Oh No! Flu???

By Linda Stevenson, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer

A virus causes the flu and there are several types of flu viruses, other viral illnesses can have some flu like symptoms, so it is often hard to tell what you or your child has. You can have a mild case of the flu or a severe one. The most common flu symptoms are a fever along with body aches, headache, chills, and fatigue. You can also have a sore throat and cough and occasionally a runny nose. Some can have diarrhea and vomiting. The common thread is that you feel miserable. Kids do not want to play and sometimes will refuse to eat.

The best action is prevention, we want to people from getting the flu. Getting the flu vaccine is the first step. This year the CDC does not recommend use of the flu mist nasal spray due to at least 2-3 years of poor prevention of the flu with its use. Everyone will receive the injectable flu vaccine.  It is also good to remember that you cannot get the flu from the injectable flu vaccine, as it is a killed virus. It takes a couple of weeks for your body to build immunity after receiving the vaccine, that is why we get the vaccine early before flu season starts.

Many people think that it isn’t important to be vaccinated against the flu because we work from home or we homeschool our children, but anytime we are around others we have the opportunity to get the flu or other viruses. The children we worry about are those under 5, especially if they are younger than 2 years, and adults who are over 65. If your spouse who works outside the home gets a mild case of the flu it is not a problem, but if he gives it to your 3 month old and grandfather who has a heart condition it may not be so mild and they may have to be hospitalized and it can be very serious.

Other actions that can be taken to try to prevent the flu are to wash hands frequently, stay home if you are ill so you do not spread the illness to others, teach children to cough into their elbow or use a tissue then wash their hands, and avoid close contact with sick persons.  If your child has had a fever they should stay home for 24 hours after the fever has resolved. A person is contagious 1 day before the flu symptoms develop and for 5 to 7 days after becoming ill.

If you think your child has the flu and it is mild, keep them home and call your health care provider. Usually mild cases do not require antiviral medications such as Tamiflu, but this will be between you and your pediatrician based on your child’s symptoms, medical history and their clinical judgment. Mild illness can be treated with acetaminophen or ibuprofen for the fever and muscle aches or headache; lots of fluids, chicken soup and rest. 

But if your ill infant doesn’t want to eat, has fewer than normal wet diapers or seems to be working hard at breathing you need to have them seen by a health care provider.  If your older child is breathing fast at rest, has difficulty waking up, fever that does not respond to medications or fever with a rash or if they have had flu symptoms that resolved and then returned with fever and a worsening cough they need to be seen by a health care provider. It is also possible that your child could have the flu along with another virus. 

Tis the season for viruses – stay healthy!!

 

Back to School Health & Safety Review

It’s back to school time. Here’s a review of actions we can take to make it a healthy year!

Health & Wellness

  • The most effective way to avoid catching or spreading germs is with hand washing. 
  • When hand washing is not available hand sanitizers are a good alternative.  But after using the restroom hand washing is essential since some bacteria such as Clostridium difficile bacteria are not removed with hand sanitizers. 
  • After using hand sanitizer 3 times in a row the next time should be to wash hands. 
  • One of the dirtiest areas in school according to the Center for Disease Control is the water fountain and the next is the non-disposable lunch tray. 
  • It is a good idea to pack hand sanitizer wipes in your child’s lunch box.
  • Children who are ill with fever should be kept home until fever free for 24 hours. 
  • Be sure the school nurse and teacher are aware of any conditions your child may have such as asthma or a seizure disorder, and that the nurse has a written plan of action for any problems. 
  • Cover all exposed wounds when your child is at school.
  • If your child who has always been attentive at school suddenly seems to not be following the teacher have their eyes checked. 
  • Teach your new kindergarten child to cough in the crook of their arm.
  • Children exposed to the flu may not begin to have symptoms for up to 3 days. 
  • Good sleep is essential to good school performance Elementary school age need 8-10 hours a night and teens should have 9 to 10 hours. 
  • Classroom pets such as rodents and reptiles can be a source of Salmonella infections – remind your child to wash their hands after touching and check with the classroom teacher for in school pet policies. 


Backpack Safety

  • Backpacks should have wide padded shoulder straps and a padded back.
  • They should not weigh more than 10-20% of your child’s body weight when full. 
  • Your child should always use both shoulder straps; using one can strain muscles.
  • For older children check into a rolling backpack if they carry a heavy book load. Check to see if your school allows this and if the locker will accommodate it. Also remember it might have to be carried up stairs which is awkward with a rolling bag. 
  •  

Car Pooling

  • All passengers should wear a seat belt.

