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Hand, Foot and Mouth Disease

7 May

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My daughter has blisters on her feet and hands and I just noticed when she was screaming on the scale that she has some in her mouth too.”

“Can I re-arrange those words for you to help you out? Ever heard of hand, foot and mouth disease?”

“Oh yeah, there was a sign up at day care last week talking about that.”

What is Hand, Foot and Mouth Disease?

Hand, Foot and Mouth Disease (HFMD) is caused by a virus.  In addition to the sores whereby it gets its name, children can also get blisters on the genitals as well.  A related virus called herpangina causes the mouth blisters but not much else besides some fever.

What Do I Worry About?

The sores themselves are not particularly concerning with hand foot and mouth disease. The bigger concern is that often our babies won’t drink much because of the oral sores, and dehydration can become an issue.  It’s important to watch for wet diapers; your child should have one about every 6 hours.

How Do We Treat HFMD?

Well…it’s a virus so check out this post on why antibiotics won’t be effective (Sorry, It’s “Just” a Virus (PedPathForParents)-Why Doesn’t My Child Need an Antibiotic?).  The main treatment is treating the pain with tylenol and motrin.  Some doctors recommend using a mixture and maalox and benadryl for the oral ulcers.  Call you doctor to ask if they do provide this recommendation and the dosing for your child.

Also provide cold and soft foods as they may help your child to eat and drink more.

So, You’re Not Going to Give Me Anything Else?

Nope, sorry…just the peace of mind that it will be better in about 3 days.  Also a reminder to wash your hands frequently when caring for your child as I had a dad catch it last week who said, “It’s the most miserable I ever remember feeling.”  Good luck and push fluids!

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Running Like a Faucet-Allergies

1 May

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It seems like everyone in Abilene has allergies…people who have never struggled other places move here and their noses start running like crazy.

So, how do you know if your child is suffering from allergies?

Here are the symptoms:

  1. Sneezing
  2. Runny nose
  3. Nasal congestion (“His nose is stuffy and runny”)
  4. Nasal itching

Most adults will do the adult thing and blow their nose when it gets runny.  Unfortunately, kids just usually do that really annoying throat clearing sound and then swallow that huge loogie down just to get on their mom’s nerves.

I had to look up loogie in the urban dictionary to get the spelling and like the definition enough I thought I should share it: “a large slimy glob of spit, mixed with nose snot, that is formed by coughing up and hocking whats in your throat. cooks in restaurants are notorius for making secret deposits on patrons food.”  Let’s hope the cooks at our restaurants don’t have allergies…

Another annoying thing kids (and adults) with allergies do (me included) is find a clever way to manipulate their tongue so that it can scratch their itchy throats and palates.

So, what options do we have for treating allergies?

Not medicine:

Avoid time outside when specific allergens are high- I find this to be difficult for most families. The times that allergens are high are the times that most families want to be outside…

Saline nasal rinse-This will at least flush the congestion out so your child can eat/sleep.  If you want to use the shotgun of the nasal rinse ammunition, go with the Neti Pot.

Humidifier-Running a humidifier at night will keep nasal passages moist and air flow as smooth as possible.

Medicine:

Antihistamine-I recommend Zyrtec because it’s given once a day and can be used after 6 months.  Some other popular brands are Allegra and Claritin.

Singulair-If a patient is unresponsive to an antihistamine my usual next step is singulair.  Singulair works very differently from the antihistamines so it can be given together with them for an added benefit.

Nasal steroid sprays-Nasonex and Flonase, etc are considered the gold standard (best) treatment for allergies and are often life savers for patients with severe allergies.

Allergist-If all else fails and the allergies are severe enough that they are affecting the child’s life (poor sleep or school performance, etc) then a referral to an allergist could be in order.

So good luck with your allergies this year…this crazy up and down with the weather isn’t helping anyone!

Red, White and Hard-What is Abnormal Poop?

26 Mar

When you were sitting around before kids you never thought about how much you would think and stress about poop but now you do.  If you’re not worried about the color, you’re worried about the frequency and once you get a handle on those you wonder when it will be sitting at the bottom of the toilet and not in a diaper.

I get tons of questions and statements about poop every week.  Here are some of the most common:

1) Is green (or black or purple) poop normal?

2) My baby is constipated because…the haven’t pooped all day or they strain and turn red when the poop.

So what kind of poop is abnormal.  I always try to keep it simple and this might be my most simple explanation yet…Red, White and Hard.

Red

Red poop can be normal.  Especially if your child just drank a bunch of red gatorade or juice.  So if you first see red poop, think about your child’s diet.  If your child’s poop is red because it has blood in it, that is abnormal.

