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*Please be aware that information provided on this website is for your further education only. It is not to replace the medical care you would receive from our office in response to specific symptoms and questions.  If you have any questions, call the office.                                

What's Going Around?                                                                                November 2008

 

 

 

 

 

Allergies

Although this time of year brings renewed life to our trees, plants and lawns, it also renews symptoms of allergy sufferers.  If this time of year brings the onset of itchy, watery eyes, sneezing and a red, stuffy nose you probably suffer from seasonal allergies.  Tree pollens tend to cause problems in winter and early spring, grass pollens arrive in late spring and early summer; weed pollens can cause allergies in late summer and early fall.  Over the counter antihistamine products generally work well to relieve symptoms.  Also, reducing your exposure to allergens will help to alleviate symptoms.  Recommendations include:

  •  Stay inside in the morning when pollen counts are typically highest.
  •  Keep windows and doors closed and use your air conditioner to reduce pollen in your house.
  •  Wash your hair before bedtime.
  •  Remove your clothes and shoes outside of the bedroom.
  •  Don't let pets sleep with you after they've been outdoors.

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Allergy do's and dont's 

  • Do learn when you're most likely to suffer symptoms.  Dry or windy days are worse than rainy days, when residual pollen is washed away.  Pollen counts are typically highest in the morning.

  • Do keep windows and doors closed and use your air conditioner to reduce pollen in your home.

  • Do wash your hair, face and hands before bed.  Remove clothes and shoes before entering the bedroom.

 

  • Don't let pets that have been outdoors sleep with you.

  • Don't expose yourself to allergens to "desensitize" yourself.  Learn what triggers symptoms and avoid the triggers.

  • Don't be afraid to have flowering plants in your garden.  Flowers are pollinated by insects, unlike trees and grasses which are wind-pollinated plants. Trees and grasses cause the most allergy symptoms because their pollens are light, small and easily inhaled.

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STREP THROAT

This is a sore throat caused by the streptococcus bacteria.  It can only be diagnosed with a rapid strep test or a throat culture.  Symptoms often include fever, complaints of a sore throat, headache or stomachache.  If your child has any of these symptoms for longer than 24 hours they should be seen to be tested for strep.  Untreated strep throat infections can have serious complications such as rheumatic fever.  Strep throat is usually treated with penicillin.  Generally, after being on the antibiotic for 48 hours symptoms have improved.  After taking the antibiotic for 24 hours, your child is no longer contagious and can return to school if the fever is gone and they feel better.  Tylenol or Motrin can be given along with the antibiotic to treat fever or for pain relief.  Warm salt water gargles and a soft diet are also helpful.  The incubation period after exposure is 3-5 days.  Anyone in close contact that develops symptoms during this time frame should be tested for strep throat.

 

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SCARLET FEVER

This is a strep throat infection with a rash.  The rash is caused by a special rash-producing toxin that is present in some strep bacteria.  The rash usually appears 18-24 hours after developing a sore throat and a fever.  The skin appears sunburned, with very small red bumps and it feels rough, like sandpaper.  The rash usually clears in 4-5 days after treatment with penicillin.  Occasionally the skin will peel where the rash was most prominent.  Your child is no longer contagious after being on the antibiotic for 24 hours.  The rash itself is not contagious.

 

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SORE THROAT

Most sore throats are caused by viruses and are part of a cold.  Tonsillitis (temporary swelling  and redness of the tonsils) is usually present with any throat infection, viral or bacterial.  The presence of tonsillitis does not have any special meaning.  Sore throats caused by a virus usually last 3-4 days.  Children with a postnasal drip from draining sinuses often have a sore throat from frequent throat clearing.  Treatment for sore throats include:  Tylenol or Motrin for pain and fever relief, warm salt water gargles and a soft diet.  Your child should be seen if the pain is severe, or if they are experiencing a great difficulty in swallowing, or are drooling or spitting.

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RSV(Respiratory Syncitial Virus)

RSV is a virus and the major cause of bronchiolitis (viral infection of the lower respiratory tract) and pneumonia in children less than one year of age.  It occurs most often during the winter and early spring.  It most often occurs in infants and small children under 2 years of age.  It is very communicable, by the time children reach the age of 2 years nearly 100% will have acquired an RSV infection.