  • Children should ride in a belt-positioning booster with a harness until the car seat belt fits properly – usually when your child reaches 4 feet 9 inches tall and is between 8 and 12 years of age. 

  • All children under 13 years of age should ride in the rear seat of a vehicle. 

  • Be aware of your state laws for teen drivers and consider a parent-teen driver agreement. A sample parent-teen driver agreement can be found at: www.healthychildren.org/teendriver


School Day Nutrition

  • Children who eat a nutritious breakfast do better in school, are able to concentrate and have more energy.
  • Check out your child’s cafeteria menus so you can anticipate any days when you or your child feels that the meal is not what either of you prefer. Then you can make a lunch.
  • Know what is in the vending machines at your child’s school. Work through your PTA and school administration to promote healthy selections in the vending machines. 
  • Remember a soda a day increases a child’s risk of obesity by 60%. Sodas contain 10 teaspoons of sugar.
  • Gatorade is to replenish electrolytes after workouts not for daily consumption.


Bullying

  • According to the Academy of Pediatrics bullying is when one child picks on another repeatedly, verbally, physically or socially. It can occur anywhere – at school, in the neighborhood, on the Internet or through their mobile device. 
  • Know your child’s school policies on bullying and how it is handled.
  • Teach your child to ask a trusted adult for help.
  • Make sure the school principal, counselor and teacher are aware of the problem and can look out for your child. 
  • If your child is the bully be sure that they know that bullying is never okay. Set firm and consistent limits on your child’s aggressive behavior. Get counseling assistance to help your child/family. 
     

Healthy habits keep children’s immune systems strong; that includes exercise, healthy diet and adequate sleep.

 

Q.care Launches FREE Nurse Triage Service

Questions about the care for a child are among a parents greatest need, and often at a time when their pediatrician isn’t available.

Now PediaQ brings parents a FREE pediatric nurse triage service with Q.care, the smartphone app that gives parents immediate access to a pediatric nurse for any questions about the care and condition of their child.

With the Q.care app and one touch of a button, parents can speak to a pediatric nurse through voice or video, get answers to questions and be directed to the appropriate level of care.

We look forward to taking you to the next level of care - Q.care!

 

Fever in Children

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer

Most parents have experienced their child awakening from a nap or late at night, all hot, sweaty, and flushed. You take their temperature and they have a fever. Now what!! How high is too high? Is it really a fever or were they just bundled up in too many blankets, they didn’t seem sick when they went to bed. Fever can be scary!

Fever is believed to be the body’s way of fighting off illness. It is fighting the viruses and bacteria that cause infections. Because germs don’t like heat your child’s body increases the temperature to fight off any infection. A fever is usually considered any temperature over 100.4F.

Temperatures can vary by age of the child and with the time of the day. Temperatures rise during the day. You may notice that late afternoon is when your child usually spikes a fever. Normal temperature is considered to be 98.6F, but a toddler can have a temperature of 99F and it can be normal. Older children may have a normal temperature lower than 98.6F. 

High temperatures can indicate a serious illness in children over age 12 but not always in younger children. Infants who are over dressed or bundled with blankets can have an increased temperature. Always unbundle the infant, wait 30 minutes and retake the temperature. Any infant with a temperature greater than 100.4F you should call their pediatrician, particularly if they are less than 3 months of age.

When your child has a fever always look at how they are acting. Are they drinking okay? Are they playing when the fever goes down and behaving normally? Or are they not drinking, lethargic and not behaving normally? Children with a fever may breathe faster than usual and have a faster heart rate. This is expected but if they seem to be working hard at breathing then they need to be seen by their pediatrician.

Fevers of less than 5 days in a child with relatively normal behavior and drinking well are not concerning. From over 3 months to 3 years children can have a fever up to 102F and it not be concerning. Children can have a fever one day and be back to normal the next. Low-grade fevers, less than 101F can occur after immunizations and it is considered normal if it lasts only a couple of days.

When do you call your pediatrician if your child has a fever? 

