When is it time to worry about the cough?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

It seems like kids cough all winter long. When is it time to worry about the cough? When can you treat it at home and when should you go to the doctor?

There are many causes of coughing in children. Most commonly, a cough is caused by a viral upper respiratory infection. However, coughs can also be caused by asthma, pneumonia, croup, bronchiolitis, whooping cough, sinusitis, allergies, reflux and even an inhaled foreign body. This article will review the …

Viral upper respiratory infections

This is the common cold. A cough from a cold will typically last two weeks. There is commonly some productive phlegm toward the end of a cold. Antibiotics do not help viral illness so it is best to let this type of cough run it’s course. It is common to have some fever with a viral upper respiratory infection for the first few days. However, you should visit the doctor if the fever lasts more than a few days. You should also be seen if the cough lasts more than a week or the fever comes back after having stopped.

Whooping cough (pertussis)

Recently there has been a resurgence of pertussis. Pertussis will start off looking like the common cold. However, instead of getting better, the cough gets worse. Children with pertussis will cough many times in a row.

They will often lose their breath and take a big “whoop” breath at the end of a series of coughs. Babies with pertussis will sometimes stop breathing and turn blue. Pertussis is extremely dangerous to babies and is preventable by vaccine. It is important to make sure that your baby gets all his pertussis vaccines. In addition, we now give teenagers and adults a pertussis vaccine.

Asthma

A cough from asthma is usually not associated with a fever. Kids with asthma will cough more with exercise and at night. Asthma is usually triggered by a cold so children who have a history of wheezing should always see the doctor when they are coughing.

Bronchiolitis

Bronchiolitis is when a viral upper respiratory infection moves into your baby’s chest and causes wheezing. Signs that your baby’s cold might be bronchiolitis include trouble nursing or taking a bottle, heavy or fast breathing and wet sounding cough. In general, babies with a cough should see the doctor.

To learn more about coughs, or any other medical conditions your child may be facing, visit HealthyChildren.org.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

My Child Has A Fever, Should I Be Afraid?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Everyone gets nervous when their child has a fever. However, fever is not dangerous. There are many myths surrounding fever. Here are some facts about fevers:

Fever helps the body fight infection. Fever helps slow growth of bacteria and viruses. It also enhances the immune fighting cells in the blood.

A high fever does not necessarily mean that there is a serious disease. Many viral illnesses can cause very high fevers. While these fevers might be high, they will go away without any help in three to five days.

Fevers do not cause brain damage.

Again, fever is a normal physiologic response. The only time that fever is dangerous is when it is from heat stroke or hyperthermia. Symptoms of heat stroke are red hot dry skin with no sweating and confusion.

Infections and illnesses that cause fever do not cause heat stroke and are not dangerous. It is true that a small percent of children who get a fever will have a febrile seizure. Febrile seizures occur in about 4% of kids. They can be very scary to watch but they do not cause brain damage.

Medicines to lower fever are not expected to bring the temperature down to normal.

Ibuprophen and acetaminophen are often used to bring down fever in children. However, these medicines will only help the child feel better for a short time.

When the medicine wears off, the fever will return. Your child will continue to have fever for as long as the illness lasts (usually 3-5 days). Also, these medicines will lower the fever but they are not expected to bring the temperature back to normal.

It is expected and helpful to have some fever while your child is sick.

Of course you want your child to be comfortable and you do not want your child to get dehydrated from a high fever but remember that the fever is helping your body fight infection.

Also when your child is sick, he or she should be resting. If you bring the temperature back down to normal with medicine than he will want to run around a play. The goal in using medicine for fever control is to keep your child comfortable while his body is fighting the illness.

Fevers will not continue to rise without treatment. The brain has a “set point” temperature that it will reach and then start to come down, even without medicine.

Medicines to bring down fever will not prevent a febrile seizure.

One in twenty five children will have a febrile seizure. It is impossible to predict and it is impossible to prevent. Remember that while they are scary, they are not dangerous.

Do not use medicine to try and prevent a seizure. Medicine for fever should only be used to keep your child comfortable.

It is most important to determine the cause of your child’s fever.

Fever is just a symptom.

If the fever is from strep throat or an ear infection then he might need antibiotics. If the fever is from a virus, then it will need to “run its course”.