Transmission:  RSV is acquired by contact with infected secretions, primarily infected hands touching the eyes or nose.  It is not an airborne illness.

Symptoms:  After exposure, the incubation is 5-8 days.  Symptoms include:  fever, large amounts of nasal secretions, ear or eye infections and development of a wet, choky cough.  As the illness progresses, these symptoms may appear:  wheezing, rapid or difficulty breathing and retractions (pulling in of chest muscles when breathing).

Prevention:  Good hand washing is the best prevention.  Wash toys between each use, cover mouth and nose with a tissue when coughing or sneezing, then wash your hands.  Dispose of all tissues in the garbage.  Don't share towels or washcloths to prevent the spread from dried secretions.

Treatment:  Treatment includes management of the symptoms, use of a cool mist vaporizer, and plenty of rest.  If your child's symptoms are worsening or with any difficult respirations call the office to be seen.  Some children require hospitalization to manage the respiratory symptoms.

 

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FLU (INFLUENZA)

Flu or influenza is caused by a virus.  Flu almost never causes gastrointestinal symptoms; the illness that people often call "stomach flu" is not influenza.  A flu virus is more active from fall to early spring. 

Transmission: Influenza viruses are spread from person to person primarily through coughing and sneezing of infected persons.  The typical incubation period is 1-4 days with 2 days being the average.  Adults can be contagious from the day before symptoms appear through day 5 of the illness.  Children can be infectious for greater than 10 days and can shed the virus several days prior to the development of symptoms.

Symptoms:  Influenza is characterized by the sudden onset of fever, headache, malaise, non-productive cough, sore throat and runny nose.  Among children ear infections, nausea and vomiting are also sometimes reported.  Symptoms usually resolve after 3-7 days for the majority of people, although the cough and malaise may last longer than 2 weeks.

Prevention:  Each year a new flu vaccine is formulated from inactivated (dead) viruses.  The preparation is based on the strains in circulation at the time and those predicted to be in circulation during the winter.  The vaccine should be given 6-8 weeks before the flu season begins in order to stimulate antibodies to prevent infection or reduce the severity of symptoms.  Target groups for receiving the vaccine can be found on the What's New page on this website.  Check with your local health department regarding the availability of flu vaccine.  Other measures to help prevent the flu include:

  • Avoid close contact with people who are sick.

  • Stay home when you are sick.  If possible, stay home from work, school and errands while you are sick to prevent the spread of illness to others.

  • Cover your mouth and nose with a tissue when coughing or sneezing.

  • Clean your hands often.

  • Avoid touching your eyes, nose or mouth.  Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.  Keep antibacterial sanitizer handy and use it often.

Treatment:  Treatment includes management of the symptoms.  Analgesics to reduce fever and ease muscle pain, fluids, and plenty of rest are recommended.

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  Concussions

A concussion is a broad term and can apply to a range of injuries.  It is a brain injury associated with an immediate and 

temporary loss of normal brain function.  According to the American Academy of Pediatrics, 20% of the head injuries that occur are sports related.  An even more sobering statistic is that 20% of all high school football players and 40% of all college football players will suffer a head injury at some point in their career.  Concussions represent a diffuse injury to the brain.  The optimal treatment is to prevent the injury in the first place.  Using seat belts and wearing proper equipment while playing sports, can help avoid a concussion.

The good news is the brain can repair itself.  A concussion shakes up the signal pathways of the brain, so it may take a period of days or weeks for everything to return to normal.  Symptoms that should raise red flags are persistent headache, nausea, vomiting or the sudden onset of weakness, seizure or abnormal pupil size.

Most children make a good recovery and return to normal function.