  • If your infant is under 3 months of age and has a temperature of 100.4F or greater
  • If your child’s fever lasts more than 5 days
  •  If your child’s fever does not respond to acetaminophen or ibuprofen
  • If the temperature is over 104F
  •  If your child is not acting normally, or not drinking or urinating
  • If your child has a seizure with the fever 
  • If your child was immunized and the fever is over 102F or the fever continues for over 48 hours
  •  If your child is working hard at breathing and this does not improve when the fever decreases

Some of the medical literature discusses the fact that fever of 102F or below does not need to be treated unless your child has a medical issue such as heart disease/defect, seizure disorder, etc.  But it is hard to see your child feeling so uncomfortable when they have a fever. There is no research that says giving fever reducers to a child alters the immune response so it is ok to give acetaminophen or ibuprofen to help your child feel better. Based on how your child is behaving you can give them acetaminophen every 4 to 6 hours or ibuprofen every 6 hours. The dose should be based on your child’s weight. Remember infants under 6 months should not receive ibuprofen and never give children of any age Aspirin unless specifically ordered by your pediatrician.

Keep your child’s room cool. Dress your child in light clothing and do not over bundle infants. Increase fluids when your child has a fever due to the increased risk of dehydration. Children usually do not want to eat normally when ill, but as long as they are drinking enough to keep their mouth moist, have good tears and are wetting their diapers 4 to 6 times a day or using the toilet every 6 hours they will be okay not eating well for a couple of days.

 

When in doubt over what to do for your child’s fever, you should call your pediatrician.

Pediatric House Call App PediaQ Expands to Houston

Serving the The Woodlands Saturdays & Sundays 8am-8pm

APRIL 14, 2016 (DALLAS) - PediaQ, the app based solution for after-hours pediatric house calls based in Dallas, TX expands today to The Woodlands area of Houston in its first step outside of the Dallas-Fort Worth area.

PediaQ is for parents who want to avoid waiting rooms and instead, use an app to receive a high quality, convenient, and immediate house call for their child when their pediatrician is not available. When a worried parent uses PediaQ, a pediatric specialist arrives within an hour and spends significant time with their child in the comfort and safety of their home, diagnoses the condition, and sends in a prescription if required. With high convenience and an overall cost that is less than urgent care centers or emergency rooms, PediaQ has rapidly captured parents’ attention. Since its launch in the fall of 2016, PediaQ has made almost 2,000 house call visits in the DFW area with 100% five star ratings, and is now bringing its service to The Woodlands.

PediaQ is only available on nights & weekends (when children seem to get sick the most) and accepts most insurances, so the consumer pays their normal co-pay plus a $25 convenience fee. PediaQ also works closely with the family pediatrician to make sure the highest level of care is continued, and strives to align with Children’s Hospitals in those markets where it launches its service.

On the expansion, CEO Jon O’Sullivan says, “With hundreds of 5-star ratings from parents, high convenience, and a lower cost of urgent care, as the only service of its type, our goal is to expand our service well beyond our launch markets in North Texas. The strong presence of and potential to work with large provider groups like Texas Children's Hospital, Memorial Hermann Children's Hospital or other provider groups in Houston, along with numerous growing family centered areas like The Woodlands, make Houston an ideal market for PediaQ to demonstrate its innovative platform and bring after-hours pediatric care back into the home.”

PediaQ is available in the app store or online at pediaq.care. If you are a Woodland’s family who uses PediaQ we would love to hear from you. To see our parent reviews or to send PediaQ a message, please look on our Facebook page: facebook.com/pediaq/

Snake Bites

Guest Blog by Tina Bayle, MSN, RN, CPNP- PC/AC

It's springtime in Texas!  The days are getting longer and warmer.  The trees and flowers are blooming.  With the days getting warmer, it's time to start looking out for snakes!  Snakes, being cold blooded, rely on their environment to be warm in order for them to be more active.  Snakes are slower in the mornings since it is usually cooler.  This has brought close encounters with snakes and resulting snakebites.  Some children (and adults alike) will see a snake stretched out and perfectly still trying to soak in the warmth of the sun.  Assuming the snake is dead or injured, the child will pick up the snake and OUCH!  The bite happens.  As scary of a scenario as this is, there are few fatalities from snakebites each year.   

What Venomous Snakes Are In Texas? 

Copperhead: The adult Copperhead has reddish brown bands on a lighter colored body.  But juvenile Copperheads have grey bodies and bands and have not developed their distinctive copper color so they are often picked up accidentally.  Copperheads like to hide under leaves and logs and try to blend in and hide in their environment.  Although typically not aggressive, Copperheads will strike to defend themselves without warning. 

