Our typical sizzling summer has officially begun and temperatures are rising across the nation. My thermostat isn't reading as hot as some places like southern California (currently 114 degrees), but it's still pretty toasty outside.
Last night, a patient called me and wondered if their daughter had appendicitis. I always thought it would be the easiest diagnosis, and that we would call the surgeon and whisk the patient off to the operating room for an appendectomy, just like Madeline (one of my favorite books as a child). Well, over the years have I been taught a few things. At times the diagnosis is easy. The patient has the classic symptoms of a "tummy ache" that starts around the belly button, they may vomit a few times and have a fever and the parent in all of us thinks, "yuk, another one of those tummy viruses". But over several hours the tummy aches worsens, and moves from around the belly button (peri-umbilical) to the right lower quadrant and the nausea and vomiting persist and your child just looks SICKER. At the same time you may notice that they have a funny walk, and won't stand up straight, as they try to get to the bathroom and when possible, they move very little at all, as any movement makes the pain worse. This is classic appendicitis. For a parent, that means a phone call to the pediatrician, day or night, as that child needs to be examined. On the other hand some children just forgot to read Nelson's text book of pediatrics. They don't vomit, they may not have a fever, they are a little nauseated, but when pressed could still eat, and it only hurts in their right lower quadrant, everything else is just okay. These are the difficult cases to diagnose. These children require a lot more history, repeat exams and lab tests and may even need a CAT scan to look at their appendix. But, you don't want to miss an appendicitis, as a perforated appendix is serious and requires a lengthy hospitalization. So as a parent and a doctor, if your child's tummy ache seems to be getting worse, it may be worth a trip to the doctor to feel that tummy, run a few tests and decide how to proceed. It is not always as easy as in a book or on TV. That's your daily dose, we'll chat tomorrow!
I seem to get several calls each year about acute mountain sickness which may occur when traveling to altitudes above 5,000 feet (1,500 meters), but is typically associated when travelling to altitudes of 8,000 14,000 feet (2,440 4,270 meters). To give you a frame of reference, Denver, Colorado is 5,280 feet above sea level, while Vail, CO is 8,200 feet. Fortunately, most people will not have serious problems when traveling to higher altitudes. The human body acclimatizes to higher altitudes by allowing your body to function with less oxygen without having distressing or debilitating symptoms. Despite that, the body is not functioning as well as it does at sea level, as the air is less dense at higher altitudes and consequently there is less oxygen available for breathing. The first thing you may notice is a slight increase in respiratory rate, which will help to increase oxygen delivery to the lungs but at the same time results in the loss of extra CO2. Some people may also notice an increase in heart rate. I think that most children without underlying medical problems (chronic pulmonary or cardiac problems), seem to actually acclimate better than adults. But in some cases you may notice that your child has non-specific symptoms such as irritability (I must admit hard to tell if altitude, traveling or just having a bad day), decreased appetite, headaches, disrupted sleep (always seems to happen when travelling with children) and occasionally vomiting. All of these symptoms usually resolve after several days and may be minimized by planning a gradual ascent to higher altitudes. So, driving may be better than flying, but..I can remember several days while driving to Colorado with cranky children and we were not even out of Texas! I also think one of the boys vomited due to the driving and not altitude. Oh well, fond memories nonetheless. For some children and teens who have experienced repetitive episodes of altitude sickness
It's the sick season and colds are rampant right now. Everyone is asking: what is the quick fix to get rid of a cold? Unfortunately, when it comes to a cold nothing is quick.
The common cold starts with a runny nose then a scratchy throat followed by a cough. Your child may tell you they just feel yucky.
Don't be alarmed if your child's mucous turns from clear to colored. A green runny nose does not mean a bacterial infection, so need to ask your doctor for an antibiotic they do not help the common cold and are not needed.
The only proven treatment for a cold is a tincture of time and treating your child's symptoms will help them feel better, sooner.
Here's what I recommend to my patients:
-For a runny and stuffy nose, start with a hot shower to loosen up the secretions.
-You can also try nasal suctioning with a bulb syringe or a nasal aspirator for young children.
-For older children, I encourage saline rinses with an irrigation system like a Neti pot. Many of my patients swear by it.
At night, place a cool mist humidifier in your child's room to add some moisture to the dry heat in the house.
You can expect your child's cold to last about 7 to 10 days. Don't forget to tell your kids to cover their nose when they sneeze and wash their hands to stop the germs from spreading to everyone in the family.
I'm Dr. Sue with The Kid's Doctor helping parent take charge.
Those of us who opted for flu vaccine earlier this fall are hopefully already protected and it looks like this years vaccine is a good match for the 3 types of flu that are already circulating.
The flu vaccine contains 3 different types of flu strains, 2 Flu A, and 1 Flu B. We are seeing both types of flu right now, as is a great deal of the southern United States as well as the Midwest. Last week, the CDC reported flu in 49 out of 50 states
For those of you who haven't been immunized yet, GET THE VACCINE NOW! Call your pediatrician, local pharmacy or health department, as the vaccine is not readily available.
If you have been fortunate enough and not have had to visit your pediatrician since the fall (good healthy kids!), you may not have had the opportunity to be reminded to get the vaccine. In fact, the last patient of the day yesterday was a 10 year old boy with classic flu symptoms: sudden onset of fever, chills, cough, scratchy throat and body aches. His mother thought that she had been in and had gotten the vaccine but when I looked it was LAST fall and the time had just escaped her. Not uncommon when you have healthy children who only see their pediatrician once a year.