The American Academy of Pediatrics divides concussions into 3 categories:

1.  MILD:  confused, but not knocked out.  May return to play after 20 minutes if symptoms completely clear. 

2.  MODERATE:  confused, with memory loss.  May play after one week if all symptoms clear completely.

3.  SEVERE:  knocked out.  May play after one month if all symptoms clear.

~American Academy of Pediatrics

In addition, the CDC has offered the following information regarding concussions:

Signs and Symptoms

Observed by Parents or Guardians

  • Appears dazed or stunned.
  • Is confused about assignment or position
  • Forgets sports plays
  • Is unsure of game, score or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can't recall events prior to the hit or fall
  • Can't recall events after the hit or fall

Symptoms reported by the Athlete

  • Headache or "pressure" in the head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  • Does not "feel right"

What you should do if you think your child has a concussion:

1.  Seek medical attention right away.  A health care professional will be able to decide how serious the concussion is and when it is safe for your child to return to play.

2.  Keep your child out of play.  The brain needs time to heal.  Don't let your child return to play until a health care professional says it's OK.  Children who return to play too soon - while the brain is still healing - risk a greater chance of having a second concussion.  Second or later concussions can be very serious.  They can cause permanent brain damage, affecting your child for a lifetime.

3.  Tell your child's coach about any recent concussion.  Coaches should know if your child had a recent concussion.  Your child's coach may not know about about a concussion your child received in another sport or activity unless you tell the coach.

 

For more information visit:  www.cdc.gov/ConcussioninYouthSports

 

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Roseola

Roseola is a viral rash caused by the human herpes virus6.  This virus generally affects children ages 6 months to 4 years of age.  The rash is a fine, pink rash on the trunk of the body.  The rash is preceded by 2-3 days of fever.  The fever goes away and then the rash appears.  There is no treatment necessary other than fever management.  The child is contagious while with the fever and until the rash is gone usually in 1-2 days.

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LICE

Head lice spend their entire lives on the human scalp, clinging to the hair while feeding, mating, and laying eggs.  They are unrelated to hygiene or living conditions. Lice cannot jump or fly (they have no wings).  Transmission is after close physical contact-head to head.  The transfer of lice from host to an object to a new host is relatively rare.  Though it is possible for lice to be transferred from a personal item; pillow, hat, towel, brush, it would have to be used immediately after it was used by an infested person.  Lice cannot live off the human body for more than 24 hours.

Diagnosis:  The main symptom is itching.  Diagnosis is confirmed by the presence of a live, mobile louse.  The louse is about the size of a sesame seed and brown in color.  Nits (eggs) are deposited on the hair shaft usually within 6mm of the scalp.  These eggs will hatch in 7-10 days.  Nits can remain stuck on the hair shaft for weeks or months after an infestation has been treated.  A positive diagnosis is based on the presence of a live louse.  If someone in the family is diagnosed with lice, the entire family should be checked.

Treatment:  Nits can be removed with a fine tooth comb.  Part the hair into small strands and comb through hair.  Examine the comb for any lice.  If no live lice are found, repeat the procedure in 1-2 days.  If live lice are found the first line of therapy is over the counter pediculicides (Rid, Nix, Lice Arrest, for example).  Follow the package directions closely.  Treatment is for external use only.  A second treatment should be applied in 7-10 days, if a live louse is found, because 25-30% of lice eggs survive treatment.  In general, these preparations are safe to use.  Prescription treatment for lice is used only if infestation has not responded to safer treatment.

Linens, towels, clothes worn 2 days before treatment should be washed in hot water and dried on high heat.  The room should be vacuumed or wet mopped.  Dry clean items that are not washable or seal in plastic bags for 2 weeks or place plastic bag in the freezer for 3 days.  Remember to vacuum furniture and car seats.  Soak brushes and combs in dishwashing detergent and hot water for one hour, rinse and dry.

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PINWORMS

Pinworm infections are caused by a small, white intestinal worm.  Pinworms live in the rectum of humans.  While an infected person sleeps, the female leaves the intestine through the anus and deposits eggs on the surrounding skin.  The main symptoms of infection are rectal itching, disturbed sleep and irritability.  Pinworms are the most common worm infection in the United States.  School age children have the highest rate of infection.  The mode of transmission is the fecal-oral route.  You can become infected after ingesting infective pinworm eggs from contaminated surfaces or fingers.

