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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?                                                                               July 2009

             

 

 

 

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.

For more suggestions, check our what's new page.

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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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Swimmer’s Ear

  • itchy, painful ear canals

  • pain when earlobe is moved up and down

  • pain when tab of earlobe overlying ear canal is pushed in

  • currently in swimming or water sports

These symptoms occur when water gets trapped in the ear canal.  The lining of the ear canal becomes swollen and prone to infection. 

Treatment includes antibiotic ear drops until symptoms are gone.  Children should stay out of the water until symptoms are gone.

Prevention includes keeping ear canals dry.  After swimming dry ears and pull on earlobes while tipping head to side to help water run out.  

 

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Poison Ivy

-  plant that emits the oily irritant, urushiol.  The urushiol chemically “locks on” to skin proteins within 20 minutes after exposure to the plant.  Contact with this annoying oil produces a rash in three out of four people. Symptoms include:

  • rash with redness and blisters

  • eruptions on exposed body surfaces

  • shaped like streaks or patches

  • extreme itchiness

  • onset 1 to 2 days after patient was in a forest or field

  • symptoms usually last two weeks.

The best treatment is prevention, however if you find yourself with the rash, treatment includes:  cool soaks to affected area, 1% hydrocortisone cream twice/day for 3 days.

Cut fingernails short to prevent infection from scratching.  Benadryl orally may be used to decrease itching.

Contagion:  The fluid from the sores is not contagious.  However, anything that has poison ivy oil or sap on it is contagious for about one week.  This includes shoes and clothes the patient wore, as well as any pets with oil on them.  Wash items with soap and water.  The rash begins 1 to 2 days after contact.

Prevention includes learning to recognize the plant.  

 

                                      Poison Ivy

 

Wear long pants or socks when walking through the woods.

If you think you have come into contact with this plant wash any exposed areas of skin several times. Try to do this within one hour of exposure.

Need to be seen if poison ivy is on the face, eyes or lips or if with signs of infection (pus or soft yellow scabs).  

 

Poison sumac and Poison oak contain urushiol also so be aware of these plants too.

        

                  Poison Sumac                                                         Poison Oak

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Insect Bites or Stings

Most insect bites cause local irritation and inflammation. In most children, localized swelling (area of the bite) may be noticed for several days. If stung, remove the stinger if still visible in the skin. 

Treatment:  Apply ice to area. Apply paste of baking soda to insect bites, paste of meat tenderizer to stings.

                    Can apply 1% Hydrocortisone cream to area 2-3 times/day 

                    Benadryl orally every 6 hours as needed for itching. 

                    Call 911 if any breathing difficulty is noted.

 
Follow-Up: If swelling or redness increase after 48 hours, if with purulent drainage, if with red streaks in area of bite or with fever

 

SPIDER BITES

Learn to identify the types of spiders that are common to your area.  Most spider bites are not dangerous and will heal in a day or two. 

The Black Widow spider is black with a red hourglass shape on its underbelly.  It can be found in dark, quiet places, such as lawn furniture and in garages.  A bite from this spider is very painful, and results in headache, shortness of breath, fast heart rate, nausea and vomiting, abdominal pain and muscle spasms.  These symptoms occur within 30 minutes but could be delayed for 12 hours.

The Brown Recluse spider is light brown with a distinctive violin shaped marking on its back.  It lives in dark corners, under porches and in closets and basements.  Although its bite is mild, the area of the bite becomes painful, reddened and swollen within a day or two.

If bitten by a spider, clean the bite area with soap and water.  Elevate and apply ice to the area, and avoid strenuous exercise.  Seek medical attention if you think the bite is from a Black Widow or Brown Recluse spider.

INSECT STINGS

Stinging insects such as wasps, hornets, and yellow jackets embed a sharp stinger into the skin and secrete venom.  Scorpions, centipedes and some caterpillars also sting.  To prevent stings, avoid recreational activities when bees and wasps are nearby.  Do not wear fragrances or brightly colored clothing when outside.

If stung by a bumblebee or honeybee, remove the stinger immediately by scraping with the edge of a plastic card or long fingernail.  Barbs from caterpillar stings can be dislodged by placing the sticky side of a piece of masking tape over the area and gently pulling it off.

