February
Coughs, colds and fevers
During the winter months, it seems like everyone is sick almost constantly. Even excluding Flu and Strep throat, there are dozens of respiratory viruses that can make us sick. I often get asked by parents “ is my child sick too often?”
Usually the answer is no. Most children average 9-12 illnesses a year, and most occur in the winter. So that means at least once a month or more in winter is normal. As children get older, this usually lessens unless your child has asthma or some other chronic medical condition.
The number of illnesses is not as important as the severity of them. Most childhood illnesses should be mild and come and go quickly. If your child gets frequent complications that are difficult to treat, then your Pediatrician may need to do some extra testing or consult an Immunologist.
For most childhood illnesses, antibiotics do not help and are not needed. There are always exceptions, like Strep throat and urinary tract infections. Call your doctor if your child has been sick for longer than 3 days or you’re not sure of the best treatment.
Please do not send your child to school until they are fever free for 24 hours to prevent spread to other children.
If you have further questions, need an appointment or want to read previous newsletters, go to my website at www.pedihousecalls.com or 214-558-0037.
November
Stomach bugs: It’s really a virus
When are antibiotics needed? NEVER!!
Gastrointestinal illnesses are very common in the winter months and can spread rather quickly around home, school or the office. Despite being call stomach “bugs”, they are actually viruses that are spread from person to person. Symptoms can include nausea, vomiting, diarrhea with cramps, and low grade fevers. There are a few viruses that cause congestion, cough and cold symptoms prior to the stomach symptoms starting. These are called viral syndromes and appear to be more common in children less than 5 years old. These viral illnesses usually last about 2-4 days and then rapidly start to improve, although the stomach pain can linger for up to a week after other symptoms have diminished. The biggest worry about these illnesses is dehydration. This can be avoided in most cases by encouraging your children to drink small amounts (1/2 ounce) very frequently (every 15 mins). This keeps the body hydrated without filling up the stomach, which can induce more vomiting. If your child cannot keep fluids down in small, frequent amounts after 24 hours, they made need an anti-nausea medication like Zofran. It is very effective and safe for children and adults. There is no health benefit to persistent vomiting, but it is different for diarrhea. Diarrhea is the body’s way of getting rid of the virus so it can heal itself. If you give anti-diarrheal medications, you may stop the diarrhea, but the virus will remain and can potentially make your child worse. There are very few exceptions to this rule.
Antibiotics will not treat viral infections and are never used for this purpose. There are some bacterial causes of diarrhea like Salmonella and Shigella, but usually only very sick children requiring hospitalization are given antibiotics for these infections.
So when should my child see the doctor? 1) concern for moderate to severe dehydration requiring IV fluids. 2) to obtain a prescription for anti-nausea medications if your pediatrician will not prescribe it over the phone. 3) bloody diarrhea, or diarrhea lasting longer than one week without improvement. 4) a child under 2 years of age that is not drinking well.
Signs of moderate dehydration are dry, cracked lips, sticky tongue with whitish color , no urination in 8-12 hours and increasing fatigue. Anyone one with these symptoms, regardless of age, should seek medical care immediately.
Good hand washing, especially after bathroom breaks or diaper changes, is the best way to avoid stomach viruses. Giving probiotics and temporarily avoiding foods with lactose (dairy) will help shorten the length and severity of diarrhea. Your child should not go to school until all symptoms have resolved for 24 hours.
If you have further questions, need an appointment or want to read previous newsletters, go to my website at www.pedihousecalls.com or 214-558-0037.
October
Fever Phobia:
When do I worry?
Fever is a normal part of childhood.
Since the weather will turn cooler soon, that means cough and cold season is right around the corner. One of the most common pediatric complaints during the cooler months is fever. For the 13 years I’ve been practicing pediatrics, nothing is more surrounded by myth and misunderstanding than the concept of fever. Let’s start with the definition of fever: it is a body temperature above 100.4 F or 38 C. Even if your child normally runs “low”, they may have an elevated body temperature, but they do not have a fever unless they are above 100.4. Body temperature elevates daily around 2-3:00pm, so if your child feels warm after school, that is normal.
Fever can be the only symptom of illness, or it can occur with other symptoms like cough, congestion, fatigue, vomiting or diarrhea. Over 90% of the time, these are viral illnesses and your child’s fever will improve in 2-3 days. They do not necessarily need to see a doctor and only need fever reducing medication, rest, good hydration and time. There are a few exceptions to this rule: 1) Fever lasting for more than 5 days with no improvement. 2) Fever that develops after your child has been sick for 3-4 days already without fever. 3) Fever and burning with urination in a girl. 4) You suspect strep throat, seasonal flu or ear infection. 5) Fever with severe headache and rash.
You may have noticed that I did not mention anything about how high the fever can get before you need to worry. Viral illness usually cause fevers as high as 104-105, but respond well to medications like ibuprofen. The fever usually returns when the medication wears off. The fever will cycle up and down for 3-4 days and then resolve. Bacterial illnesses usually have lower fevers of 102 and below, but don’t respond as well to fever reducers. It takes a fever of 108 to cause brain injury, so treating fevers is more about the comfort of the child. Anything over 102 causes irritability, physical discomfort and increased risk for dehydration. For a fever under 102, you do not have to treat unless your child is uncomfortable. There are exceptions to this, children under 5 years old with febrile seizures or infants less than 6 months old.
I hope this has been informative, and it helps you feel more comfortable with the idea that fevers are a normal part of childhood and can be managed. Reminding your child to cover their cough and wash their hands can prevent many illnesses.
For questions call me at 214-558-0037 or email me at keajohns@hotmail.com or info@pedihousecalls.com.
August
Strep Throat:
When are antibiotics needed? ALWAYS!!!
Since we are about to begin another school year, I decided to discuss a topic that never goes out of season: Strep throat. Despite the fact that it seems to be more common in the winter months, it is with us all year around. I know that makes us all cringe a little bit. It’s miserable for everyone, spreads easily to family and friends, and usually means at least one day of missed school.
Strep throat is a bacterial infection of the tonsils that is spread from person to person through direct saliva (i.e. eating, drinking and kissing). Surfaces of water fountains can become contaminated and spread the illness over an entire class or school. Everyone knows the classic symptoms of Strep throat, sore throat and fever. But there are actually 5 symptoms of strep and they can all occur together, or in any combination. It’s not always what you expect. The 5 signs are sore throat, fever, rash, stomach pain and headache. The stomach pain is sometimes accompanied by nausea and vomiting. The rash usually starts on the face or chest and is fine and sandpaper- like in feel. It can be easily missed. If your child develops any of these symptoms (alone or together) for more than 2-3 days, they need to have a Strep test. If they have been exposed to Strep, then don’t wait. Children without tonsils can still get Strep Throat as well.
For children under 21, untreated Strep infections can cause long-term heart, kidney and brain disorders that are unfortunately untreatable. Adults who have young children at home should also be vigilant about being treated for their children’s safety.
To help prevent the spread, children should not eat or drink after one another. They should never share toothbrushes. A new toothbrush is always needed after about 2-3 days of antibiotic treatment for an active infection so they do not re-infect themselves.
If your child has a tendency to contract Strep throat more than 2-3 times a year, you may want to discourage them from using water fountains and have them bring their own water bottle to school and sporting activities.
If your child does get Strep throat, it is mandatory that they stay home for 24 hours once treatment is started. Not following this rule is the main reason Strep throat is almost epidemic during the school year.
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