Diagnosis:  Checking the rectum at night or first thing in the morning could reveal the presence of adult worms.  These will appear as tiny white threads.  Occasionally, worms are seen in the stool of infected persons. If you have found worms on your child call the office for treatment.

Treatment:  Pinworms are treated with prescription medication which is a two dose treatment.  Close family contacts may also require treatment.

To prevent the spread of infection:  change and wash your underwear each day, change pajamas frequently, trim fingernails short, encourage good hand washing after using the toilet, before eating and after changing diapers.  Discourage nail biting and scratching of bare anal areas, these practices help reduce the risk of continuous self infection.

After diagnosis, linens and towels of the infected person should be washed in hot water.  Vacuuming the entire house or washing sheets everyday are probably not necessary or effective. 

~Centers for Disease Control

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Fever

Fever is the body’s defense against illness and the body’s natural way of fighting infection.  The main reason to reduce fever is to make the child more comfortable.  If fever causes discomfort for your child, you may give acetaminophen (Tylenol) every four hours, or, if your child is over 6 months of age, ibuprofen (Advil, Motrin) every 6 hours.  Do not alternate acetaminophen and ibuprofen to treat fever.

Contact the doctor if your child:

-has a temperature of 100.4 (rectal) in an infant under 8 weeks of age

-has had the fever for 3 days with no other symptoms

-has had the fever for 24-48 hours with other symptoms of illness (ie. cold symptoms, cough, urinary frequency, sore throat, etc.)  

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Colds

A cold or upper respiratory infection is a viral infection of the nose and throat.  These viruses are spread from one person to another by hand contact, coughing and sneezing - not by cold air or drafts.  Since there are up to 200 cold viruses, most healthy children get at least 6 colds per year.

   Symptoms include:  A runny or stuffy nose, usually has fever, sometimes associated with a cough, hoarseness and red eyes.

   Expected course:   Usually the fever lasts for 3 days, and all nose and throat symptoms are gone by 2 weeks.  A cough may last 2 to3                                      weeks.  The main things to watch for are secondary bacterial infections such as ear infections or conjunctivitis.                                      Thick yellow nasal drainage lasting longer than 2 weeks could be a sinus infection in children over 2 years of age.                                           

   Treatment:  The best treatment is clearing the nose for a day or two.  Older children should be encouraged to blow their noses. 

                        Infants can have secretions removed gently with a soft rubber suction bulb.

                        Fever (over 102 F) can be treated with acetaminophen or ibuprophen.

                       Warm salt water gargles and hard candies can soothe sore throats in children over 4 years of age.

                       Run a humidifier in the child's bedroom to provide extra moisture in the air.

Call the Office:  If  the fever lasts longer than 3 days

                           The nasal discharge last more than 14 days.

                           The eyes develop a yellow discharge.

                           You cannot unblock the nose enough for your infant to take adequate fluids.

                           Your child develops an earache.

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Croup

Croup is a viral infection of the vocal cords.  It is usually part of a cold.  The hoarseness is due to swelling of the vocal cords.  Stridor occurs as the opening between the cords becomes more narrow. Croup has a distinctive cough, it is tight and often sounds like a barking seal.  The voice is usually hoarse.  Croup usually lasts for 5 to 6 days and is generally worse at night.  The worst symptoms are seen in children under 3 years of age.  Using a cool mist vaporizer in the bedroom will help ease the cough.  Warm clear fluids may help relax the vocal cords and loosen mucus.

   If your child suddenly develops stridor or tight breathing, do the following:

  • Steam up your bathroom and take the child in there for at least 10 minutes.  Warm moist air seems to relax the vocal cords and break the stridor.
  • Taking them outside into the cool night air will also help to alleviate stridor.
  • If the stridor continues, call the office IMMEDIATELY.  If your child turns blue, passes out or stops breathing, call 911.

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Coughs

Coughs are an associated symptom of a cold.  Most coughs appear after having upper respiratory symptoms (colds).  In general, if your child does not have a fever, the cough is not affecting their activity or sleep, and is not causing respiratory difficulty the symptom should resolve in 5-7 days.  Over the counter cough medicines can be used at bedtime to promote restful sleep. Use of a cool mist vaporizer in the child's bedroom will often help quiet the cough.