You should bring your child to the doctor to help determine the cause of the fever. Once you know the cause, you can relax.

Medicines come in many shapes and sizes and they are dosed based on your child’s weight. To determine how much medicine your child should take, visit Allied Pediatrics – Med Dosage Resource

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

Your Child’s Fever, Good or Bad?

Photo Credit: http://www.thesitsgirls.com/

Written by Kristen Stuppy MD

Fever is scary to parents.

Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage. In reality the way a child is acting is more important than the temperature. If they are dehydrated, having difficulty breathing, or are in extreme pain, you don’t need a thermometer to know they are sick.

Fever is uncomfortable.

Fever can make the body ache. It is often associated with other pains, such as headache or earache. Kids look miserable when they have a fever. They might appear more tired than normal. They breathe faster. Their heart pounds. They whine. Their face is flushed. They are sweaty. They might have chills.

Fever is often feared as something bad.

Parents often fear the worst with a fever: Is it pneumonia? Leukemia? Ear infection?

Fever is good in most cases.

In most instances, fever in children is good. It is a sign of a working immune system.

Fever is often associated with decreased appetite.

This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food. Kids typically increase their intake when feeling well again. Don’t force them to eat when sick, but do encourage fluids to maintain hydration.

Fever is serious in infants under 3 months, immune compromised people, and in under immunized kids.

These kids do not have very effective immune systems and are more at risk from diseases their bodies can’t fight. Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.

Fever is inconvenient.

I hate to say it, but for many parents it is just not convenient for their kids to be sick. A big meeting at work. A child’s class party. A recital. A big game or tournament. Whatever it is, our lives are busy and we don’t want to stop for illness. Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home. Don’t expose others by giving your child ibuprofen and hoping the school nurse won’t call.

Fever is a normal response to illness in most cases.

Most fevers in kids are due to viruses and run their course in 3-5 days. Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F).

The height of a fever does not tell us how serious the infection is. The higher the temperature, the more miserable a person feels. That is why it is recommended to use a fever reducer after 102F. The temperature does not need to come back to normal, it just needs to come down enough for comfort.

Fever is most common at night.

Unfortunately most illnesses are more severe at night. This has to do with the complex system of hormones in our body. It means that kids who seem “okay” during the day have more discomfort over night. This decreases everyone’s sleep and is frustrating to parents, but is common.

Fever is a time that illnesses are considered most contagious.

During a fever viral shedding is highest. It is important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help). Wash hands and surfaces that person touches often during any illness.

Continue these precautions until the child is fever free for 24 hours without fever reducers. (Remember that temperatures fluctuate, so a few hours without fever doesn’t prove that the infection is resolved.)

Fever is an elevation of normal temperature.

Normal temperature varies throughout the day, and depends on the location the temperature was taken and the type of thermometer used.

Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury. Ear thermometers are not accurate in young infants or those with wax in the ear canal. Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.

To identify a true fever, it is important to note the degree temperature as well as location taken. (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn’t identify a true fever and therefore the need to isolate to prevent spreading illness.)

I never recommend adding or subtracting degrees to decide if it is a fever. In reality, you can look at a child to know if they are sick. The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child. Fevers in children are temperatures above

• 100.4 F (38 C) rectally
• 99.5 F (37.5 C) in the mouth
• 99 F (37.2 C) under the arm

Fever is rarely dangerous, though parents often fear the worst.

This is the time of year kids will be sick more than normal. With each illness there can be fever (though not always.)

What you can do?

1. Be prepared at home with a fever reducer and know your child’s proper dosage (especially with the recent dosing changes to acetaminophen!)
2. Use fever reducers to make kids comfortable, not to bring the temperature to normal.
3. Have an electrolyte solution at home in case of vomiting.
4. Teach kids to wash their hands and cover coughs and sneezes with their elbows.
5. Stay home when sick to keep from spreading germs. It is generally okay to return to work/school when fever – free 24 hours without the use of fever reducers.
6. Help kids rest when sick.
7. If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or xray) is needed to identify the source of illness in these cases. A phone call cannot diagnose a source of fever.
8. Any infant under 3 months or immune compromised child should be seen to rule out serious disease if the temperature is more than 100.5.

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

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Pink Eye: Is it all the same?

Written by Melissa Arca MD

I get so many questions from parents about this, mostly it goes like this: “ewww…I hope it’s not pink eye!”