Even if you have been unlucky enough to already have had the flu, which really knocks you down for at least 5-7 days, you should go get the vaccine once you are over the acute illness. Believe it or not, you could actually contract one of the other strains of flu that will continue into the flu season. Some might say that it can't happen, but it does!
Lastly, if you do get the flu keep your child home from day care or school and all of their other activities. Flu is very contagious, and going to school just spreads the virus to others. This is also true for parents, who need to stay home from work with the flu as well.
Keep washing those hands! We have a long winter ahea
What is that hissing noise in the air? Plenty of wheezing and coughing ushering in upper respiratory season. With all this noise, I'm on the lookout for respiratory distress. As I start to see more and more sick kids, my office becomes a cacophony of coughing. While many of the coughs sound horrible, fortunately most of the children I will see do not have any real respiratory distress.
I will spend a lot of time this respiratory season talking to parents about respiratory distress and what to watch for. Just like so many things in parenting, observation is the key. Watching your child's breathing when they are coughing or even wheezing is the most important thing you can do. But knowing what is distress or shortness of breath really often means you need to know what to look for.
I just saw a precious little girl in the office, my first patient of the morning. She had a history of a few episodes of wheezing, and did have a nebulizer and medications at home. She had been well all summer and the mother hadn't thought about wheezing, but noted that her daughter started to cough over the weekend and had then gotten worse and had coughed all night, which made her come to the office bright and early the following am.
When I walked into the room I immediately could see that the little girl was in a bit of respiratory distress. Not only was she coughing (which every other patient seems to be doing), she was also retracting or pulling. She was still happy and playing but you could see that she was working to breath. Her tummy was moving in and out and you could see her ribs pulling in and out a bit. She was still well oxygenated and pink.
Her mother had not looked at her chest and had forgotten about her daughter's nebulizer (you know, out of sight out of mind), as she had not used it for 6 months and was not clued back into coughs and respiratory season.
A quick review and she remembered what we had discu
The weather has been up and down all over the country with some unseasonably hot days, followed by cold days and then warm days in between. At the same time lots of people are experiencing the first colds of the fall season. Funny, I continue to hear the reason I am sick is this weather, hot and cold, up and down, just makes you sick!
But, I am sure that you really do know that the weather change does not make you sick. That seems to be a long-standing old wives tale that my grandmother used to tell us as well. She would also say, don't go to bed with a wet head or you will catch a cold.
The change in weather does not cause illness. It may mess up your wardrobe choices, or cause a last minute change in birthday plans when your outdoor party is moved indoors due to a 30 degree drop in temperature, but it will not cause an illness.
The truth is that viruses live better in cooler weather. Children are spending more time in together in a classroom sharing knowledge and germs. As the weather turns cooler, wetter and gloomier, we all tend to move from outdoor activities to indoor activities. The combination of all of these factors suddenly converge and viral upper respiratory season arrives.
Bottom line: it is not the change in weather that is making you catch a cold, but rather the usual respiratory viruses that are back as the seasons change. It is just the beginning of the cold season, so despite ups and downs with temperatures, the best protection is not a coat, but rather good hand washing and covering those mouths when you cough. Personally, I love this weather; every day is different!
Has your baby had their first cold yet? It is just the beginning of cold season and there are many more colds ahead during the next 5 months of upper respiratory season.
I remember as a mom/pediatrician that the first cold a baby has is the hardest. Like so many things in life, once you have some on the job training, you can look back and realize that you can manage many issues, including the common cold.
A baby with a cold looks like we all do, they have red rimmed eyes, a runny nose, a cough and they act like they don't feel well. A baby may also run a bit of a fever on the first day of a cold, so remember, fever is your friend (another post).
The best way to treat a cold is the same for baby/child/adult, you just have to treat your symptoms. Unfortunately, there is still not a cure for the common cold, and when there is one day, the cure will win the Nobel Prize in Medicine!
For an infant, one of the biggest problems is the congestion and runny nose and the fact that cannot yet blow (or even pick) their own nose. But, at the same time they are snotty and have a hard time breast feeding or taking a bottle and worst of all they don't sleep well. Us older parents were used to using the bulb syringe, but now the parents of babies are swearing by the Nosefrida.
I must admit I was totally skeptical and thought they were inserting this contraption way into their baby's nostril! We doctors used to use a Lee catheter somewhat like this in the delivery room to clear a baby's nose but this little device is placed at the edge of the nostril, rather than into the nose itself.
A small tube extends from this and the parent then uses their mouth to suck on the tube (like a straw) and the mucous is sucked into this little tube with a filter to keep the mucous from going up the tube. (no buggies in the mouth). Does that all make sense? You can use just the right am
It only took a month of school being in session for the lice (pediculus capitis) problem to rear its angry head! I have had phone calls, emails and even frantic texts from many parents who are fighting head lice in their homes. This causes a lot head scratching in kids but even more anxiety in their parents (a few of whom have also gotten lice).
The first line treatment for lice is NOT to shave your child's head (as one mother threatened), but to buy one of the over-the-counter products for the treatment of head lice. These products contain either permethrin or pyrethrin.
It is important that a parent follow the directions: using a hair conditioner before the use of the OTC product can diminish the effectiveness, and many products recommend not washing the hair for several days after finishing the application. It is also important to follow the directions for re-applying the product in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert!
But with that being said even with parents following the directions to a T, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice.
There are now four fairly new prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is currently preferred for use.
Lastly, there has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA lab