Kid Doc — Good Job Being the Mom!
A fun and informative podcast for all the challenges parents face in raising their brood!
Kid Doc — Good Job Being the Mom!
Summer, Summer, Summertime--Challenges of Illness and Injury Unique to Summertime
SUMMERTIME BUGS--GERMS AND INSECTS; PLUS THE ALLERGIES THAT WE KNOW AND LOVE!
IT’S A LITTLE LATE IN THE SPRING/SUMMER SEASON, BUT WE WANTED TO COVER PROBLEMS THAT ARISE WHEN THE WEATHER WARMS UP
WHAT DOES THE WARMER WEATHER BRING BESIDES AN INCREASE IN INJURIES?
LET’S COVER ALLERGIES AND INSECTS FIRST AND THEN MOVE INTO THE SEASONAL ILLNESSES LIKE INTESTINAL VIRUSES AND HAND-FOOT-AND MOUTH DISEASE.
ALLERGIES ARE THE BIGGEST ITEM WHEN IT GETS WARM AND THINGS START BLOOMING.
WHAT IS THE CYCLE OF ALLERGENS?
WHEN DO YOU RECOMMEND TESTING FOR ALLERGIES?
WHAT NON-MEDICATION STEPS CAN PARENTS TAKE TO PREVENT ALLERGIES?
WHAT IS FIRST-LINE MEDICATION HELP?
HOW DO YOU STEP UP TREATMENT IF NOSE OR EYE SYMPTOMS ARE ESPECIALLY BAD?
INSECT BITES AND STINGS ARE A BIG PART OF KID PROBLEMS IN THE WARMER MONTHS. HOW DO YOU MANAGE THESE?
CAN WE DO ANYTHING TO PREVENT THE SWELLING REACTIONS TO MOSQUITO BITES?
WHEN TO PARENTS NEED TO COME IN?
WHAT IS YOUR BUG SPRAY ADVICE?
ANY COMMENTS ABOUT BEE STINGS?
WHAT ARE THE MOST TYPICAL ILLNESSES WE SEE IN THE SPRING AND SUMMER?
SO A LOT MORE OF THE INTESTINAL VIRUSES THAT WE HEAR ABOUT ON CRUISE SHIPS ARE HAPPENING NOW?
HOW DO INTESTINAL ILLNESSES PRESENT?
WHAT MAKES DIARRHEA COMPLICATED IN KIDS?
WHAT PROBLEMS ARE CREATED BY NOT PROCESSING LACTOSE APPROPRIATELY?
HOW DO WE MANAGE THE TEMPORARY LACTOSE INTOLERANCE?
WHAT ABOUT HELPING THE GUT FLORA?
ARE THERE DEHYDRATION CONCERNS?
WHEN SHOULD PARENTS BE CALLING FOR HELP?
SPEAKING OF LONGER-LASTING INTESTINAL SYMPTOMS, AREN’T SOME OF THESE INTESTINAL ILLNESSES CAUSED BY OTHER PATHOGENS BESIDES VIRUSES? WE TALK ABOUT THE WEBER WATER HERE IN DAVIS COUNTY.
ARE THERE RASH COMPLICATIONS OF INTESTINAL ILLNESSES?
WHAT DO WE NOT WANT TO MISS?
LET’S TALK ABOUT HAND-FOOT-MOUTH DISEASE
WHAT DOES THE RASH LOOK LIKE WITH HAND FOOT AND MOUTH
HOW LONG IS IT CONTAGIOUS AND HOW DO WE CARE FOR THE KIDS?
YOU MENTIONED VIRAL MENINGITIS AS WELL
WITH PLAYING OUTSIDE, KIDS GET LOTS OF CUTS AND SCRAPES THAT GET INFECTED.
IS IT FINE TO USE NEOSPORIN INSTEAD OF A PRESCRIPTION TOPICAL ANTIBIOTIC?
AND LAST IS THE CLASSIC SWIMMER’S EAR.
HOW ABOUT PREVENTION FOR SWIMMER’S EAR?
THIS WRAPS UP OUR DISCUSSION OF WARM WEATHER INFECTIONS AND MEDICAL PROBLEMS. REMEMBER TO APPLY YOUR SUN BLOCK.
