergy, especially in the spring or fall. Mattering of the eyes usually means infection, and if severe or persistent, the child should be seen. Home treatment consists of keeping the eyes clean with warm water. Warm, moist compresses followed by gentle massaging of the junction of the eye with the nose is often helpful, and you may obtain boric acid eye wash from your pharmacy to "wash out" the eyes (follow directions on the label). Sterile saline may also be used to rinse out the eyes. Many children will have concurrent ear infection with conjunctivitis, and an in office evaluation is necessary for children with pink eye.

Back to Top

---

COUGH

Concerns regarding cough account for more calls to the office than any other single symptom in childhood. It is one of the most common signs of illness in children and may be dry, wet, hacking, barking, tight, wheezing, or just plain irritating.

To some degree, cough accompanies most colds in infants and children. Usually these coughs occur when the child is lying down during the night and are often heard in the afternoon and evening. Cough with colds cause the parents more distress than the child in most instances. Coughs that don't seem to bother the child generally are harmless, especially if of short duration (less than one and half to two weeks).

A "chest cough" is described as a loose, wet, mucus producing cough that seems to come from deep within the chest (frequently a “rattle” is felt) and is usually associated with nasal congestion and runny nose. It is best treated with a medication to relieve the post nasal drainage, such as Pediacare, Dimetapp, Triaminic, or other cough and cold remedies. Refer to the section on cold medications. A chest cough is a cause for concern only when accompanied by a wheeze, breathing difficulty, shortness of breath, chest pain, or prolonged fever.

For the dry, hacking cough (it sounds as if it is in the back of the throat and it’s most annoying feature is it’s persistence), a vaporizer to provide humidity and a cough suppressant such as Robitussin DM or Delsym are best. All of these preparations can be obtained without a prescription, and the directions for their use are on the bottle. This type of cough almost never indicates a serious problem. Refer to the cold medication section for precautions with these medications.

A wheezing or crackling cough is the one heard least often and the one that usually suggests difficulty in the chest such as pneumonia, asthma, or bronchitis. It is accompanied by wheezing during expiration, and/or a crackling sound during inspiration. If such a cough develops, the child should be seen in the office for evaluation.

A cough that is present at night and silent during the day frequently indicates an allergic sensitivity. It can be a stuffed animal, pillow, blanket, or mattress. If your child has a persistent night cough with very little coughing during the day, try putting him to sleep in the living room with a different pillow, different blanket, and no stuffed animals. If you notice improvement, it is simply a matter of finding out what in his room is causing the cough. (Carpets are a frequent cause of sensitivity in children.)

Children, especially young children, will sometimes cough extremely hard, hard enough and long enough to gag and vomit. The frequency with which this occurs varies from child to child. It results from an easily stimulated gag reflex and is not harmful. It does not indicate the severity of the illness that underlies the cough.

All coughs will show some improvement with fluids. Fluids loosen the mucus and makes the cough more productive and thereby, more beneficial. Small infants and children are helped by elevating the head of the bed at night, permitting better drainage. Most children with cough do not need to be seen by the pediatrician. In most instances cough is a normal accompaniment to a cold and can best be handled with simple home remedies, and patience. However, if the cough is associated with fever for more than 48 hours, if it is accompanied by a wheezing or crackling sound, if the child is able to cough up mucus plugs, or appears ill in any other respect, than he/she should be seen for evaluation.

The child who has a cough for three to four weeks without other symptoms should also be evaluated. Judge the severity of the problem by all of the symptoms (fever, appetite, level of activity, etc.), not just by cough alone.

Back to Top

---

CROUP

Croup is a viral infection which affects the area around the vocal cords. This causes a barky cough which is very distinctive and sounds much like the barking of a seal. Croup usually begins in the middle of the night with the child waking up with the barking cough and difficult breathing. They often make a harsh raspy noise when inhaling, called stridor. There is often a fever.

Treatment consists of adding moisture to the air with a vaporizer or humidifier, or steaming the child for ten to fifteen minutes by sitting in the bathroom with the door closed and the hot shower running with the fan off. This usually will relieve some of the distress and allow the child to go back to sleep. If he/she continues with breathing difficulty, dry him/her and dress warmly, and go outside into the cool/cold night air. This will provide dramatic relief most of the time. If there is no relief within 15 to 20 minutes of the steamy bathroom or outdoor air treatment, immediate evaluation is indicated and he/she should be taken to the Emergency Room.

Children with croup usually improve during the day and get worse again at night for two to three nights. Most cold and cough remedies are useless with croup. Ibuprofen seems to help more than acetaminophen with croup, most likely because of it's anti-inflammatory activity. Some children with croup are treated with stronger anti-inflammatory medication (steroids). A decision as to whether this is necessary for your child can only be made after evaluation in the office.

If a child has difficulty breathing, if he/she is drooling profusely, or if you are concerned with the rapid progression of the illness, we should be notified immediately.

Back to Top

---

BRONCHIOLITIS (RSV)

Bronchiolitis is an illness seen mostly in infants that affects the small breathing tubes (bronchioles) of the lungs. Bronchiolitis can be caused by several different viruses, but Respiratory Syncytial Virus (RSV) is the most common. Bronchiolitis is a seasonal illness, seen mostly from December through March each year.

RSV is spread by direct contact with an infected person's mucous or saliva, especially by coughing or sneezing, or from virus that has contaminated toys, table tops, drinking fountains, etc. The virus can persist for several hours on such objects. The incubation period is 2 to 8 days.