Watch the person who has been stung for at least an hour for any severe allergic reaction (hives, wheezing, tongue swelling or inability to breathe properly).  If an allergic reaction develops, call 911.  If available use an allergy kit injection or administer chewable antihistamines.

For symptom relief, apply hydrocortisone cream 1%.  A cold pack applied to the bite area will reduce pain and swelling.

FIRE ANT STINGS

Fire ants usually attack with multiple burning stings causing local swelling, itching and pain.  In time, the sting area becomes a small pustule.  Fire ant stings usually go away in a few days with no ill effects.  

If there is a sign of infection, see a healthcare provider.  Applying cold compresses and topical hydrocortisone will relieve burning and itching.  Do not apply heat to the area and do not open the pustules because they may become infected.  Effective oral medications include ibuprofen or acetaminophen, and antihistamines.

MARINE ANIMAL BITES

Marine animal bites cause either puncture wounds or rashes.  Pain, swelling, and skin discoloration are the first signs, sometimes followed by vomiting, paralysis, seizures and breathing difficulties.

A puncture wound from a stingray appears as a laceration with blue edges, pain, swelling and some bleeding.  A scorpion-fish puncture wound has immediate and intense pain, a red halo, and rapid swelling.  Many small punctures accompanied by immediate and intense burning with severe muscle aching and evidence of venomous spines are probably the work of a sea urchin.

Rashes can be caused by bristle worm, fire coral, sea anemones (instant burning, itching hives), and jellyfish.  Most jellyfish create "tentacle prints", or a whip like pattern of darkened reddish brown or purple.  They can leave frosted and crosshatched stripes on the area of contact.

First aid for punctures and rashes includes washing the area to remove any visible pieces of spine or animal parts.  The area can be shaved with a dull knife or plastic card to remove smaller animal parts.  If the wound looks infected, see your healthcare provider.

For fire coral, jellyfish or sea anemone stings, liberally soak the rash with a 5% acetic acid (vinegar) to relieve the stinging.  Use 40% to 70% rubbing alcohol if no vinegar is available.  Apply the vinegar or alcohol for 30 minutes or until the pain is gone.  Ice or cold compresses after treatment may help to relieve swelling and itching. Do not use fresh water on jellyfish stings as it may cause the microscopic cysts to swell and burst, causing more stinging.

SEA LICE INFESTATION

Sea Bather's eruption occurs within a few hours of bathing in the Caribbean, off the coasts of Mexico , Florida , Long Island, or New York .  It is caused by sea lice, the larvae of jellyfish.

The eruption (rash) consists of intense, itchy, red welts like mosquito bites in areas covered by swimwear.  The lesions usually go away without treatment in a few days, but some people experience severe rashes and reactions that include itching, fatigue, fever, chills, nausea and headache. 

Taking an oral antihistamine or applying a topical hydrocortisone cream will soothe the itching.

~Centers for Disease Control

 

 

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Tick Bite Prevention

Many infectious diseases are transmitted by ticks.  Lyme disease is the best known, but others that may not sound so familiar include Rocky Mountain spotted fever, tularemia and tick paralysis.  Not all ticks carry disease, and not all that can make your child sick, will.  Here are some precautions you can take when outdoors, especially in wooded areas and grasslands.

  • Simple avoidance:  Ticks usually climb from the ground or vegetation, so it helps to avoid tall grass or thick ground cover as well as dense woods.  Try to stay on cleared trails, away from brush and vegetation.

  • What to wear:  Ticks are most likely to bite in areas of warmth-at the beltline or neckline, at the tops of shoes or boots, on the scalp, or in the groin or armpits.  Wear long pants tucked into socks or boots.  Wear a long sleeved shirt that is snug around the wrists and tucked into the waistband.  Don't wear sandals or open toed shoes.  Wear light colored clothing to make it easier to find ticks.

  • Use repellents:  Spray a repellent containing permethrin on clothes (not skin), if product is available.  Be careful when using products with DEET in children.  Use in small amounts, and follow the label directions carefully.  Too much DEET can cause side effects.  Ask your veterinarian about tick repellents for your pets.