Pink eye is one of those afflictions that causes us to squirm, think “oh no!”, and inspire us to wash our hands a million times throughout the day. Most of us tend to hide away inside our homes until the icky looking discharge oozing from our child’s eyes disappears.

So, what exactly is pink eye, and what do we truly need to do about it? Not all pink eyes are created equal. Only half of the cases in children are truly bacterial.

Here are some quick facts about pink eye:

•  Pink eye is a general term for what we pediatricians call conjunctivitis.
• Conjunctivitis is the inflammation of the mucus membrane of the inner eyelids.
• Conjunctivitis can be caused by viruses, bacteria, environmental allergies, or a topical irritant.
• Viral conjunctivitis in young children is very common, especially during the summer.
• Viral conjunctivitis will go away on it’s own, without antibiotic drops.
• Only bacterial conjunctivitis needs to be treated with antibiotic eye drops.

How do we know if it’s bacterial conjunctivitis?

• With bacterial conjunctivitis, the eye discharge is more likely to be yellow/green and “icky”.
• Children with bacterial conjunctivitis often wake up with their eyes “sealed shut”.
• Can be associated with an accompanying ear infection.
• These cases need to be treated with antibiotic drops.
• A child with bacterial conjunctivitis may return to school 24 hours after initiation of treatment and obvious signs of improvement.

Five factors pointing to a non-bacterial culprit for conjunctivitis:

• The child is older than 6 years old
• It’s summer time: viral conjunctivitis is more common during the late spring and summer months.
• The discharge from your child’s eye is clear, watery, and may or may not be associated with allergy symptoms such as sneezing and eye itching.
• No yellow/green eye discharge
• Child does not wake with his eyes “sealed shut”.
• If your child meets most of the criteria above, her conjunctivitis is more likely due to a virus or may be part of her allergy symptoms.

Tips for Treatment and Prevention:

• Be vigilant about hand washing. Both viral and bacterial conjunctivitis are extremely contagious.
• HAND WASHING. It’s worth repeating.
• If it’s bacterial and your child is prescribed antibiotic drops, finish the designated days of treatment.
• In most cases, treat both eyes even if only one appears to be infected at the time. Young children will inevitably spread it to the other eye. Avoid the ping pong effect.

Tip for antibiotic administration: have your child lie down, it’s okay if her eyes are closed. Place the drop in the inner eye, near the nose. Once your child starts blinking, the drops will enter the eye.

Look for the signs above, consult with your pediatrician, and above all…keep on washing those hands.

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

Contagious Diseases and Siblings

Written by Jesse Hackell MD

In the fall of 1957, the Asian influenza pandemic was spreading across the country. My younger sister had just been diagnosed with that flu, and my grandmother had arrived shortly thereafter to help at our home when my mother entered the hospital to give birth to another sister. In those days, one could count of a solid seven days in the maternity hospital, even for an uncomplicated delivery.

Knowing the extremely contagious nature of the flu (she had lived through the devastating influenza pandemic of 1918), my grandmother set out with every weapon known to modern grandmotherhood to prevent my father and me from getting sick, fearing the consequences for my mother and newborn sister. With isolation, chicken soup and constant scrubbing and disinfecting, my father and I were spared the disease, as were my mother and sister, and, as long as she lived, my grandmother delighted in telling the story of how she confounded the pediatrician who had predicted that we would all very soon be ill.

Flash forward fifty-four years to 2011. What are the risks to siblings today when one member of a family contracts a communicable disease, and how should we respond? I think that the answer depends on many factors, one of which concerns the nature of the particular illness that one person has contracted.

Viral Illnesses

Some viral illnesses are highly contagious, even without direct contact. Certainly chicken pox and measles used to spread through families like wildfires, but immunization has largely reduced the occurrence of these diseases, primarily by greatly reducing the amount of disease in circulation, and, further, by producing immunity in children who might somehow be exposed. The same goes for influenza, the bane of my grandmother; since universal influenza immunization was recommended a few years ago, the burden of disease has been reduced, although not as much as it could be if everyone actually did get their flu shots.

Contagious Illnesses

How about other types of infectious, contagious illnesses? The common cold is just that, common, and most people will suffer one or multiple episodes each year. Unfortunately, there is no effective preventive immunization, and it does tend to spread readily; fortunately, it tends, in most people, to be relatively  mild and of short duration.