Bronchiolitis typically starts with cold symptoms such as cough, fever, runny nose, and nasal congestion. After one to two days the infection spreads into the lungs and the cough worsens. The virus causes the lining of the small airways in the lungs to swell with congestion, which decreases the flow of air through the lungs and makes it hard to breathe.

The severity of Bronchiolitis varies greatly. Some infants get simply a cold, just like the older children. Others develop significant wheezing and may need to be hospitalized. Symptoms of more severe bronchiolitis include rapid breathing, labored breathing (including flaring nostrils and retractions between the ribs), panting or grunting noises, wheezing (a tight whistling type sound when breathing), severe cough, vomiting, and refusing to eat. If your child has any of these symptoms, he or she needs to be evaluated as soon as possible. Please call our office for instructions. Some children require medications to help their breathing.

The majority of patients with RSV, or bronchiolitis, do not need medications or hospitalization, but simply patience and diligent care at home until the infection resolves. Antibiotics are never helpful for bronchiolitis due to it's viral cause (though sometimes they are necessary for accompanying infections such as ear infection). Home treatment consists mainly of using a cool mist vaporizer, suctioning the nose as needed, saline nasal drops, and elevating the head of your child's bed. Sometimes having infants sleep in a more upright position reduces the nasal congestion and they will sleep better. Cough and cold remedies are rarely useful. Tylenol™ may be useful if there is fever involved.

Contagion varies with the length of illness. Infants may return to daycare once they have no fever, feed normally, and are acting well. A lingering cough and nasal congestion may last as long as 3 to 4 weeks. Careful hand washing is the best way to protect your infant from RSV. Whenever possible, avoid close contact with children or adults that have cold symptoms.

Back to Top

---

INFLUENZA

Influenza is a common seasonal viral infection which typically occurs in outbreaks from December through February. There are several different strains of the Influenza Virus, however the symptoms are largely indistinguishable between the different strains.

Influenza is a respiratory illness whose symptoms include a loud harsh cough, headache, runny nose, high fever, sore throat, and generalized aches and soreness, especially of the muscles in the back. Weakness or fatigue as well as diminished appetite are also common. Occasionally vomiting and diarrhea can accompany this illness. The illness typically lasts 6 to 7 days, but can last as long as 10 to 14 days.

Influenza is highly contagious and can be spread on the hands, by coughing and sneezing, or on contaminated objects. The incubation period is typically 1 to 3 days.

Treatment is primarily supportive. Good hydration is essential. Cough and cold medications may be tried but they are generally of little use with this virus. Tylenol (acetaminophen) or Ibuprofen may be used for fever control. Ibuprofen is typically more helpful in controlling the muscle aches. Avoid Aspirin. Antibiotics are useless against viral illnesses such as Influenza, but may be necessary if there is a secondary infection such as an ear infection. A humidifier is useful in the bedroom. Recent anti-viral medications have been approved to limit contagion and lessen symptoms, however these medications are not approved in children less than age 6, and the average improvement shortens the illness by only 1 to 2 days.

If a child has difficulty breathing, appears dehydrated (little or no tears, dry mouth, infrequent urination), develops a stiff neck, or if you are concerned with the rapid progression of the illness, he/she should be evaluated in the office as soon as possible.

Influenza vaccine is available yearly for the prevention of this illness.  The vaccine is 90% effective. The vaccine is strongly recommended for any child with a chronic medical condition such as Asthma, Diabetes, or a Heart or Kidney disorder. The vaccine is available to any other child whose parent desires to protect him/her from this illness. The vaccine is available beginning in October of each year and it is recommended that it be administered between October 1st and December 15th. Side effects are infrequent and minimal, consisting of local soreness at the injection site and low grade fever. The vaccine may be administered to any child older than 6 months of age. For children under age 9 that are receiving the vaccine for the first time, 2 doses given 1 month apart are recommended for optimal immune system response. Parents and siblings of small infants should receive an influenza vaccine.

A preservative free Influenza vaccine is available for children under age three years at an additional cost.  For some children, an intranasal influenza vaccine (Flu  Mist) may also be available at an additional cost.

The Influenza Vaccine is available in our office without an appointment, however, please try and utilize the least busy times of day (early morning or during or just after lunch). There is less wait when our “flu clinic” appointment slots are utilized.

Back to Top

---

CONSTIPATION

Normal, healthy infants do not need to have a bowel movement every day. Infants may go up to a week without a bowel movement, though some breast-fed infants will have five to ten seedy (not watery) bowel movements each day. There is very wide variation between children. As long as the stool that is passed is soft, the baby is not constipated regardless of the frequency. Constipation means painful bowel movements that are difficult to pass and noted to be small and hard, or ball-like, in appearance. Remember, some grunting, groaning, and fussing with bowel movements are normal and do not necessarily mean constipation.

If your child has difficulty with painful bowel movements or large, hard bowel movements, the problem usually is the diet. Baby foods generally tend to be constipating because there is little non-digestible residue. Of the baby foods, cereals, squash, carrots, and meat tend to be the most constipating. Foods that contain non-digestible material such as the vegetables (except for the carrots and squash), and foods that contain bowel stimulants such as fruits (especially prunes), tend to increase the frequency of bowel movements. Introduction of whole milk often is associated with less frequent, firmer stools.