  • Self-inspection: After you've been outdoors, especially in wooded areas or grasslands, check your child's body carefully for ticks twice a day.  Don't forget to inspect the neck and scalp.  You can use a fine tooth comb to find ticks in the hair.  Be aware that some ticks, including the one that transmits Lyme disease, are tiny-about the size of a poppy seed-before they are swollen with blood.  Be sure to check pets for ticks, too.

  • Tick removal: If you find a tick on your child the best way to remove it is to grasp the tick at the point of attachment and apply slow, steady traction.  This should remove the tick intact with the cement.  Using a lighted match, heated nail or pocketknife may burn your child or cause the tick to regurgitate its contents into the host and does not stimulate the tick to detach.  Experts recommend using a blunt medium tipped pair of forceps or tweezers.  Be sure to remove all mouth parts and cement with forceps or tweezers.

  • Treatment after exposure:  It is unnecessary to preserve the tick in alcohol because the predictive value of tick analysis has not been defined.  Post exposure prophylaxis with antibiotics is also not recommended, because of, first, the low risk of disease transmission after a tick bite and, second, the risk of adverse effects from the antibiotic.  Prophylaxis will be considered if a person has multiple tick bites or if a tick's attachment is known to have lasted 72 hours.

~Contemporary Pediatrics May 2006

 

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Lyme Disease

Lyme disease is caused by a bacteria transmitted to humans through tick bites.  Left untreated, it can lead to heart problems, neurological symptoms or arthritis.  Most reported cases are concentrated in the coastal Northeast and mid-Atlantic, as well as Wisconsin, Minnesota and Northern California, but the disease has been reported in nearly every state.  Outbreaks tend to occur in summer and early fall.

Deer ticks are so small that they can be difficult to see, so you may not realize you've been bitten.  The telltale sign of infection is a red expanding rash (usually at the location of the bite) that swells to form a circular or oval shape, like a bull's eye.  This rash can show up three to 30 days after transmission and is usually not painful or itchy.  Other signs may include fever, headache, muscle and joint pain, stiff neck, sore throat, fatigue and changes in vision.  Treatment usually involves a three week course of antibiotics which often provides a full cure.

Although many ticks don't carry Lyme disease, bites should be monitored.  Carefully remove the tick.  Your chances of contracting Lyme disease are greatly reduced if you remove the tick within 24 hours.  Studies show that transmission does not occur until 36 to 48 hours after the tick attaches to your body.  If symptoms occur, see your doctor immediately.

~Centers for Disease Control

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West Nile Virus

West Nile virus is spread to humans, birds and animals by the bite of an infected mosquito.  The mosquito becomes infected from biting a bird with the virus.  Crows and bluejays are the birds most likely to die from the infection.

If you find one of these dead birds contact your local health department in case they want to test the bird for the virus.  To dispose of the bird wear rubber or plastic gloves or use a shovel to pick up the bird.  Place the bird in a plastic bag, tie it shut and place inside another plastic bag and close.  Wash hands well when done.

Most people infected with West Nile virus have no symptoms or experience mild illness.  The illness would occur 5 to 15 days after getting bit by the infected mosquito.  The virus is not communicable between humans. 

Symptoms are generally mild and include:  fever, headache, body aches, skin rash and swollen lymph glands.  Severe infections are marked by high fever, neck stiffness, stupor, disorientation, coma, occasional convulsions and paralysis.

Prevention is the key to avoid infection.  You can reduce the number of mosquitoes around your property by eliminating areas of standing water.  Turn over wading pools when not in use, dispose of cans or containers that hold water.  Clean birdbaths weekly.  Aerate ornamental ponds or stock with fish. Use yellow bug lights in your outdoor lights, bugs are less attracted to these lights.

Wear light colored clothing, long sleeved shirts or jackets and slacks.

Use insect repellent with Deet (6-30%) for children when outdoors.  Remember to wash off when come inside, spray onto clothes rather than skin.

Stay indoors if possible when mosquitoes are most active, generally two to three hours before and after dusk and at dawn when the air is calm.  This is when the females are most likely to bite.