Summertime bugs—germs and insects; plus the allergies that we know and love
IT’S A LITTLE LATE IN THE SPRING/SUMMER SEASON, BUT WE WANTED TO COVER PROBLEMS THAT ARISE WHEN THE WEATHER WARMS UP
It is interesting to view the seasonality of care we give in our office—most problems definitely have a season to them
WHAT DOES THE WARMER WEATHER BRING BESIDES AN INCREASE IN INJURIES?
Yes. We definitely see more broken bones and stitches which is to be expected with more outside activity.
But there is also a seasonality to bugs—both the seasonal germs and the insects that are out.
We see the various allergies in spring, summer, and fall. And Swimmer’s ear comes along with fun pool use.
LET’S COVER ALLERGIES AND INSECTS FIRST AND THEN MOVE INTO THE SEASONAL ILLNESSES LIKE INTESTINAL VIRUSES AND HAND-FOOT-AND MOUTH DISEASE.
ALLERGIES ARE THE BIGGEST ITEM WHEN IT GETS WARM AND THINGS START BLOOMING.
WHAT IS THE CYCLE OF ALLERGENS?
Exact cause of allergic symptoms can be difficult to know with certainty without testing. But in general we see tree allergens in the Spring, Grass allergies in the summer, and weed allergies in the fall.
WHEN DO YOU RECOMMEND TESTING FOR ALLERGIES?
Really only when considering immunotherapy—oral or injection treatment for allergies that can take many months or years.
The analogy I use is similar to LASIK surgery. If someone is fine managing their vision problems with glasses or contacts then stick with it. If they aren’t doing great then you can move to a more permanent solution like eye surgery.
Same with allergies—manage with what you can do at home and if you need more help then you can move to immunotherapy. Otherwise, if you do allergy testing and find out what you are allergic to, you still are left doing the same things you can do at home
MAKES SENSE.
WHAT NON-MEDICATION STEPS CAN PARENTS TAKE TO PREVENT ALLERGIES?
A huge help—Wash hair at night to prevent the accumulated pollen from depositing on pillow and worsening allergy symptoms overnight—They have this Pollen Pillow they sleep on all night.
I liken this to people that smoke that have asthma—thankfully I don’t have all these little kids that smoke—you can give more medicine to asthmatics that smoke OR you can stop smoking and help your lungs. Same with allergies—we can get rid of the Pollen Pillow exposure and help their allergies.
Wash sheets and pillows and stuffed animals on bed once weekly
Consider purchasing a one-room air purifier with HEPA filtering.
WHAT IS FIRST-LINE MEDICATION HELP?
Use claritin or zyrtec for several months at a time. If symptoms return after stopping use then restart the medication. This will make sure you are not stopping too often and will help to define the season the medication is needed.
Zyrtec or claritin dose is: 5-10 mg OR 1 mg for every 10 pounds
HOW DO YOU STEP UP TREATMENT IF NOSE OR EYE SYMPTOMS ARE ESPECIALLY BAD?
For extra bad nose symptoms: Use steroid nose spray, one spray each nostril every night for two weeks at a time. If symptoms return after stopping then use for two more weeks. This will make sure you are not stopping too often and will help to define the season the medication is needed.
Steroid to use is: nasonex or flonase or other...
For extra bad eye symptoms you may use Zaditor OTC one drop each AM and PM as needed
INSECT BITES AND STINGS ARE A BIG PART OF KID PROBLEMS IN THE WARMER MONTHS. HOW DO YOU MANAGE THESE?
For Mosquito bites I recommend: Benadryl 1 ml per 5 pounds every 6 hours to help with itch and redness. AND Zyrtec 1 ml per every 10 pounds every 24 hours for the next few days AND 1% hydrocortisone to affected area 2-3x/day to help with itch
SO A VERY SIMILAR REGIMEN FOR ALLERGIES?
Yes. Although this isn’t a mosquito allergy, your body kicks out histamine in response to the anti-coagulant the mosquitoes inject to keep the blood flowing..
CAN WE DO ANYTHING TO PREVENT THE SWELLING REACTIONS TO MOSQUITO BITES?
Option for doing zyrtec every day during seasons when they are around lots of mosquitos. It won’t change the number of bites but will minimize the reaction to the bites.