For treating constipation in infants, do the following:

1) Increase fluid intake by adding additional water in between feedings.

2) Offer two to four ounces each day of regular prune juice diluted 1:1 with water (full strength if the he/she is over nine months). Gerber also makes an apple/prune juice combination.

3) If the above are not successful, add one teaspoon of Maltsupex powder to each feeding until the constipation is relieved. Then slowly wean the child off the Maltsupex. No laxatives or enemas should be used without consultation. Maltsupex powder is available at most pharmacies without a prescription.

For treating constipation in older children, do the following:

1) Increase fluid intake.

2) Give natural laxatives such as fruits, prunes, prune juice, fruit juices, bran flakes, etc.

3) Increase fiber in the diet (salads, bran & oat cereals, vegetables). If necessary, a fiber supplement such as benefiber may be added.

4) Diminish dairy product intake.

Some common causes of constipation are too much milk in the diet, or not enough bulk such as wheat products, fruit, and vegetables. Frequently, a change in diet alone will improve the situation. If your child does have a constipation problem that does not respond to alteration of diet, we recommend Benefiber. Instructions for use are found on the package. Maltsupex may also be used; it is a malt extract from barley which is quite safe to use for prolonged periods of time. It can be taken in any number of ways. When mixed with milk, both powder and liquid help make malted milk drinks (especially if a little vanilla or chocolate is added). The powder mixes easily with beverages (flavored beverages are more acceptable than water alone). The powder can also be sprinkled over cereals or dusted on ice cream to make a sundae. Do not use laxatives (i.e. Castoria) that stimulate the bowel. Do not use enemas.

If your child continues to have difficulty with constipation even with the use of Benefiber or Maltsupex and the avoidance of the constipating foods in the diet, please make an appointment for an evaluation.

Back to Top

---

VOMITING AND DIARRHEA

VOMITING: You can be sure that your child is going to throw up once in awhile. Usually illness is the cause, but almost anything can result in vomiting. Fear, anxiety, nervousness, over-excitement, anger, emotional upset, a fall, a blow on the head, or injury to the abdomen, all can result in vomiting. Sometimes it is simply a matter of eating too much of a good thing.

Infants often spit up a small amount when being burped, and some children will spit up following every feeding. This is normal and requires no treatment if he/she is growing and gaining weight properly. Occasionally a small infant will hiccup and will appear to vomit quite a bit. The vomiting may even appear to be "projectile". This can happen from overeating or from being handled excessively. If should cause no concern if it occurs only occasionally.

Severe or recurrent vomiting causes a loss of fluids. Adding more fluids to the stomach initially will only make the problem worse. Wait for the vomiting to settle for three to four hours and then begin with very small sips of clear fluids. Sips consist of one-half ounce at a time, given as often as every 30 to 40 minutes. Clear fluids are those fluids that you can see through such as Pedialyte (the best choice), water, diluted Gatorade, diluted Kool-Aid (a poor but adequate choice), or non-cola carbonated drinks that have "gone flat" (7-Up). The idea is to replace liquids that have been lost, but you must proceed slowly. If the drinking brings on more vomiting, stop. Wait for one to one and a half hours and then try again. Continue with clear fluids until he/she has been free of vomiting for 12 to 18 hours and then gradually start small amounts of solids (avoiding fatty foods and milk). After 24 hours free of vomiting, your child's appetite is usually your best guide to the amount of food to give.

When your child begins vomiting, check for other signs or symptoms of illness. Does he/she have a fever? Is the vomiting persistent? Is he/she passing urine normally? Are there stomach pains or stomach cramps? Does he/she have diarrhea as well? Does he/she "appear" sick? Most vomiting is caused by minor "food poisoning" and lasts for 12 to 24 hours. Vomiting associated with illness is frequently caused by a virus and generally lasts 24 to 48 hours. If you are concerned that the illness is prolonged, or if other symptoms are present that cause you concern, arrange to have him/her evaluated.

DIARRHEA: It is surprisingly difficult to define diarrhea. Stools that may be described as "loose" by one parent may be "severe diarrhea" to another or "normal" to yet another. In an infant, stools are normally loose "cottage cheese" to "Karo syrup with lumps" and may vary in number from one every three or four days to six or seven stools per day (especially in breast-fed babies). Usually, stools in older infants are pasty to firm and are passed up to three times per day. During periods of teething, stools may loosen and become runny because of the excess saliva swallowed at that time. Such stools need no treatment or diet change. They are nothing more than a nuisance and will not interfere with the child's health or growth.

Diarrhea is defined as frequent (more than five per day) loose or watery stools that are usually passed with a great deal of gas ("explosively"). There may or may not be cramps. Often there will be some vomiting. Children with true diarrhea (not just loose stools) generally act as if they do not feel well. They act sick.

Just as a child cannot run when he has a sprained ankle, he cannot digest properly when he has diarrhea. The most important part of treatment is to put the bowel at rest by giving as little food as possible yet providing simple sugars, simple starches, salts, and fluids. When your child starts to get diarrhea, begin the following diet:

Day 1: Stop all milk, formula, and solid foods. Offer clear liquids such as Pedialyte (best), 1/2 strength Gatorade or similar sports drink, diluted Kool-Aid (a poor choice), water, and flat 7-Up.

Day 2: No cow's milk or solid foods except infant cereal (with water), and dry toast or crackers (for older infants and children). In Addition, continue clear liquids as on Day 1 and add soy formula such as Isomil, or a soy formula designed specifically to help diarrhea, Isomil DF.