For more information go to the Ohio Department of Health website at www.odh.state.oh.us.  Search for “ West Nile ”.

 

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Rashes

In general, most rashes are viral in nature or the result of contact with a skin irritant.  Rashes often appear and disappear without any treatment.  Call the office if your child has a fever with the rash, the rash is hive-like in appearance, or if the rash is spreading or appears infected.

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Injuries:  Abrasions, Cuts/Lacerations, Falls 

This is the season of outdoor activities which means the number of injuries increases significantly.  Maintaining outdoor equipment in proper working order and wearing appropriate safety gear will help to reduce injuries. Treatment for the most common injuries is as follows:

Abrasions:  These result in injury to the top layer of the skin.

Treatment:  Cleanse with an antibacterial soap, apply antibiotic ointment and observe for signs of infection: increased redness, tenderness, swelling or discharge at the site.

Cuts or Lacerations: These are generally deeper, more irregular wounds.  Depending on the wound these may require sutures.

Treatment:   If the wound won't stop bleeding after pressure is applied or if the wound is gaping (like a buttonhole) it is recommended to seek treatment at an emergency department for possible suture closure. 

Falls:  These accidents can result in the above injuries and also could include fractures and serious head injury.

        Fractures:  If your child has sustained a fall or trauma and is unable to move an extremity, has limited range of motion, bruising, swelling or point tenderness at the site of the injury, they should be seen at an emergency department for radiographic evaluation of the injury.

        Head Injury:  If your child has sustained a fall or blow to the head it is important to assess for signs of serious head injury.  These include:

            - loss of consciousness.  

            -  persistent headache or vomiting (greater than two times)

            -  clumsiness or inability to move a body part

            -  abnormal speech or behavior

            -  oozing of blood or fluid from ears and or nose

            -  convulsions

If your child exhibits any of these symptoms following a head injury call 911 or seek treatment at an emergency department.

If your child has none of the above symptoms, apply ice to the injured area and observe for the above signs of a more serious head injury.  It is not unusual to see a lump form over the injured area.  This is normal and could last for several days.

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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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Sunburn

We recommend the use of sunscreen with an SPF of 30 or higher on all children over 6 months of age.  If your child is sunburned:

  • Use Tylenol or Motrin for pain
  • Apply cool compresses to affected area.
  • If blisters appear, allow them to break open on their own.
  • Once the blister has broken, observe for signs of infection (discharge, increased redness or tenderness, fever)
  • Follow up at the office is recommended if the sunburn with blisters  involves a large portion of the body or face.            

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Fifth Disease (Slap Cheek)

 

A bright red rosy rash on both cheeks for 1 to 3 days (slapped cheek appearance). Rash on cheeks is followed by pink “lacelike” rash on extremities, mainly on thighs and upper arms. The rash can come and go for a period of 1 to 3 weeks. Usually no fever or with a low grade fever.

 

This illness is caused by the human parvovirus. It is a mild illness with few other symptoms. The incubation period is 10-14 days after exposure. This illness is mainly contagious the week before the rash begins. If you are pregnant and exposed to a child with fifth’s disease contact your obstetrician. 

 

Treatment: No treatment is necessary. The distinctive rash is harmless and causes no symptoms requiring treatment.  

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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 (LiceMD, 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 are not recommended in children under 6 years of age. A recent study in the Archives of Pediatrics & Adolescent Medicine, found that one teaspoon of honey before bed worked better than cough medicine.  Honey should not be given to children under 1 year of age. 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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Coxsackie (Hand, Foot and Mouth)

 

Symptoms include small ulcers in the mouth, small water blisters or red spots on the palms and soles of the feet and in between fingers and toes. This illness can be accompanied by low grade fever (100degrees F). Mainly occurs in children 6 months to 4 years of age.  

 

It is caused by the Coxsackie virus. The incubation period after contact is 3 to 6 days. The fever can last 3-4 days with resolution of the rash in 7-10 days.

 

 Treatment includes acetaminophen for fever, lots of fluids, and a soft bland diet. Avoid salty, spicy and citrus foods. 

 

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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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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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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