WHEN TO PARENTS NEED TO COME IN?
Call for any worsening and expanding redness OR worsening fever--would look at doing antibiotics.…
WHAT IS YOUR BUG SPRAY ADVICE?
Only products with DEET work very well—DEET is the gold standard. May use the Deep Woods high percentage DEET for older kids and spray it on clothing but only use the lower percentage Family Strength products for younger kids. Use clothing as first line protection and protect the small surface areas needed with bug spray after that.
ANY COMMENTS ABOUT BEE STINGS?
Bee and wasp stings—hymenoptera genus that share common toxins in their venom. Mostly it will be localized swelling which can be minimized with the same medications for mosquito bites as well as some cold compresses. There are different pastes that people apply. Obviously we are calling 911 for any breathing concerns after bee or wasp stings. People with known anaphylaxis to these hymenoptera insects need to keep their epinephrine with them all the time.
WHAT ARE THE MOST TYPICAL ILLNESSES WE SEE IN THE SPRING AND SUMMER?
While we still get some low-level colds, most of the big players for respiratory illnesses go away such as influenza and RSV.
Then we start to see an influx in contact-spread illnesses like intestinal viruses and Hand Foot and Mouth and viral meningitis.
SO A LOT MORE OF THE INTESTINAL VIRUSES THAT WE HEAR ABOUT ON CRUISE SHIPS ARE HAPPENING NOW?
Yes. Many of our our intestinal viruses are in full swing in the summer. I am glad to have rotavirus go away which was always very high in January—but some of the lower level intestinal viruses are prevalent when it warms up.
HOW DO INTESTINAL ILLNESSES PRESENT?
Most begin with either vomiting and then diarrhea follows, or diarrhea can be the first symptom. Each type of virus has varying degrees of fever. The vomiting usually subsides after the first 12-24 hours but sequel to diarrhea for 5-7 days or longer.
WHAT MAKES DIARRHEA COMPLICATED IN KIDS?
The problems created by diarrhea are that we lose the superficial enzyme of lactase as well as a lot of the healthy bacteria flora is flushed out. Both of these create digestion problems that can prolong the diarrhea especially where milk is a staple for most little kids.
WHAT PROBLEMS ARE CREATED BY NOT PROCESSING LACTOSE APPROPRIATELY?
The increase in undigested sugars pulls water with it which prolongs the diarrhea. And having undigested sugars going into the colon creates more pain from the gas that forms there—so more and longer-lasting diarrhea and more pain along with it.
HOW DO WE MANAGE THE TEMPORARY LACTOSE INTOLERANCE?
So, I always recommend that we remove lactose— milk and milk-based products— from diet until stool is back to normal for a day or two—this is only a temporary lactose intolerance and will get back to normal. Use lactose-free or plant-based milk instead as a replacement until all symptoms have resolved for a couple of days.
WHAT ABOUT REPLACING THE GUT FLORA?
For this I recommend using an age-appropriate dose and form of acidophilus to restore normal gut flora. Yogurt used to be our mainstay but the lactose complicates things so I recommend just buying a kid-friendly probiotic at your pharmacy. Sometimes the kid formulations cost more so I say to just use about half of an adult dose by opening capsules onto applesauce or similar.
ARE THERE DEHYDRATION CONCERNS?
Definitely possible. Fluids are most important. Food is secondary. Don't go to solid foods until there is no vomiting for 16-24 hours.
Goal of doing an age-appropriate number of ounces of electrolyte fluids (pedialyte ideal) per day with a pace of 1-2 ounces every 15 minutes. About 1 cup per movie is a good goal for those having a hard time. May do popsicles as well.
WHEN SHOULD PARENTS BE CALLING FOR HELP?
Call me for any concerns about poor urine output, dry mouth, no tears when crying or other concerns for dehydration OR if symptoms are lasting longer than a week
SPEAKING OF LONGER-LASTING INTESTINAL SYMPTOMS, AREN’T SOME OF THESE INTESTINAL ILLNESSES CAUSED BY OTHER PATHOGENS BESIDES VIRUSES? WE TALK ABOUT THE WEBER WATER HERE IN DAVIS COUNTY.