Day 3: If vomiting and diarrhea are not under control, continue with the treatment of Day 2 and call the office. If improving, start vegetables and lean meats. Avoid cow's milk, fruits, and fruit juice.

Day 4: For older children, return to a regular diet even if stools are a little looser than normal.

Day 5: Full strength regular (pre-illness) formula for infants as well as a normal diet for the child's age.

MEDICATIONS: Kaopectate is useful with loose stools, but of no value in true diarrhea with watery stools. For loose stools, give Kaopectate two teaspoons per year of age after each loose stool up to four to six times daily. For watery stools do not use Kaopectate. Treat the child by diet as above. Opiates such a Paregoric, Lomotil, Donnagel-PG, Parepectolin, Immodium AD work by decreasing the movement of the bowel and slowing the muscle contractions that move the stool through the bowel. They may be dangerous in childhood (since they slow down the process of elimination of toxic wastes) and are NOT recommended.

Problems such as diaper rash or a "burned bottom" are best prevented with a heavy application of vaseline, Desitin, or A&D ointment in addition to keeping the diaper area clean and dry. On many occasions, keeping the buttocks exposed to the air is the best treatment.

Back to Top

---

SORE THROAT

A "sore throat" is one of the more common complaints of children. It can arise from such things as nasal congestion with a post-nasal drip, viral infections of the throat or tonsils, or a bacterial infection of the throat or tonsils (a "Strep throat"). The cause of a sore throat cannot accurately be determined without the use of a throat culture. Because of this, we recommend that when your child does complain of a sore throat lasting more than a day, or is associated with fever, headache, stomachache, vomiting, etc., he/she should be brought in for an examination and culture of his/her throat.

Of all the causes of sore throat, Streptococcus ("Strep") is felt to be the most serious. The symptoms of Strep throat are really no different from that of viral sore throat, but the complications can be much more severe. Untreated, Strep throat can cause Rheumatic Fever, or a form of kidney disease (Acute Glomerulonephritis). The primary reason for giving antibiotics (usually Penicillin) for ten days is to prevent these complications. Scarlet fever is simply Strep throat with a sandpaper like rash and resolves with proper treatment.

The symptoms of sore throat may be alleviated by a number of measures. Cool liquids or foods usually are soothing. If the child is old enough to gargle, a warm solution of one-half teaspoon salt per eight-ounce glass of water may be helpful. Throat sprays, such as Chloraseptic, may also be of value. For the child who is old enough, sucking on hard candy, "cough drops", or throat lozenges is beneficial. Aspirin, ibuprofen, or acetaminophen are helpful for fever and pain relief. They have no other action. Vaporizers or humidifiers provide some relief at night.

Back to Top

---

Hand, Foot, and Mouth Disease

Hand, Foot, and Mouth Disease (HFM) is a viral infection that is common in the toddler age group. There are actually numerous similar viruses that cause illnesses quite similar to HFM, and although the rashes may differ, they are all treated the same. HFM is the most common of these illnesses, and is caused by Coxsackie virus. It frequently occurs in outbreaks at daycares. Symptoms include numerous white sores inside the mouth, and a rash on the palms and soles, and often rash on the buttocks and legs. The rash does not itch, but the sores in the mouth can be painful and typically cause diminished eating. Fever is common.

Treatment is supportive only. A combination of liquid Benadryl and liquid Maalox in a 1:1 mixture can be used to dab onto the lips, gums, and cheeks for pain relief. Older children can swish this same mixture in the mouth and then spit. Good hydration is essential. Affected children are contagious for as long as symptoms are present (usually 5 to 7 days).

Back to Top

---

WORMS

Pinworms (thread worms) are very common in young children. Although there are other types of worms, pinworms are the most prevalent. Their presence does not imply a child is unclean.

Many people have no symptoms with pinworms. However, the usual history is one of rectal itching, especially at night, sleep disturbances, and in girls, vaginal itching and occasional pain on urination. The small white, thread-like worms may occasionally be noted in the stools, but more commonly are found by the parent at night around the anal area where the eggs are laid. Seeing pin worms may be alarming; however, it is not an urgent or emergency situation.

There is an over-the-counter medication for pinworms - Reese's Pinworm Medicine - which you may use if you are comfortable making the diagnosis of pinworms in your child. However, if you are unsure, please call for an appointment for an examination and lab tests during regular office hours. For discomfort, a warm bath (with or without baking soda) often relieves the itching.

Back to Top

---

POISONING

Over 5,000 children died last year from poisons. Two thousand of these children died from swallowing things in their home -- and most of the poisons were not in their original container! Over 90% of these home poisons occurred in children below five years of age.

For crawlers (six months to one year), most poisons (such as furniture polish, bleach, ammonia, etc.) are found in "low places" such as kitchen and bathroom cabinets at floor level and pantries. Toddlers (one to two years of age) have the highest accident rate. These children get medications from "safe, high places" such as medicine cabinets, shelves, and kitchen cabinets above counters. Safety proof your home!

TAKE 10 STEPS TO PREVENT POISONING!

LOCK UP MEDICINES: Keep all medicines and potentially dangerous household substances out of reach of children, in cabinets with child protection safety latches. Store medicines away from household products. Keep household products away from food.

USE ORIGINAL CONTAINERS: Keep medicines or household products in their properly labeled original containers. Original packaging is usually required to contain child safety precautions. Labels include information for poison control centers in case of an emergency. Never put dangerous products in containers from which people eat or drink.