Cottonmouth: Also called Water Moccasins, Cottonmouths get their name for their white mouths that they open and display when threatened.  Their bodies are heavy and dark brown to black with dark bands.  Young Cottonmouths have brightly marked bands and have yellow on the tip on their tails.  They tend to be more aggressive than other venomous snakes, but very rarely chase after humans. 

Rattlesnake: Known for their famous tails, Rattlesnakes are probably the most recognized of the venomous snakes.  Rattlers will give a warning by rattling their tails and try to escape before striking.  Rattlesnakes can be found from the rocky desert areas of Texas to the eastern pines.  The Western Diamondback has some of the most potent venom of all the snakes in Texas.  But once again, encounters and fatal bites are quite rare. 

Coral Snake: Did you know that the Coral Snake is related to the Cobra?  Coral snakes are found in the southeastern part of the state in woodlands and the coastal plains.  They are brightly colored snakes with a broad black ring, a narrow yellow ring and a broad red ring.  The red and yellow rings always are next to each other for this snake.  The Milk snake has similar markings but is harmless.  A way to remember the Coral snake markings is 'Red on yellow, kill a fellow; red on black, venom lack'. 

How to Avoid a Snake Bites

  • When in nature centers, parks with lakes and even fields, always wear shoes, (not just flip flops).  This is true even within cities, suburbs and rural areas. (I have seen snake bites from Plano, Flower Mound and Allen, just to name a few)  
  • Keep the lawn around your home cut low and keep wood and rocks piles away from your house.  (These are great snake hiding places!) 
  • Never put your foot or hand in a hole where you cannot see the bottom.  Snakes like to borrow other animals' burrows or hide in holes. 
  • Check before stepping down when going over logs and fallen trees. 
  • Look up and down at lakes when there are trees and bushes near the water.  Snakes like to hide in and under bushes and even up in trees! 
  • If you see a dead or injured snake, leave it alone.  Don't pick it up or poke at with a stick.  It could just be sunning itself and spring into action!  And of note, if a snake was recently killed, there is a reflex that causes the jaw to bite...even when dead!! 

What to DO IF a Snake Bite Occurs

  • Always assume the snake is venomous and seek immediate medical care.  Most venomous bites are instantly painful and swell within a few minutes.  (Of note, it is best to go to an emergency department attached to a hospital, as they tend to have access to anti-venom.  The free standing ERs usually do not have antivenom.) 
  • Try to identify the snake that inflicted the snakebite without risking another person being bitten.  Here's where cameras on cell phones are priceless. 
  • Keep the bite victim, yourself and other members of your group as calm as possible.  This helps reduce the spread of venom in the victim. 
  • Remove jewelry, shoes or tight fitting clothing around the site of the bite.  These areas will often swell significantly. 
  • Reduce movement of the limb that was bitten by using a splint and lowering below the level of the heart to slow the spread of venom.  It is not recommended to use a tourniquet as this decreases too much blood flow to the limb and causes more tissue damage to the site. 
  • Wash area with antibacterial soap or clean with hand sanitizer if available. 
  • Do NOT cut or try to suck the venom out of the wound.  (It may work in the movies but really does not work in real life!) 
  • Do not apply ice or other cold compresses to the bite.  This will also lead to worsening tissue damage. 
  • Avoid giving aspirin or ibuprofen for pain as this can lead to more bleeding. 
  • Avoid alcohol as this dilates blood vessels and spreads the venom faster. 

In closing, if you see a snake just let it be.  Snakes, both venomous and nonvenomous, are important to nature.  They keep the rodent population in check and small snakes eat bugs and other pests.  Enjoy the spring and beautiful weather but be aware that snakes are also out enjoying the warm weather as well. 

Picky Eaters

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer

What happened to your wonderful child who would happily eat whatever was put in front of them? Now “it tastes funny” or “it’s orange”, or “I only want macaroni” is all that you hear. They seem to live on air. It can be very frustrating and worrisome for any parent.

Toddlers are seeking independence, developing skills to feed themselves and exerting control over their food choices. They are developing food preferences and eating habits. They love the feeling of success when they can control at least one small aspect of their lives. All this is happening at a time when there are increased energy and nutrient requirements.  Strategies such as nagging or making deals don’t work in the long run. Children who learn to negotiate and make deals for eating, learn to make deals and expect rewards for doing other things such as going to bed on time or brushing their teeth, or getting ready for school. They quickly learn everything is negotiable and they have power.

