Technical Names: Allergic Rhinitis

Nicknames: Hayfever, Allergies

What it is: allergic reaction to something in the environment such as pollen, dust, molds, animal hai. It is an overreaction of the immune system – a “normal” reaction on overload. People can grow in and out of allergies throughout their lives. Genetics determines some predisposition but environmental factors can also overload the immune system.

Seasonal Issues:

Many people have season allergies particularly around season change times. Some people are allergen specific and others have year ’round allergies.

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The last decade has produced some amazing changes in child health. Recently, I consulted some of the top pediatricians in the country to figure out where we’ve come from and where we are going next.  Some of these changes may surprise you, so hold on to your seat!

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Q) Dear Dr. Gwenn,

Thanks,
YP

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Bug has many definitions that all apply to your family’s health. Bug can mean an illness, such as the flu, or a pesky problem, such as an injury or allergies or social or psychological issues. Both types of bugs are most certainly part of life and impact all of us. What fascinates me is that most bugs are seasonal and there are many that go about all our towns as if on a road trip!

Bug Of The Month will highlight what’s going around your community, and what ones to look out for!  You’ll get the nuts and bolts, issues to monitor for and resources for more information. Of course, your pediatrician is still your best resource but having a heads up can give you an invaluable peace of mind and help you decide if you need to call for more advice.

Some of the Bugs included on the BugRoll include:

• Animal Bites
• Asthma
• Back-To- School-itis
• Croup
• Ear Pain
• Fifth Disease
• Food Poisoning/Salmonella
• Hayfever (Seasonal Allergies)
• Hives
• Lyme Disease
• Meningitis
• Mono
• MRSA
• NoroVirus
• Pertussis
• Pneumonia
• Poison Ivy, Oak or Sumac
• RSV (Respiratory Syncytial Virus)
• Senioritis
• Sprain and Strains
• Strep Throat and Scarlet Fever
• Swine Flu
• The Flu (Influenza)
• The Stomach Flu (gastroenteritis)

More Bugs are added all the time so check back often!

Technical Names: laryngotracheobronchitis

NickNames: croup, barking seal cough

What is it: infection of our trachea – the main tube in our throat

Typical Ages for Illness: infants and toddler most usually but occasionally younger elementary school children.

Typical Symptoms:barky, seal-like cough often worse at night; +/- fever; +/- trouble breathing. Often starts as a bad cold then suddenly worsens.

Etiology: most commonly parainfluenza virus types 1 and 2, but many winter/flu season viruses possible culprits including influenza, adenovirus and RSV.

Seasonal Issues: usually winter illness, sporadic cases during other seasons

How’s It Spread? person to person by respiratory droplets – i.e. getting coughed or sneezed on, or fomites – touching droplets on an object.

Incubation Period? 2 to 6 days

Symptom Duration: there is usually a few days of a early, cold like symptoms, then 1-3 days of the barky cough which tends to get worse over the first couple of nights before improving.

Treatment:

• cool steam, air – take child outside on front stoop if really barking
• possible steroids if cough is severe
• try taking the child into the bathroom with the shower running for steam

Call Your Pediatrician If:

• trouble breathing: fast rate, skin between abdomen or ribs sinking in
• stridor: tight, squeaky sound
• looking sick
• high fever
• drooling
• inability to talk a complete sentence

Prevention:

• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets

School and After school Activity Issues

• may return to school when fever free for 24hours
• avoid large groups of kids if cough is not controlled to prevent further spread

Internet Resources for Parents

Kids Health Information on Croup

WebMD Information on Croup

Technical Name: otalgia

NickName: ear pain

Causes: ear pain is a symptom that doesn’t always mean ear infection.  The most common causes of ear pain include:

• Ear infection
• Ear irritation of ear canal
• Fluid in ear building up pressure
• Foreign body in ear canal
• Pain from the  mouth or neck

To learn more about the anatomy of the ear, click here.