Strep Throat

Strep throat is another common contagious illness, especially in children. There certainly are families where multiple members will get strep in close temporal relationship to each other, and these may be the result of spread within the family.

But it is also possible that multiple family members were exposed at school or work, and contracted the illness elsewhere.  But strep is harder to spread than some of the illnesses discussed previously, and there are many cases where one family member gets it, and no one else becomes sick. This is one illness where good handwashing, and avoidance of sharing of food, utensils and so on, can be a useful preventive measure.

Infectious Mononucleosis

The same can be said for infectious mononucleosis–“mono,” also known as the “kissing disease,” primarily for its reputation as a common occurrence during adolescence. Yet in most of the families where one child has mono, it is very uncommon for other siblings to also contract it. Thus simply sharing a room, or time at the dinner table, is generally not enough to transmit an illness like mono.

Pneumonia

Pneumonia in children is also common, and the vast majority of cases are viral in origin–and they are often caused by the same viruses which cause the common cold. I tend to think of most cases of pneumonia as “a common infection in an uncommon place,” and generally feel that, while another member of a family might catch the same virus, it is far less likely to be caught as pneumonia. Rather, it might cause a head cold, sore throat or ear infection in someone else.

So why does this matter?

Rare is the day which goes by that I am not asked a question like “his brother has strep (or pneumonia of the flu or…), so why can’t you just treat all my kids for it without having to see them?” In response, it is important to point out that every person who gets a fever after being in contact with someone who has strep is far from guaranteed to have strep as the cause of that fever; most illnesses are just not that contagious, and most fevers require individual evaluation regardless of the person’s exposure.

The same thinking goes into my response to the schools who send home notices every time someone in a class is diagnosed with strep, ostensibly warning parents to be on the lookout for strep in their children. About the only thing these notices accomplish is the wasting of paper.

I would far prefer that parents react to each of their children’s illnesses in a vacuum, paying no attention to what the child might have been exposed to (assuming, of course, that the child has been fully immunized, thus pretty effectively–but not 100% completely– ruling out those preventable illnesses as a cause of the fever.)

What to do when your child is ill

When your child is ill, pay more attention to how he or she is acting, how sick he or she appears, and how well the illness is being handled by the child, than to what diseases he or she might have been exposed to.  Discussing that information with your pediatrician will enable you to better decide what y our next course of action should be for evaluating the illness in that child.

 

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

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To Teen Guys: Yes, We Really Need To Check ‘Em

Recently, I was called to our community hospital to consult on a teenager with severe lower abdominal pain. The young man, whom I’ll call Dan (not his real name), lived outside of our community, and I’d never met him before. I arrived in Dan’s hospital room, introduced myself, and started talking to him and his mom about his symptoms. After reviewing his chart and getting his history, I proceeded to examine his heart, lungs, and belly. Then I told him, “OK, I need to check your privates, to make sure everything looks healthy and normal. Is that OK?” I was unprepared for Dan’s surprised, negative, very forceful reaction: “NO WAY!” and his mother’s simultaneous exclamation, “No, you DON’T need to do that!”

I asked permission, as I always do, and he definitely hadn’t given it! So I backed up a little bit. “I know it’s embarrassing to have your privates checked. But we don’t have a good explanation yet for the pain you’re having, and if it’s related to something going on with your genitals or your bottom, I definitely don’t want to miss that.”

Dan was still pleasant, but I could see in his eyes he was definitely not buying my explanation. “If you would feel more comfortable with a man doctor, or without your mom in the room, we can definitely do that.” His horrified expression spoke volumes; I think he would have preferred a spinal tap without anesthetic.

His mom said, “Why do you have to do that? The emergency room doctor and the surgeon who’ve seen him today didn’t feel that was necessary.” I explained, in that case, if no one else had checked “down there,” I felt even worse about blowing off that part of the exam. Dan, still with the deer-in-the-headlights look, volunteered, “I had it checked at the clinic where I got my sports physical done. Can we count that?”

We talked about it some more, but Dan stood firmly to his position: “My genitals are not your business, doc!” In the end, I never did perform this important exam.