Contact the doctor if your child:

- has had a cough for several days and then develops a fever lasting longer than 24 hours.

- has a cough that is nonstop or causing them to gag

- is having any difficult respirations. (wheezing, panting, etc.)

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Ear Infections

An ear infection is a bacterial infection of the middle ear (the space behind the eardrum).  It is usually a complication of a cold.  The pain is due to pressure and bulging of the eardrum from trapped, infected fluid.  The peak range for ear infections is 6 months to 2 years, but they continue to be a common childhood illness until 8 years of age.

Treatment includes an antibiotic to kill the bacteria causing the ear infection.  Acetaminophen or Ibuprofen can be given along with the antibiotic to treat fever or for pain relief.  Ear infections are not contagious.  A follow up appointment in 3 - 4 weeks is needed to be sure that the infection has cleared up.

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Vomiting

Most vomiting is caused by a viral infection of the stomach and usually lasts 6 to 24 hours.  The main concern with vomiting is to prevent dehydration. 

If your child vomits, do not give anything to drink for one hour.  After the hour you may rehydrate slowly with clear liquids (Pedialyte for infants to 2 years), gatorade for children over 2 years of age.  Start with a tablespoon of clear liquid every 15 minutes for an hour. If there is no further emesis, gradually increase the amount each hour.  If your child vomits again, you must wait an hour before retrying any liquid, this gives the stomach a chance to rest.  Remember, GO SLOW! Your child should remain on clear liquids for 12 to 24 hours before advancing diet. 

Observe for signs of dehydration:  no tears when crying, no urine output in eight hours, dry, sticky mouth and lethargy. Call the office if vomiting lasts longer than 12 hours in infants under 6 months of age, longer than 24 hours in children 6 months to 2 years of age and longer than 48 hours in children over 2 years of age, or if with signs of dehydration.

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Diarrhea

Diarrhea is the sudden increase in the frequency and looseness of bowel movements.  It is usually caused by a viral infection in the intestines.  Diarrhea usually lasts from several days to a week.  The main goal is to prevent dehydration due to loss of fluids.  Replacement fluids include pedialyte, gatorade in children over 2 years of age, ginger ale, popsicles and jello.  Avoid fruit juices as they may make diarrhea worse.  The diet should be changed to foods high in fiber and starches (breads, crackers, rice, mashed potatoes, and noodles). 

Call the office if your child has greater than 10 watery stools in a day, if the diarrhea lasts longer than 7 days, or if you notice blood or mucus in the stool.

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Conjunctivitis

Among the patients that a pediatrician sees on a typical day at the office, at least one child usually presents with a red eye (pink eye).  This is an infection of the clear membrane covering the white of the eye and the underside of the eyelid.  The cause can be viral, bacterial or an allergic response.  Bacterial conjunctivitis is the most prevalent cause of conjunctivitis.  This is because when a child has an irritated eye he will rub it, thereby secondarily infecting the eye with bacteria.  Children easily spread the infection through direct contact with the discharge, or through items they have touched such as towels, desks and toys.

Bacterial conjunctivitis is often associated with ear infections, sinus infections and a yellow-green eye discharge.  Bacterial conjunctivitis is the most common cause of pink eye in preschool children.  Viral conjunctivitis is usually associated with non strep sore throats and a whitish mucousy discharge from the eye.  Allergic conjunctivitis has a stringy, clear eye discharge.

Treatment of bacterial conjunctivitis aims to shorten the illness, lower the recurrence rate, reduce the contagiousness of infection, eradicate the causative germ and improve quality of life for the child.    This treatment usually involves the use of antibiotic eye drops.  Other suggestions to decrease the spread of the illness are good hand washing, proper disposal of tissues, and using separate towels and washcloths.

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Gemini Towers - 2001 Crocker Rd. #600 - Westlake, Ohio 44145 - 440-871-5100
Fairview Hospital Medical Building - 18099 Lorain Rd. Suite 304 - Cleveland, Ohio 44111


tel(216) 476-2300