Bloody stool can be a really simple problem.  One of the most common causes is small tears near the opening of the rectum right before the stool comes out.  With this, you will see small streaks of blood around the stool or on the toilet paper.  The child has usually struggled with some constipation just prior to the blood showing up and this problem resolves by softening the stool for a few days so that the small tears can heal.

If there is more than just small streaks of blood in the stool there are some other problems that need to be considered.  These need to be addressed with your doctor by at least a phone call.  Some of the possibilities are infections (salmonella, shigella, c dificile), bowel diseases (such as Cronhn’s or ulcerative colitis) and other anatomic/surgical problems.

White

White stool should always be with your doctor.  In babies, this is a sign that there is a lack of bilirubin in the stool which can be a sign of a very serious condition called biliary atresia.  In this condition, the bile ducts that get rid of bilirubin are not connected to the intestines properly and result in a buildup of bile and liver problems if the problem is not corrected.

Hard

I define constipation as hard stools.  I don’t really worry about the frequency of the stool.  There are babies that go with every meal and there are babies that go once a week and everywhere in between is normal.  As long as the stool is soft, I’m not concerned.  Also, every baby turns red and strains when they are trying to poop.  I think of it like they are trying to figure out what muscles they need to push with.  Usually, after all that pushing and straining, the stool comes out runny or at least soft.  So, what can we do about that?  Make it runnier or softer?  No, I would say, leave it alone.

If you are seeing hard stools, let us know, so we can talk you through how to treat them.

 

Vomiting…Blaahh

11 Mar

Not much else to say here.  To me, there is nothing worse than throwing up…besides maybe feeling nauseous all day thinking that any sudden move could make you vomit but not.

It’s also never a good sign to see the child walk in the office with what is obviously the family puke bowl: some of my favorites are the very large silver metal bowl or the smaller plastic bowl with the paper towel inside…

My least favorite in the kidney bean shaped emesis basin that we provide to our families.  Who pukes so politely that this thing will actually catch it all?

The most common cause of vomiting is gastroenteritis.  This is usually a viral illness that is self-limited (meaning it goes away on its own with no treatment).  I have a post that goes into more detail about the timing etc. here: Stomach Bugs-Why all the Poop? (PedPathForParents).

So, what do we recommend for vomiting?

Fluids, fluids, fluids

  • My favorites are Gatorade or Pedialyte
  • Small frequent sips are the way to go (1 tsp every 5 minutes is 2 ounces in an hour which is more than enough for most children and not so much that it will cause vomiting); use the medicine syringe if you have a baby that won’t drink

Close Observation

Watching your child for:

  • Activity level-a baby who is laying around and won’t wake up to drink, can’t stay hydrated
  • Urine output-if the child is peeing every 6-8 hours, you’re probably OK

If you see a change in either of these things, you need to contact your doctor.  It is possible that your child is already dehydrated and may need some IV fluids.

So, good luck and happy cleaning…

 

OK, Who’d You Kiss? Mononucleosis

4 Mar

I love having this conversation with families in my office…of course you don’t have to kiss someone to get mono but this famous means of contracting it is the funniest to talk about and makes teenagers squirm in their seats…

The most common age to get infected with mono is in early childhood but most of these children do not develop symptoms.  It is when you somehow avoid mono until later that you develop more symptoms.

The most common symptoms of mono are: fever, sore throat, swollen neck lymph nodes and fatigue.

Mono is contracted by trading saliva with an infected individual through kissing or sharing of food/utensils.  So, you don’t have to kiss someone to get mono from them but you do have to have pretty close contact with them.

One of the fears associated with mono is that it can cause your spleen to swell.  This can cause pain in the upper left of your abdomen but is often without symptoms.  Limitation from contact sports is important to decrease the risk of rupturing the spleen; although this is uncommon, it is a dangerous complication that can be avoided by limiting contact sports/activities.

The fatigue with mono can last up to 2-4 weeks and thus patients should gradually increase activity as they begin to feel better.

There is no specific treatment for mono aside from providing treatment for pain and fever and allowing for extra rest.

And…remember that you have to take a break from kissing your girl/boyfriend or else everyone will know…If your parents haven’t figured it out, I’ll make sure and tell them.

Itchy Bottoms-Pinworms

26 Feb

Why does my child have his hand down the back of his pants all the time?

Why does he sit in bed and scratch all night instead of going to sleep?

It could be pinworms.  Yikes!

What are pinworms?