Clearly, I failed Communication 101 with Dan at explaining the importance of a complete body check, especially in a kid who’s sick enough to be in the hospital. I suspect if I’d known Dan better, he might not have felt so awkward. What I really wanted to communicate was this:

• It needn’t take very long. A comprehensive external genital exam takes under a minute in boys.
• We can do whatever it takes to satisfy modesty and cultural appropriateness. It’s OK to kick your mom out and have your dad come in. Or vice versa. It’s OK to request a male doctor. Or vice versa. It’s OK to have a chaperone — in fact, I prefer it that way.
• We do find problems “down there.” Honestly, most doctors are in such a hurry – we wouldn’t waste time doing something if we never found a problem. In Dan, a rectal exam for his kind of pain would have helped reduce his need for expensive, high-radiation tests. From time to time, either as part of a problem check or as part of a checkup, we’ll find hernias, hormone problems, cancer, eczema, abnormal birthmarks, ulcers, urinary issues, and infections of many kinds (not just STDs). Many years ago, a wise pediatric infectious disease physician taught me to check the whole body – even the unmentionables – for clues to “mystery patients.” He was right, and since then I’ve diagnosed herpes encephalitis, Behcet’s disease, and Crohn’s disease – based primarily on what I found in the genitals and rectal area.
• Parents, assume nothing. You may think your child has no concerns about his genitals because he’s never mentioned them to you. You may think your son could never have an STD. You may think your son would notice if he had a small amount of blood in his stool. You may think he knows what a hernia or testicular mass feels like. And all these things might be completely true. But they might not.
• Getting it all “out in the open” makes it easier for a child to bring up a concern. Let’s say a young man discovers a small lump on his genitals, and it’s worrisome to him. When I’m doing a genital exam and already have things uncovered, it seems easier for a concerned teen to “casually” point to the spot and say, “Hey, [indicating] is this OK?” I can easily say, “Oh yes, that’s a ______ and lots of guys have those. They’re normal and won’t interfere with peeing or sex or anything. I have a great handout about that for more information.” It’s harder for a kid to bring up issues “down there” if he thinks that a genital exam isn’t part of the equation. Will I think he’s a pervert or weird for asking: “So… doc…. I have this… thing… on my… privates?”
• Your female counterparts seem to have gotten over this. I’ve noticed (and I’m not sure why – maybe because I’m a woman) that I rarely have girls or their parents look horrified or surprised when I ask to check a girl’s breasts or pubic area. Much more frequently, I have mothers ask me, “Are you sure 13-year-old Kathy doesn’t need a complete pelvic exam, now that she’s having periods?” Sometimes this is a subtle hint to check for pregnancy or STDs; sometimes parents are trolling for information about their child’s sexual activity, or lack thereof. But much of the time, parents know that ensuring “the lady parts” are important to keep healthy, just like everything else.

So: It’s OK to be embarrassed. It’s OK to sigh, blush, groan, and/or roll your eyes at the doctor. But guys, yes, we really need to check ’em.

Suzanne Berman is a general pediatrician in rural Tennessee. She tries to minimize embarrassment to her husband and son, too.

Back to School Illnesses… Please Don’t Spread the Lovebugs

Written by Melissa Arca, MD

First of all, realize it’s inevitable: Children will get sick. I have yet to meet a child in school who went the whole school year without coming down with something. That being said, there are measures we can take to lessen the chances of our children falling prey to some of these viruses.

First, I will outline 5 of the most common culprits causing illness in the preschool and school age child during fall and winter. Then I will give you some practical tips on containing these viral bugs.

Hand Foot Mouth Disease: This is most commonly caused by the coxsackie virus and peaks in the summer and early Fall. This virus affects mostly young children (children under 10). The symptoms consist of a fever, decreased appetite, and sore throat. Usually painful mouth sores develop on the tongue, inside of cheeks and back of throat. This may or may not be accompanied by the non-itchy skin rash on palms and soles of feet.

The Common Cold: Your child may be afflicted with this a few times a year. The most common culprit here is the rhinovirus though there are several different viral strains producing symptoms of the common cold. Hence, several colds can be caught during one season. The symptoms vary but most commonly include: stuffy nose, sore throat, cough, mild fever, and sneezing.