USE CHILD RESISTANT PACKAGING: Credited with saving at least 700 children's lives since its introduction in 1970, child resistant packaging is still often used improperly. Be sure to replace caps securely. Adult friendly packaging now makes it easier for arthritic hands or frustrated adults to protect children without being inconvenienced themselves.

READ THE LABEL: Do not administer medicine in the dark. Do not trust your memory for dosage instructions. Use your eyeglasses or contacts to read the fine print.

DISPOSE OF OUTDATED MEDICINES: When you regularly clean out your medicine cabinets, flush medicines that are outdated. Do not throw medications into wastebaskets or trash containers.

KEEP UP WITH THE TIMES: Discard substances used for old fashioned treatments, such as: oil of wintergreen, ammoniated mercury, oil of turpentine, and camphorated oil.

DO NOT BE DISTRACTED: If the phone or doorbell rings while you are administering medicine or using a potentially poisonous product, secure the product you are using: Replace its cap, put in back in the cupboard, or take it or the child with you while dealing with the distraction.

PLAN AHEAD: Educate your children. Post the poison control center phone number with other emergency numbers by every phone. Keep ipecac syrup on hand (see below) so that if the poison control center advises you to administer it, you are prepared. Support your poison control center!

SET A GOOD EXAMPLE: Do not take medicines in front of children. Do not drink from containers, such as cough syrup bottles. Children love to imitate! Never refer to medicine as "candy." Children are likely to adopt these behaviors.

AWAY FROM HOME: Some 23 percent of poisonings involve prescriptions drugs belonging to someone the child does not live with, most often grandparents. Thirteen percent of all child poisonings occur in homes other that the child's.

Syrup of Ipecac is no longer recommended and should be discarded.

Always know, if possible, the following information before calling:

1) Item ingested; label ingredients.

2) Place ingested (such as in the kitchen).

3) Amount of ingestion.

4) Time of ingestion.

5) Symptoms present (vomiting, lethargy, etc.).

For any type of poisoning that you are concerned about, please call us for instructions. If you are unable to reach this office promptly, call the Poison Control Center (1-800-222-1222 or the local poison control number in your phone book). While you are waiting for the doctor or Poison Control to call back, if the child is conscious, give him/her either water or milk, as much as he/she will swallow. Do not give any other medications until you have heard from one of us.

Back to Top

Increasing numbers of parents are turning to complementary and alternative medical therapies to promote health, prevent illness, and treat acute and chronic conditions in their children. Herbs are the most commonly used of these therapies. Herbs and medications share a common history. Many well known medications were derived from herbs. Though many physicians lack a detailed knowledge of the hazards of natural herbal remedies, most regularly counsel their teen patients on the most widely marketed herb of all - tobacco. Tobacco illustrates two key principles of herbal toxins: 1) Although some herbs have been used for thousands of years, historical use is not a guarantee of safety; 2) The toxicity of an herb may not be apparent with single or occasional use, and short term safety is no guarantee that chronic exposure is free of danger.

Consumers of herbal products often assume that they are safe. However, according to federal legislation enacted in 1994, herbs and other dietary supplements can be marketed without testing for safety or effectiveness. This has led to a multitude of products marketed as herbal or holistic or natural. Many of these products have no proven therapeutic value and have potential undocumented side effects. In fact, many holistic remedies are not even labeled with the complete list of ingredients.

The physicians and pediatric nurse practitioners of EVCC welcome your thoughts and questions on this subject and also refer you to the following informative internet web sites:

National Institute of Health Office of Dietary Supplements: http://dietary-supplements.info.nih.gov/

FDA MEDWATCH, monitoring program for reporting adverse effects: http://www.fda.gov/medwatch or call 1-800-FDA-1088.

USDA Phytochemical and Ethnobotanical Database: http://www.ars-grin.gov/duke/

The Herb Research Foundation: http://www.herbs.org

Back to Top

---

HEAD INJURIES

Very few children reach kindergarten without some sort of head injury. Fortunately, most are minor and require minimal attention. The most minor type of head injury is a blow that causes either no swelling or a small raised "bump" or bruise, no blood or bleeding, and no change in the child's behavior after the initial tears and crying. Treatment consists of TLC (tender, loving care) and a "kiss where it hurts".

A little more concerning is the head injury that results in a brief period of confusion (a "dazed look" lasting no more than five minutes) and a desire to sleep, occasionally preceded by vomiting a few times. These children need to be observed carefully. If the "dazed period" is brief and the child seems all right in all other respects, let him/her go to sleep for 30 to 60 minutes. If he/she then awakens and feels fine, or has no more than a headache and two or three episodes of vomiting, continue to observe at home. Within one or two hours he/she should be "normal". If not, call us. If he/she is difficult to awaken after a 60 minute nap, call us.

If your child wishes to eat or drink after suffering a blow to the head, we recommend only offering sips of clear fluids such as water, carbonated beverages, or sports drinks. It is common for children to vomit a few times in the first few hours following a head injury.

If the injury occurs at night or just before bedtime and no loss of consciousness occurs, we simply recommend that you watch your child throughout the sleeping hours. We recommend that you attempt to awaken your child every two hours for that night. Waking him or her every hour is unnecessary. Your child should act normally just as if he or she has just awoke in the morning for the first time.