So what is a parent to do? First, remember that mealtime is more than about eating. It is a time of socialization, a time to build relationships as a family.  Create routines around meal and snack times. As soon as they are able, have infants and toddlers sit at the table for family meals. This is a time for conversation that involves all, learning about everyone’s day, and a time for electronics to be off (phones, TV’s, computers).

Serve small portions. Serve new foods along with favorite ones. Try serving veggies with a favorite dip or sauce. Cut foods into shapes. Set your menu for the week and have your picky eater help with choosing the foods. Let them help with prep based on their age; even toddlers can help set the table, arrange carrots on a plate with a dip, or put fruit in a bowl after you have cut it up. Adding finely chopped or pureed vegetables to spaghetti sauce, or adding cauliflower, turnips and squash to mashed potatoes are a great way to get extra veggies to your child. The ‘polite one bite’ rule that many parents have is great but don’t push it farther. Remember that you have to offer a new food at least 10-15 times before children will become accustomed to the taste and eat it.

Other parents are a wonderful resource for finding ways to get your picky eater to eat healthy. One mother shared that she would puree chicken with a little unsalted chicken broth to add to the cheese sauce for mac & cheese. It was a great way to get protein in to her child who would only eat mac & cheese. Her child is now 13 and he eats everything but there was a lot of worry early on. Roasting vegetables can bring out their sweetness and using lemon can decrease the bitterness of some vegetables such as broccoli or brussel sprouts. Young children have many more taste buds than an adult; this plays a role in why they refuse certain foods.

Dessert is often used as a bargaining chip with children. If dessert is a part of your family meals then treat it as a part of the meal not something special that you get after you have eaten what you really don’t want. You want to take away the power of the sweet. You can also try substituting fruit and cheese as a last course.

What about school lunches? Is it okay if your child wants the same chicken or pbj sandwich every day? As long as you add other nutritious foods to the lunch such as fruit or cut up veggies for dipping etc. they will be fine. And at some point they will venture to other foods, particularly if they have been exposed at home. Also, sometimes they want a particular food because they know they can get it eaten in the short time they have for lunch, or because their best friend also eats that meal at lunch.

But what about the child who never wants to eat at the table with the rest of the family? Keep a journal about everything your child eats and drinks daily for a 2-week period. Sometimes what you will find is that your child drinks juice or milk or Gatorade all day and so they get full on all the liquid and sugar and are not interested in food at mealtime. Others may be snacking on goldfish or other small crackers and so they really do not feel hunger and consequently don’t want to eat. Set meal and snack times so your child has a chance to get hungry. Kids do not need to walk around with a tumbler of juice; this sets them up for eating problems as they age.

When should you be concerned? Most picky eating behaviors are part of normal growth and development but if your child is not meeting their developmental or growth milestones your pediatrician will have noticed and will be discussing therapy options particularly if there are sensory issues. When eating preferences make it difficult for your child to eat with others, or they have increasing social anxiety with meals, or other altered behavior it is time to explore working with a therapist, both nutritional and psychological.

Remember most of the time picky eating resolves as your child ages. Although it is your job to provide healthy food choices and pleasant meal and snack times, it is your child who gets to decide which of the foods and how much to eat. Try to keep mealtime from becoming a battleground, as research has shown that forcing a picky child to eat worsens the picky behavior. Your goal is to teach that all foods are okay in moderation; this creates a healthy eater who knows when they are full and enjoys a wide variety of foods.

Zika Virus

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer

Zika virus is in the news almost daily and can sound a little scary, but what does it mean for children who will undoubtedly want to play outside as the weather improves? What exactly is this virus?

The Zika virus was first discovered in the 1940’s in Africa and made its way to Polynesia by 2007 where over 70% of the people were infected. In 2014 it appeared in Brazil and other Latin American countries. In Brazil it was noted that women who were infected with the virus during pregnancy were delivering infants who had microcephaly, a condition with a markedly small skull and altered brain development. The virus has been found in Puerto Rico and there is concern that the Gulf Coast is at high risk. It has recently been found to be present in the semen of men infected with the virus for up to7 to 10 weeks after the onset of symptoms.

The virus is carried by mosquitos specifically the Aedes aegypti mosquito. This mosquito is already found in parts of the U.S. It is also known to transmit dengue, yellow fever and chikungunya viruses. Mosquitos can pick up the virus by biting someone infected with the virus and then transmit it to an unsuspecting victim. There is no vaccine to protect against the virus and no specific treatment if one acquires it.