The Flu: Ahh… the dreaded flu. Influenza and its various strains cause the dreaded flu symptoms. As opposed to the common cold, the flu gives more pronounced and severe symptoms: high fever (usually over 100.4), sudden onset of symptoms, profound body aches, headache, and general malaise with decreased appetite. With the common cold, respiratory symptoms such as sneezing, congestion and cough are more prominent than in the flu. So far, the only preventive medical defense we have against this is the seasonal flu shot.

Strep Throat: Unlike the above conditions, this one is caused by a bacteria (Group A Strep.) and not a virus. So, this must be treated with antibiotics. So how do you tell the difference from a common sore throat (viral pharyngitis) and strep throat? Here are the key differences: strep throat involves a higher fever (usually above 101 F), red and swollen throat with possible pus formation, absence of cough, and swollen lymph nodes in neck. Strep throat may also be accompanied by abdominal pain, possible vomiting, and a body rash.

Gastroenteritis, aka the “stomach flu,” is caused by several different types of viruses, most notably rotavirus and adenovirus. The most prominent symptoms are vomiting and diarrhea. Some children may only have the vomiting, some only the diarrhea, and the unlucky ones will have both. This may be accompanied by fever and stomach ache. Having the so-called “stomach flu” does not mean you have the “flu” as in influenza.

I picked the above 5 conditions because they are by far the most common this time of year and they are highly contagious. There is just no way around it. Okay, so having thrown all that at you, what can you do to help minimize and contain these nasty viruses?

1. Frequent hand washing is the number one way to help prevent the spread of these bugs. Encourage and teach your child to wash their hands several times throughout the day. Before eating, after using the potty, after playing outside, etc. Have them sing a song while washing to make sure they wash long enough (ABC song is a good one).
2. Carry sanitizer. I always wipe my kids’ hands as soon as they get into the car from school. This time of year, it’s just a good habit. Wipe down shopping cart handles too.
3. Encourage children to sneeze and cough into their arms or a tissue.
4. Keep children home if they have a fever, are vomiting, or have significant diarrhea. Of special note: keep them home if they have eye drainage, this could signify a conjunctivitis and should be evaluated by a doctor.
5. Teach them not to share drinking cups or utensils with their friends.
6. By all means, sanitize the toys and personal items in your house after a bout with any of the above.
7. Make sure your children get enough sleep, eat well balanced meals, and exercise regularly. All of these will help insure that their immune systems stay in tip top shape.

Treatment: Since the above, with the exception of strep throat, are caused by viruses, antibiotics will not help. Keep your child comfortable by treating their fever with a fever reducer. Give plenty of fluids and rest. With the stomach flu, keep your child’s diet bland and make sure they stay hydrated with small and frequent amounts of liquids.

Possible Complications: Secondary infections can set in following colds or the flu. Ear infections and pneumonia are common secondary infections. Watch for fever recurrence, chest pain, difficulty breathing, or worsening cough. Dehydration can set in following a bout of gastroenteritis. Stay on top of your child’s liquid intake. These conditions should be evaluated by your child’s pediatrician.

Do not hesitate to contact your child’s pediatrician whenever you’re concerned or have questions regarding your child’s health.

Good luck to all of you this fall and winter season. Unfortunately, these bugs will make their way into our households — just make sure your child gets plenty of rest, fluids, and love.

We’ve already battled a short bout of gastroenteritis and a nagging cold. How about you? Have your children been afflicted by any of these back to school bugs yet?

Dr. Arca is a pediatrician, mom of two, writer, and blogger who works part time in a community clinic while raising her two young children. She has become passionate about writing and speaking about motherhood, parenting, and children’s health. She is author of the blog, Confessions of a Dr.Mom and writes a weekly column in her local newspaper, The Sacramento Bee.

What can I do to help my child’s allergies?

Written by: Kerry Frommer Fierstein, MD, FAAP

Pollen counts are high and allergies are bad. Phone calls and office visits regarding allergy have risen sharply in the last week or so. There are many steps you can take to help your child with allergies this time of year. We hope these suggestions will help, but if they don’t, please make an appointment with your pediatrician to learn about further treatment options.

The best way to decrease allergy symptoms is to avoid the things to which you are allergic.

• Wash hands when coming indoors – at school and at home.
• Change clothes upon entering the house and do not keep the laundry hamper in the child’s room.
• Shower nightly and as soon as possible when finished playing outside.
• Keep plenty of tissues around and teach your child not to use a tissue to rub his eyes, especially outdoors, because this brings the pollen right to his eyes.
• A cool compress will also help reduce swelling and itchiness.
• If the allergy is to pollen, keep the windows closed and the air-conditioner on. (Clean filters regularly.)