If a child is unconscious for even a short period of time, has persistent vomiting, or has suffered a head injury after a fall from a height of more than 4 feet, call us promptly, or call 911.

Occasionally head injuries associated with a laceration or cut require attention. Generally, if the cut is gaping (the edges pull away from one another) sutures or staples will be required for best results.

Checking your child's pupil size is unnecessary. This is a very late finding in children with intracranial complications after head injury.

Signs to watch for, in general, are:

1) Persistent vomiting -- more than three or four times, or more than 4 hours after the initial injury.

2) Inability to arouse from sleep -- your child should awaken from sleep just as he/she does in the morning.

3) Prolonged sleeping -- most children want a brief nap after a head injury, and it is all right to let them sleep provided you wake them after 60 minutes. Awaken every two to three hours through the night to assure that he/she is easily arousable and aware of his/her surroundings.

4) An extreme change in behavior or personality -- other than that expected from any minor injury with crying.

5) Difficulty with control of arms, legs, or speech.

6) Bleeding from the ears or clear nasal discharge that occurs without crying.

7) Large lacerations (cuts) that require sutures.

8) Convulsions or seizures.

9) Unusually severe or progressive headache.

10) Mental confusion or amnesia.

11) Stiff neck.

Call us or take your child to the Emergency Room if one or more of these problems arise.

Back to Top

---

NOSEBLEEDS

Nosebleeds often occur during the allergy season (spring or fall), and are associated with very dry weather, and nose picking (especially at night when neither the child nor the parent is aware that the child is picking his/her nose). Nosebleeds can be controlled with direct pressure. It is generally the septum (or central wall) of the nose that bleeds, and usually near the nostril opening. Have your child sit up and apply tight pressure to the end of the nose for 10 minutes. It is helpful to use a timer, because 10 minutes of pinching the nose is a long time, and if you let go too early, you must start over again. A piece of cotton soaked with 1% NeoSynephrine nose drops inserted into the bleeding nostril with pressure applied for ten minutes usually will also stop the bleeding. The cotton can then be removed and the nostril gently swabbed with vaseline. A & D Ointment, topical antibacterial ointment, or vaseline applied twice a day to prevent further bleeding may be used briefly. A vaporizer or humidifier will help prevent recurrent nose bleeds. If bleeding is not stopped within one hour, or if bleeding becomes a daily event, please call the office.

Back to Top

---

TEETHING

"If you can't find a reason for it, blame it on teething." This has been the attitude of many people in the past, and continues today. There are numerous misconceptions regarding the symptoms produced by teething. However, other than causing some mild, occasional fussiness, teething causes no particular symptoms. Fever greater than 100°F rectally does not occur as a result of teething. Do not attribute fever (especially high fever), colds, convulsions, diarrhea, or rashes to teething. A specific illness may remain undiagnosed or untreated if you do.

The teeth begin to erupt between the ages of six and nine months, though some children may have them erupt as early as three months or as late as fourteen months. On rare instances, infants may actually be born with teeth. Excessive drooling usually appears at age 3 months and may be several months prior to actual tooth eruption and is a condition that is not related to teething.

Teething lotions are not recommended since the minimal beneficial effects, if any, are short lived. Some people feel that massaging the gums may alleviate discomfort in certain infants. Ice teething rings are useful for many infants.

Back to Top

---

FEET AND SHOES

Most infants have bowed legs and feet that are turned inward, and all have flat feet. These normal "positional deformities" will not begin to straighten up until after the child starts walking. It will then take several months to two to three years for complete correction and rarely requires any treatment. If treatment or evaluation is needed, we will discuss this with you.

Shoes serve to protect the feet and are not needed for support. Any shoes that fit properly and protect the feet are appropriate. Shoes really aren't necessary until a child is walking outdoors. We recommend semi-soft shoes at first so the child's feet have a better chance to move. Sneakers are considered satisfactory as long as they don't cause sweating. Expensive, hard soled, high top shoes are not recommended.

HEPATITIS A

Occasionally, you may be notified that your child was exposed to Hepatitis. This is a viral infection similar to the "flu" which primarily affects the liver. It causes the skin and whites of the eyes to turn yellow (jaundice). In infants, hepatitis may be present without yellow discoloration to the eyes. It is usually a mild disease in children compared to adults.

Hepatitis A is passed by unwashed hands, contaminated water, or contaminated food. Your best protection is careful hygiene including careful handwashing (especially after using the toilet), and avoiding potentially contaminated food and water where possible. A vaccine to prevent Hepatitis A is recommended for all children at ages 1 year and 2 years.

The incubation is usually several weeks. Gamma Globulin can be given which will protect an exposed individual from developing hepatitis, but there is no emergency involved in getting your child in for treatment. If you find your child has been exposed to hepatitis, call our office during regular office hours the following day (or following Monday) for instructions. Not all exposures require a gamma globulin shot for prevention. 

HEPATITIS B

Hepatitis B is one of the most serious forms of hepatitis with over 300,000 new acute cases each year and an estimated one million carriers in the U.S. This disease is more prevalent and infectious than AIDS, and may lead to scarring of the liver, called cirrhosis, cancer of the liver and fatal liver failure, particularly if the acute infection occurs in childhood. The initial illness of hepatitis B is called acute hepatitis and may be mild or severe. When the virus continues to attack liver cells beyond a six month period, causing inflammation and cirrhosis, the condition is called chronic hepatitis.