Pinworms are very small worms that live in the digestive tract.  It is the most common worm infection and usually affects school age children.  

It is not uncommon for them to run through a day care or school class.  Of course you won’t know it because it’s not common for parents in the car-pool line to discuss their child’s bottom scratching or worm infections.

How do children get pinworms?

Just like most stomach problems…by eating the eggs that cause pinworms.  After children scratch, they pick up the worms on their hands and then spread them to other children (or their parents but we won’t go there).

Is there a test for pinworms?

There are some fancy tests for pinworms but they usually aren’t necessary.  I typically treat children based on their symptoms alone.  For you over-acheiving parents, you can do something called a “Scotch-tape” test.  The tape is applied around the anus and then you must look at them under a microscope to see the eggs.

How do we treat pinworms?

Pinworms are treated by giving oral medicine.  There is often a dose given and then repeated in 1-2 weeks to treat new worms that have hatched since the first dose.

 

My Baby Spits Up…A lot-Reflux

10 Feb

Every baby spits up…there is definitely a spectrum from the baby that spits up once in their whole life all the way to the baby that spits up every single time they eat.

So, if every baby spits up, how do I decide what is normal?

The answer to this is tricky but I’m hopeful that I can help you decide by reading further…

Studies have been done where they watch how many times a baby regurgitates milk and stomach acid by place a pH probe down the esophagus.  The answer…30 times per day.  Most but not all of these episodes were associated with milk at least making it into the mouth.

Why does this happen?

There is a muscle that sits on top of the stomach that is meant to properly relax and squeeze to allow milk into but not out of the stomach.  Unfortunately, in most young infants, this muscle is both weak and dumb.  It is not strong enough to override the pressure of the stomach pressing on it and it frequently relaxes when it is supposed to be contracting, letting stomach acid run back up into the esophagus.

So, reflux is, for the most part, a mechanical problem that is based on the pressure of the stomach and the strength of the muscle that sits on top of it.  That is why I think that the most common cause of spitting up is overfeeding.  

Often a family of a 2 month old will come in for their checkup and have questions about why their baby (who eats 6 ounces per feed) is spitting up.  The issue is that the stomach is only a few ounces big at this age and everything else that you try to squeeze into it just raises the pressure and causes the baby to spit up.

So, if it’s so common what makes it abnormal?

There’s really only 2 reasons why I will treat babies for reflux: poor weight gain or associated pain/fussiness.  So, the most common thing I will do to treat reflux is check the baby’s weight and if weight gain is good, reassure the family that they have a “happy spitter.”  

I also see babies who are consistently fussy with their spitting or that have fussiness predictably during feeds or in the 30 minutes following each feed with or without spitting up.  Some people have termed this “silent reflux” but I don’t really like that term because the screaming associated with it is anything but “silent.”  Babies can also seen to be arching their backs which is sometimes confused for seizures but is, in fact, reflux.

What do we do about it?

Many babies can be helped by just cutting back on the amount of milk they are ingesting…most babies need about 2-3 ounces per feed at 2 months and this goes up about 1 ounce per month of age after (6 ounces at 6 months).

I still commonly have families slightly elevate the head of the crib although it looks like review of the literature questions whether this is actually helpful or not so I may have to rethink this.

Studies have shown varying percentages about babies with reflux who have an allergy or sensitivity to cow’s milk protein (some studies show it as high as 40%).  Thus it is reasonable to try a short trial of a hypo-allergenic formula (Neutramigen or Alimentum).  Many babies who are sensitive to cow’s milk will also be sensitive to soy so many publications do not recommend a trial of soy but because of the expense of the hypo-allergenic formulas I will sometimes have families do a trial of soy formula first.

There have also been some reports that breastfeeding moms ingesting sea salt can be helpful for their babies reflux.  I can’t find any large studies assessing this but can’t see how it could be harmful.  I can’t find a good source that gives a dose for a formula feeding baby.

Finally, in those babies who are not gaining weight well or who are fussy with their reflux or following feeds, a short trial of an antacid medicine can be attempted to help with symptoms. There are two types of medicines that can be used: H2-blockers (ex Zantac) and PPI (ex Prevacid).  I try to remind families that neither of these medicines are meant to help keep milk in the stomach, they only change the acidity of the contents that are coming up.  So, it is likely that the baby will continue to spit.

Summary

  1. Most babies with reflux have a laundry problem and not a medical problem (think happy spitter).
  2. Limiting overfeeding is the major non-medical treatment for spit up.
  3. Medicines for reflux can be used in babies with poor weight gain or fussiness but should be used sparingly and with appropriate expectations.
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