What over-the-counter (OTC) medicines can I use?

Allergies are caused by the body’s release of histamines. Anti-histamines are a mainstay of allergy treatment. They treat the general symptoms of runny nose and itchiness.

 Benadryl is the most widely known anti-histamine, however, it is not the best choice for allergy sufferers, because its effects only last a few hours, and it often causes sleepiness. It can be useful at bedtime when symptoms are interfering with sleep.

Claritin (Loratadine is the generic name) is the most commonly used OTC allergy medication. It is dosed once a day, usually in the morning. The dose for ages 6 and up is 10mg – given either as a pill or a dissolvable tablet. A liquid form is available. It comes as 5mg per teaspoon. Children over 6yrs get 2 tsp. Children 4-6yrs get 1 tsp. Children 2-4yrs. get ½ tsp.

Zyrtec, generically known as cetrizine, is another commonly used allergy medicine available over-the-counter. Often providing more effective relief than Claritin, Zyrtec is also slightly more likely to cause sleepiness, so most physicians recommend using this once daily medication at night. The dose for ages 6 and up is 10mg – given either as a pill or a chewable tablet. A 5 mg chewable is available for children 4-6 years old. A liquid form is available as well. It comes as 5mg per teaspoon. Children over 6yrs get 2 tsp. Children 4-6yrs get 1 tsp. Chlidren 2-4 yrs get ½ tsp. Zyrtec brand liquid was taken off the market last year (along with Tylenol) and has not come back yet. Store brands of Cetrizine will work as well.

Allegra (fenofexadine) just became available over-the-counter in March 2011. If you have noticed that claritin or zyrtec are not working as well for your child, you should try Allegra. Dosing for those 12 years and older is 60 mg twice a day or 180 mg once a day. Dosing for children 6-12 years is 30 mg twice a day. For children under 6 years, check with your pediatrician. Allegra comes as liquid -30 mg per teaspoon and as 30 mg ODTs (orally disintegrating tablets.) It also comes as 60 mg and 180 mg tablets.

Decongestants, like Sudafed, can be added to antihistamines when congestion is the major problem, but this is not typically needed for Spring-time allergies.

If OTC antihistamines are not working make an appointment to discuss a prescription strength anti-histamine.

Will eye drops help?

Yes, if eye itchiness is a major symptom, then allergy eye drops will help. Zaditor is a medicated eye drop that is now available over-the-counter. It can be used in children as young as 3 yrs. It can be used on an as needed basis but will be more effective if used every day. If your child’s eye allergies are very bad this year, next year we would recommend starting eye drops in April, just before the season hits.

What can I do if over-the-counter medicines don’t work?

There are lots of prescription medicines for allergies. There are antihistamines such as Clarinex and Xyzal. Also, there are anti-inflammatories such as Singulair and there are eye drops such as Pataday, Elestat and Optivair. Lastly, pediatricians often recommend nose sprays  such as Nasonex, Flonase, Veramyst and Rhinocort.

As always, we recommend to make an appointment with the pediatrician to help you map out a plan for your child.

My child is on prescription medicines but is still having symptoms.

Often, when one medicine doesn’t work, another medicine in the same class will be more helpful. Or, it is possible to combine several different medicines. Make an appointment to see us and discuss the situation.

How can I tell an allergy from a cold?

• Allergies don’t cause fevers.
• Allergies often cause itchy eyes and noses, along with the clear runny nose.
• Allergies cause sneezing “fits” as opposed to the occasional “achoo” of a cold.
• Allergies can linger for weeks to months; colds are usually done within 2 weeks.

Do I need to see an allergist?

Allergists can be helpful when your child has not found relief from OTC meds or the prescriptions we have given you. Allergists can be helpful in many ways – identifying the cause of allergies, helping to adjust or minimize medications in chronic sufferers, and as a last resort, the formulation and treatment with allergy shots (immunotherapy).

Dr. Fierstein is a practicing pediatrician. Born in the Bronx and raised in Queens, Dr. Kerry Frommer Fierstein is a New Yorker all the way. She works atPediatric Health Associates, PC, a division of Allied Pediatrics of New York.