Hepatitis B can be transmitted through infected blood, blood products and needles. It is also frequently spread through sexual contact by carriers of the virus who may not be at all ill, and at birth from mother to baby. The virus is also found in high concentrations in saliva, but it is not known if this is a common source of spread of the infection. Nearly one third of all new cases of hepatitis B occur with no "risk factors". We do not know how the infection was acquired.

Vaccination is recommended for all newborns, infants, and teenagers. The Committee on Infectious Diseases of the American Academy of Pediatrics recommends "universal immunization" of children with particular emphasis on infants and adolescents. They note that the age group of children most at risk for acquiring Hepatitis B is the adolescent.

Back to Top

---

VAPORIZERS AND HUMIDIFIERS

Vaporizers and humidifiers do the same thing. They add moisture (water) to the air. They are helpful in the treatment of almost all infections of the nose, throat, and lungs, especially the common cold, bronchitis, croup, pneumonia, ear infections, etc. Dry air, especially in the desert of Arizona, tends to dry up the lining of the nose, windpipe, lungs, etc., and makes a cough "tight", whereas humidified air keeps these linings of the air passages moist. Moist air is also very helpful in treating nosebleeds.

Vaporizers and humidifiers are of two general types: Steam vaporizers and cool mist vaporizers or humidifiers. The cool mist humidifier is the most effective in putting moisture into the air: it works faster, doesn't make the room hot, lasts longer, and cannot burn careless children's hands as the steam vaporizers may. Hot steam vaporizers can be dangerous and we recommend against their use for this reason.

Ultrasonic humidifiers are available which are effective. They are moderately expensive and demand the use of distilled water. However, we recommend the use of distilled water in all vaporizers although this does add to the expense. The tap water, even from homes equipped with a water softener, contains high concentrations of salts that can be irritating to the lung when inhaled for a prolonged period of time.

Vaporizers and humidifiers require frequent cleaning to prevent the growth of molds and bacteria.

Back to Top

---

URINARY TRACT INFECTIONS

Infections of the urinary tract are not as common as the colds, sore throats, and ear infections which your child will have frequently. They will, however, occur in a significant number of infants and young children. Once correctly diagnosed, a urinary tract infection can be readily treated with antibiotics. Recovery is generally quite rapid even in the child who has been acting ill or hospitalized because of the infection.

Symptoms of urinary tract infection may be extremely subtle and consist of nothing more than persistent fever, or they may consist of burning with urination, frequent urination, loss of bladder control, back pain, or recurrent vomiting. Most parents suspect urinary tract infection, however, because of the symptom of burning (usually caused by inflammation of the urethra and frequently caused by the use of bubble bath).

Once your child is diagnosed and successfully treated and acting well, you may have no concerns, but unfortunately a significant number of children who have had a urinary tract infection will have developed the infection because of an abnormality within the urinary tract. This abnormality may lead to recurrent infections with or without symptoms. If not recognized and treated, this can be result in kidney damage or even kidney failure with future need for dialysis or kidney transplant.

Studies have shown that as many as 18 to 50% of children with a urinary tract infection will have an anatomical abnormality of the urinary tract. Because of this frequency of abnormalities it is very important that studies be performed to determine the presence of any abnormalities. The most common abnormality that children will have is called vesicoureteral reflux, or simply reflux. When the child voids, urine is kicked (or refluxed) back up the ureter, which is the tube connecting the kidney to the bladder. This can lead to recurrent infection. Other problems may consist of abnormalities of the bladder or kidney itself causing obstruction to the flow of urine. Some children may be found to have an extra kidney, or only one kidney.

To determine if any of these problems exist it is necessary to schedule two imaging studies (Xray and Ultrasound) for your child. Follow up for the child is based on the results of these studies, and will be individualized based on the individual needs of the child. The important thing to remember is that if these studies are done, proper treatment can be started that can prevent kidney damage or failure. All children who have had a urinary tract infection will require careful follow up, which may include frequent repeat urine cultures.

Back to Top

---

HEAD LICE

Head lice is a common problem among school age children, or those in daycare. It is not an indication of uncleanliness! Many parents "panic" when they discover head lice, but it is not an emergency. The symptoms of head lice infestation include itching of the scalp (especially at the back of the neck), small white or tan nits attached to the hair shaft (often mistaken for dandruff), and occasionally seeing a live head louse.

Transmission of head lice occurs by direct contact with infested individuals or their personal belongings such as combs, brushes, and hats. Contrary to popular belief, the head louse cannot jump. Lice can only survive 24 to 48 hours away from the scalp. The incubation period for the louse is 6 to 10 days. Hair length does not affect who will become infected, but can make treatment more difficult.

TREATMENT of head lice takes diligence but can be accomplished without an office visit. The most effective treatment is Nix hair rinse, available without a prescription. Follow the directions on the package. We recommend a second treatment 7 to 10 days after the first. We also recommend treatment of other household members routinely (except infants). All other contacts should be closely examined. Reinfestation of children from an untreated, infested contact is more common than treatment failure after proper application. Head lice can also be killed by a heavy application of petroleum jelly (Vaseline) to the scalp and hair which is kept on overnight under a shower cap. This suffocates the lice and their eggs. Clean up is difficult, however, in the child with thick or long hair. If appropriate use of over the counter medications for lice do not eliminate the problem please arrange for an office evaluation of your child. Prescription medications for lice do exist but if used incorrectly can be dangerous.