Eighty percent of people who are infected with the virus have no symptoms. When a person does have symptoms they are usually mild, and include fever, rash, muscle and joint pain, headaches, pain behind the eyes and conjunctivitis (red & itchy eyes). The symptoms last for 2 to 7 days. A very rare complication is the development of Guillain-Barre syndrome, a condition in which the immune system attacks the nerves causing severe weakness and often paralysis. Acetaminophen is effective for the fever and pain with mild symptoms. Ibuprofen and other non-steroidal anti-inflammatory drugs are not recommended until dengue fever is ruled out to avoid the risk of hemorrhage.

What can you do to help prevent a Zika virus infection? Avoid travel to areas with Zika outbreaks when possible. Use insect repellant that contains at least 20% DEET, picardin, oil of lemon-eucalyptus or IR3535 whenever your child goes outside. Apply the repellant to all areas of exposed skin. Apply it to your hands and then apply it to your child’s face & neck so as not to get it in their eyes.

Mosquitos are most active near dawn and dusk; avoid going outside during those times if possible. When possible wear long sleeves and pants when outside during peak mosquito times or when spending extended periods out of doors. If you become infected with the Zika virus, avoid getting any more bites for at least 7 days after the onset of symptoms to avoid passing the infection to the local mosquito population. Around your home follow normal precautions to prevent or decrease the watery breeding grounds for mosquitos.

Remember most of the time the infection is mild, it is only in rare instances that it becomes serious such as with women who are pregnant when they acquire the virus.  To date there have been no serious complications with children.

Ear Infections

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ Chief Nursing Officer

Ear infections are distressing to both children and parents. They can be a viral or bacterial infection that affects the middle ear. The middle ear is the space behind the eardrum that is normally air filled and contains tiny bones that vibrate in response to sound. Frequently ear infections can clear up on their own, but in infants and severe infections antibiotics are indicated. Long term issues such as hearing problems, can be a consequence of frequent or persistent infections.

When a child has an ear infection there is inflammation and fluid can build up in the middle ear. This causes pain. Some children may show little change in behavior, only a slight decrease in activity, whereas others will cry and be very fussy, not want to eat and have difficulty sleeping.

You may also notice your child pulling on their ear, having a fever of 100.4F or higher, acting fussy and irritable, crying a lot more than usual, having difficulty hearing or drainage from the ear.

When your child has an upper respiratory infection, a cold, or they have allergic rhinitis there can be swelling, inflammation and/or mucus in the Eustachian tubes causing an accumulation of fluid in the middle ear. The adenoids are in the back of the throat at the base of the Eustachian tubes. If the adenoids enlarge due to infections or inflammation they can play a role in blocking the normal drainage of the Eustachian tubes and therefore play a role in middle ear infections. This is one of the reasons it is important to keep your infant/toddler nose free of mucus when they have an upper respiratory infection.

The risk factors for ear infections include – the age between 6 months and 2 years as they have an immature immune system; group daycare as they are exposed to frequent infections; bottle fed infants who lie down with their bottle or take the bottle to bed; seasonal allergies and exposure to second-hand tobacco smoke and high levels of air pollution all can play a role in ear infections.

What can be done to reduce the risk of an ear infection? There are several things that can help, such as not exposing infants and toddlers to second hand smoke; if possible breast feed your infant for at least 6 months, but if your infant is bottle fed just be sure to always feed them in an upright position and never allow them to have a bottle in their crib or bed; try to avoid exposing your infant to others with upper respiratory infections (this is not always possible), and if your child does get an cold with congestion use saline nasal spray to loosen the mucus and a bulb suction or Nose Frieda to remove the mucus. The other action you can take is to discuss pneumococcal and flu vaccines with your pediatrician to help decrease the risk of infections.

You might have noticed that your pediatrician has a wait and see approach within the first 1 to 2 days of symptoms, since most ear infections clear up on their own. They will want to monitor your child closely. This is consistent with the recommendations from the American Academy of Pediatrics to adopt a wait and see approach for children ages 6 months to 23 months with mild pain in one ear for less than 48 hours and a temperature less than 102.2F; or a child 24 months or older with mild inner ear pain in one or both ears for less than 48 hours and a temperature less than 102.2F. Since every child is different and antibiotics may be indicated in many situations, it is important to have an open dialogue with your pediatrician on this issue.