When we see prolonged diarrhea, and parents have done a good job with what we just talked about, we may be taking about other pathogens like—cryptosporidium and giardia. These are found in nature as well as close to home in secondary water supplies that people use to water their lawns or sometimes fill their kiddie pools. We treat these pathogens with Zithromax and metronidazole. Options for testing but there are many false negatives and may require several stool samples to find the pathogen and the medications are benign so I often simply treat when there is a supportive history, symptoms and signs.
ARE THERE RASH COMPLICATIONS OF INTESTINAL ILLNESSES?
Yes and I have parents be aggressive with their skin barriers—desitin etc.
WHAT DO WE NOT WANT TO MISS?
I always worry about missing a surgical abdomen like appendicitis, but interestingly appendicitis really slows down the intestines so it looks more like fever and vomiting in a kid that looks pretty sick but no diarrhea follows after the vomiting and they get more ill appearing along with their RLQ abdominal pain.
LET’S TALK ABOUT HAND-FOOT-MOUTH DISEASE
This is a classic warm weather disease.
It is caused by a virus called Coxsackie A16
Interesting side note: this virus is in the same family and enterovirus genus as poliovirus. When we think about how common HFM disease is..
poliovirus was every bit as common as hand foot and mouth is now but polio caused death and permanent disability— definitely one of the successes of vaccinations
Yes—great example of the importance of vaccinating.
WHAT DOES THE RASH LOOK LIKE WITH HAND FOOT AND MOUTH
Well, the name describes it all—we get individual red bumps on the palms and soles of the hands and feet—they may move quite a way up the legs as well. Then we see little ulcers at the back of the throat.
HOW LONG IS IT CONTAGIOUS AND HOW DO WE CARE FOR THE KIDS?
HFM is Contagious for a couple of weeks.
The goal of treatment is to Control pain and fever.
Alternate tylenol and ibuprofen every 3 hours for 48 hours and then as needed.
Encourage fluids--whatever patient will drink.
Use cool fluids, no carbonation, nothing acidic.
YOU MENTIONED VIRAL MENINGITIS AS WELL
We have done a great job with immunizations for bacterial meningitis which is great because their is a high fatality rate as well as high rate of permanent damage like deafness with bacterial meningitis. But in the warm months there are some viruses that cause inflammation in the spinal cord with neck stiffness but the kids don’t usually appear as sick as with bacterial meningitis. It is important to get them seen if you worry about a stiff neck and fever to let us sort out the difference.
WITH PLAYING OUTSIDE, KIDS GET LOTS OF CUTS AND SCRAPES THAT GET INFECTED.
Yes, we get lots of cellulitis with infected scrapes as well as staph and strep infections like impetigo.
I treat them both about the same:
Gentle scrubbing with soap and water at least once daily.
If the infection is far enough along I will prescribe an oral antibiotic like cephalexin
I will always have parents apply mupirocin as prescribed 2x/day until resolved.
IS IT FINE TO USE NEOSPORIN INSTEAD OF A PRESCRIPTION TOPICAL ANTIBIOTIC?
Neosporin is great for prevention but it doesn’t treat an infection very well once it has started. Also many kids have a sensitivity to neomycin. And on occasion we see resistant bacteria in people with exposure to those in nursing homes and long-term hospital stays, etc. and mupirocin is just more effective.
AND LAST IS THE CLASSIC SWIMMER’S EAR.
Swimmer’s ear is really a skin infection that is in the ear canal so it is pretty tender. It isn’t actually an ear infection like one my get from having a cold so we don’t use oral antibiotics often
I will do a drop with a steroid for the swelling and an antibiotic for the infection.
HOW ABOUT PREVENTION FOR SWIMMER’S EAR?
For those kids that are prone to swimmer’s ear, I recommend that parents make up a solution of half rubbing alcohol and half vinegar and use that after each time a child swims. I have them get the water out of their ears and then put about 5 drops in each ear. The alcohol helps the water to evaporate and the vinegar alters the ph a little to prevent infections from growing.
THIS WRAPS UP OUR DISCUSSION OF WARM WEATHER INFECTIONS AND MEDICAL PROBLEMS. REMEMBER TO APPLY YOUR SUN BLOCK.
Yes—a good reminder at the end