Most schools have "no nit" policies, requiring the hair to be free of nits before returning. This can be accomplished with a fine tooth comb, or nit comb. This can be facilitated by soaking the hair in white vinegar (3% - 5% acetic acid) on a damp towel for 30 to 60 minutes.

Clothing, bedding, and stuffed animals can be disinfected my machine washing or machine drying using the hot cycles. Combs and brushes can be disinfected by soaking in hot water for 10 minutes. There is no evidence that use of insecticides is useful in the control of head lice. Additional information on head lice can be found at www.headlice.org.

Back to Top

---

PREVENTING ILLNESS IN YOUNG CHILDREN

While vaccines have eliminated or reduced the rate of many serious childhood infections, occasional illnesses like the common cold and flu are a fact of life for babies as well as adults. While it is impossible to avoid all illnesses, there are some basic and effective strategies you and your family can follow to prevent or lessen their impact.

It is important to keep in mind that hands are transportation centers for germs. Anything we touch can be transmitted directly to others around us or indirectly through household objects that other family members are likely to touch after us. Infections are commonly spread through one of three routes:

* Respiratory: Coughing or sneezing on someone; touching oral or nasal secretions of an infected person/child.

* Intestinal: Germs from fecal material spread via hands to objects (toys), and surfaces (diaper changing tables, doorknobs) which are then touched by others.

* Touching: Direct physical contact can spread infections like pinkeye, impetigo (a common skin infection), and head lice.

BREAK THE CHAIN OF TRANSMISSION:

* Ensure proper and complete hand washing of yourself and baby/child after diaper changes or toiletings, before eating or feeding babies/children, and after contact with any bodily secretions (nasal mucous, phlegm, vomit, diarrhea, or blood).

* Insist that all adults wash their hands before any contact with small children in the home.

* Dispose of diapers, baby wipes, tissues and dirty or soiled laundry in a sanitary manner.

* Keep curious toddlers away from garbage cans and diaper pails.

* Make sure infected family members have their own towels, eating utensils, and drinking glasses for the duration of their illness. Wash all of these items thoroughly before anyone else uses them.

* Wash all clothing worn by sick family members and wash and change bed linens. If possible, air the room and clean and disinfect objects and surfaces in the room.

* Sanitize medicine dispensers, toilet seats, potty chairs, thermometers, and anything that may have been soiled or handled by the sick child or adult.

* Clean toys, play surfaces, changing tables, and other objects with soap and water and disinfect with a mild solution of bleach and water (1/4 cup of bleach to one gallon of water), especially after other children and adults have been at play.

(Taken from Infants and Illness: A Guide for Parents published by ICN Pharmaceuticals, Inc. of Costa Mesa, California).

PETS:

While owning a pet can have positive effects on children, such as teaching responsibility and providing love and companionship, parents must consider the diseases pets could transmit. Pet owners are often unaware of the mode of transmission and appropriate measures to prevent the spread of diseases from pets to children. Being aware of the potential parasitic diseases and other pet related problems, such as allergies, is a good start.

Most parents are concerned about rabies from dog bites, which are responsible for 600,000 injuries in children annually. An understanding of canine behavior and choosing a good breed for children can help reduce the number of attacks.

Examples of nonaggressive breeds are golden or labrador retrievers, basset hounds, collies, and old English sheepdogs. Parents should teach children the warning signs of an agitated pet, like growling, posture, and staring, and instruct them to not disturb a dog while it is eating, sleeping, or playing with a toy. Parents should supervise small children while they are around pets.

Cat scratch disease strikes one percent of Americans, mostly children, each year. The culprit is a germ called Rochalimaea henselae, which is carried on the claws and can enter through the skin at the site of a scratch, resulting in infection. Parents should thoroughly wash any animal scratch with soap and water to prevent such infection. They are also encouraged to watch for signs of fever, headache, and enlargement of the lymph nodes nearest the scratch areas.

Other diseases transmitted by cats are Campylobacter jejuni (transmitted through direct contact or contaminated food), ringworm (direct contact), salmonellosis (direct contact or contaminated food), toxoplasmosis (ingestion of eggs shed in feces), Pasteurella multocida (bites, scratches), and Yersinia pestis (flea bites, direct contact).

In addition to rabies, dogs can be carriers of diseases such as Rocky Mountain Spotted Fever, (transmitted through tick bites), ringworm, leptospirosis (contact with dog urine), ehrlichiosis, and echinococcosis (hydatid disease transmitted by ingestion of eggs shed in feces).

Salmonellosis is spread by reptiles, rabbits, ferrets, and turtles through direct contact and contaminated food sources. Children should wash their hands after handling these pets and their cages, and parents should not bathe these pets or wash their feeding dishes in kitchen sinks.

Pets also can trigger asthma attacks or allergic reactions in children. Cats and dogs secrete allergens through skin and saliva, and most constantly shed hair and skin dander. Dogs with growing coats may release more allergens because of increased scratching.

Restricting a pet to the outdoors, keeping it out of the child's bedroom, and bathing the animal frequently help to reduce pet allergies in children. A 3% tannic acid solution sprayed on carpeting and furniture inactivates cat allergens.

Since most pet related diseases are transmitted through direct contact - bites and scratches, contact with urine, and contaminated food - teaching children to wash their hands after playing with or cleaning up after a pet is strongly encouraged.

Back to Top  

---

Copyright: East Valley Children's Center

 

EVCC Main