Diagnosis: examination by a doctor will determine the actual cause.

Treatment: for all causes of ear pain, treating the pain early on is the most important factor. The definitive treatment for the pain will be dependent on the actual cause. Here are some considerations:

1. If a foreign body is present such as a bead, do not go after it, a doctor can remove it for you in the office. However, this is not something always easily done in a pediatrician’s office and may require either an emergency room or visit to an Ear/Nose/Throat specialist.
2. Ear Canal Infection/Irritation: ear drops are usually prescribed
3. True middle ear infection: this is also dependent on the cause. If viral, it will clear with time. If bacterial, most will clear with time in older kids and 10-20% will need an antibiotic. The standard of care today is to treat the ear pain for 2-3 days and start an antibiotic at that point if ear pain is persisting. Your pediatrician can guide you more specifically based on your child’s age, ear exam and history. Children under 2 years of age are still treated with antibiotics in the United States.

Other Treatment Issues:

What should I do if my child has ear pain in the middle of the night?

Give Tylenol or motrin and call your doctor for advice the following day. If you have been given ear drops for pain the past, these are ok if you ear is not draining. Never put drops into a draining ear without a doctor evaluating the ear first.

What should I do if my child has ear pain during normal business hours?

If your child is over 2, I’d suggest you give a dose of Tylenol or motrin and gage your child’s response. Knowing that an antibiotic will not be utilized in most case for a few days, you have time to watch and wait. However, if your child appears ill or markedly uncomfortable, if the ear is draining pus or blood, or if high fever is present, call your pediatrician’s office for advice.

Resources for more information:

Ear Pain Info from Children’s Hospital Boston

Antibiotics vs  Waiting from WebMD

Swimmer’s Ear (KidsHealth)

Middle Ear Infections (KidsHealth)

Flying With Ear Infections (KidsHealth)

Foreign Bodies in Ears and Nose

What is an ear infection?(For Kids from KidsHealth)

Technical Name: Parvovirus B19

OtherNames:

Erythema Infectiosum (EI)

5TH Disease

What is it? A viral illness

Symptoms and Course:

Typically starts with a fever and mild viral symptoms such as tiredness, headache and cold symptoms, then  proceeds to a rash with slapped cheek appearance. Fever occurs in 15-30% of patient’s according to the AAP Red Book. The viral illness may occur a week before the rash. 10% of kids develop achiness of joints or true arthritis.

Spread: person to person via respiratory droplets, ie close contact

Incubation Period: 4 to 14 days, but sometimes up to 21 days, for initial illness with rash and joint symptoms occurring 2- 3 weeks later.

Diagnosis: usually clinical but a blood test can be done if needed.

Special Issues: there is often concern raised for pregnant women but risk of infection is very low given that most of us have likely been exposed during our lives. Pregnant women who are concerned about exposure should talk to their doctors about testing.

Treatment: supportive since illness is usually self-limited in it’s typical form

School Issues: Kids with the rash are  not contagious and may return to school and participate in activities.

Resources

CDC Parvovirus Information

KidsHealth Fifth Disease

Updated January 29, 2009

As of this post, the FDA has expand the peanut butter recall to include all products made by the Peanut Corporation of America in their Georgia plant since January 1, 2007. Retail jars of peanut butter that you can find at your local grocery store are still safe and not included in the recall.

Information on Salmonella Food Poisoning:

What symptoms should you watch for? The same as the stomach flu – fever, abdominal pain, diarrhea, vomiting.

When would symptoms occur if from tainted food? Within 6-72 hours of eating the food. So, if days have gone by, again, don’t worry.

How is food poisoning treated? Hydration is the main focus initially and then slowly advancing the diet. Your doctor’s office can best guide you depending on your symptoms.

When in doubt, call your pediatrician. Stool can be tested for Salmonella and this is one of the few intestinal infections we can treat with an antibiotic.

Internet Resources

Salmonella Infections (KidsHealth)

Food Safety (KidsHealth)

Food Poisoning (CDC)

Technical Names: Urticaria, Angioedema

Nicknames: Hives, welts

(from Pediatric Physical Diagnosis Electronic Atlast, Zitelli and Davis)

What are hives? Raised, red, itchy lesions on the skin that often come and go and can coalesce together in to larger, red, itchy areas. Unlike other rashes, these come and go and move about the skin.

What Causes hives? Hives occur from allergic reactions. These can be to medications but more commonly to something in the environment or a virus. In most situations of hives, we never determine the actual cause.

Some hives are caused by physical changes in body temperature such as exposure to cold, heat or extreme exercise. Some people get hives when they are nervous. Bug bites can cause hives and so can the sun.

Hives occur because the allergen, the thing we are allergic to, triggers the release of chemicals in our cells. These chemicals, histamines, cause the hives and itchiness.

How long do hives last?

Hives can come and go for days to weeks.

Treatment:

• antihistamines: over the counter benadryl or claritin; prescriptions
• antiitchy lotions such as Avreno, Sarna, Calamine

When to Call Your Doctor

• hives associates with drooling or trouble breathing
• hives associated with ingesting food
• hives associated with red eyes or swollen joints
• hives associated with fever

All these symptoms may mean a more serious allergic reaction is occuring – call your pediatrician or 911.

Internet Resources for Parents

Hives Resource Center MedicineNet

American Academy of Dermatology Hives Page

Internet Resources for Teens and Kids

Help With Hives (KidsHealth)

Technical Names: Lyme Disease

Lyme Map: Lyme has a definite geographic distribution. According to the CDC you’ll find Lyme in these three areas:

• Northeast: Massachusetts to Maryland.
• North-central states: especially Wisconsin and Minnesota.
• West Coast: especially northern California.

Nicknames: Lyme Disease, Lyme

What it is: tic-borne infection from ticks of the Ixodes genussed by the bacteria borrelia borgoferi

Typical Ages for Illness: any

Typical Symptoms: Lyme Disease has three stages.

• Early: is a characteristic rash at the site of the tic bite called erythema migrans. Its main property is an expanding, red circle.
• The second phase is more disseminated: multiple erythema migrans patches occur in 15% of patients, other symptoms that can occur during this phase are arthritis, conjunctivitis, nerve palsies, headache and fatigue. Other uncommon issues can develop during this phase if untreated.
• Late disease is chronic arthritis of the large joints, usually knees. This is very, very uncommon in kids who have been treated.

Etiology: Borrelia burgdorferi , a spirochete bacteria

Seasonal Issues: spring and summer when tics are out; geographic distribution includes New England, eastern mid-Atlantic states, upper Midwest in Minnesota and Wisconsin.

How’s It Spread? Via tic bite of infected tic

Incubation Period: 1-55 days with a mean of 11 days. Late symptoms occur months toyears later.

Diagnosis: clinical if rash present; quick lab assay that will remain positive for life – so it can be used for diagnosis but not to confirm if treatment was effective.

Prevention: REMOVE THE TIC if you remove the tic with in 2 days, Lyme will not get transmitted from the tic to the person its attached to. So, the sooner than better. How to remove? Take a tweezers and grab the tic on the head. Gently pull up and the tic will release. Don’t worry if the tic’s small pincers stay attached to the skin – those don’t carry disease and will not cause harm.

Treatment:

Antibiotics for 14-21 days orally for early disease. More complicated disease and late disease needs to be treated longer and sometimes by IV antibiotics.

Call Your Pediatrician if your child has: A tic bite where a characteristic rash began to form.

School and After school Activity Issues: no restrictions. This is not contagious person to person.

Internet Resources For Parents

CDC Lyme Page

Tick Management Handbook

Tick Bite Prevention

Internet Resources for Kids and Teens

Lyme Info For Kids

Lyme Info For Teens