What will help your child feel better when they have an ear infection? If they have fever over 100.4F they can be medicated with acetaminophen and if over 6 months of age ibuprofen. A warm moist compress/washcloth held over the affected ear can lessen pain. There are drops the provider can prescribe that also help. If they are on an antibiotic, giving it as prescribed is very important. It usually takes at least 48 to 72 hours for the majority of the symptoms to subside. Always complete the antibiotic; not doing so can result in a recurring infection and bacteria resistant to antibiotics.  If your child has recurrent infections, over 4 in a year with at least one in the past 6 months your pediatrician may refer you to an ENT specialist to evaluate the need for ear tubes.

The good news is that ear infections do decrease as a child ages and the Eustachian tubes become less narrow and less horizontal so they can drain easier. 

Hand, Foot and Mouth Disease

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Hand, foot and mouth disease is a common contagious illness that is caused by the Coxsackie virus, a member of the Enterovirus family. Children age 1 to 4 are most affected, usually because they are in childcare centers, preschool or play groups, or anywhere there is close contact with other children. The virus lives in the digestive tract and is spread from person to person by touching others or contaminated objects (think toys) or other surfaces. Because the virus lives in the digestive tract the contaminant is poop! We are always telling children to wash their hands, and this illness is one of the many reasons why.

 The illness often starts with a child having a low-grade fever (100.4 to 101F) a sore throat and loss of appetite. A day or 2 later you may notice mouth ulcers or your child’s refusal to open their mouth, drooling or refusal to eat. Painful mouth blisters, can be on the tongue, the palate, on the back of the throat, the gums or inside the cheeks. In the mouth the blisters look white with a red base. They can break open and leave an ulcer. Those ulcers are painful. There are also flat red spots that can look like small blisters that occur on the palms of their hands and the soles of their feet. Parents usually notice the hands and feet after seeing a pinkish red rash on other parts of their child’s body such as the chest, back, buttocks and thighs. Other symptoms can include irritability, poor sleeping, along with the fever mentioned earlier, drooling and refusal to eat.

 A virus causes this illness and there is no cure, it just needs to run its course.  Acetaminophen or ibuprofen can help with the fever and discomfort. Your pediatrician may prescribe “magic mouthwash”, a mixture you can apply to the mouth sores/ulcers or if your child is older they can swish and spit the solution out. Cool liquids, ice cream, Jell-O and popsicles also help with the discomfort, and since it is hard to get your child to eat and drink, they can help prevent dehydration. You want to be sure your child has a wet diaper every 4-6 hours if an infant, every 6 hours as a toddler and to urinate every 6 to 8 hours if they are school age.

 The blisters on the hands and feet need to be kept clean and dry. They do not need to be covered, but if any of the blisters pop, apply a small amount of an over the counter antibiotic ointment such as Polysporin ointment.

Although it will seem longer, hand, foot and mouth usually lasts 5 to 7 days, with day 3 and 4 being the worst days, before they slowly improve. If your child has persistent irritability, can’t be comforted or they are lethargic you should call your pediatrician. It is also important to remember that this is a contagious illness and your child can shed the virus in their poop for several weeks. So, be sure everyone washes his or her hands frequently.

Croup

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Croup is a respiratory illness that affects infants and toddlers, most commonly age 6 months to 3 years. It can also affect older children. It is caused by the parainfluenza virus and has a characteristic barky cough, your child may sound hoarse when talking or crying and if the illness progresses/worsens then you may notice a high-pitched sound like wheezing when they breathe in. The cough can sound a little like a seal barking.  Most cases of croup are mild and can be treated at home.

 Croup can follow a cold so your child may also have a lot of nasal congestion that is not related to the croup. The nasal congestion can worsen the cough due to postnasal drainage. So it is most important to keep your child’s nose clear of mucus as much as is possible. The symptoms of croup are usually worse at night, and your child will awaken with the characteristic barky cough. Croup lasts anywhere from 3 to 7 days but occasionally may last 14 days. 

Another type of croup is called spasmodic croup. This is a type that begins suddenly and can also occur after a mild cold. The cough begins at night and worsens quickly. There is usually no fever. 

Breathing in moist air can help a child with croup feel better and breathe easier. Rest, fluids and a cool mist vaporizer all ease the course of the illness.  If you do not have a vaporizer, you can run a hot shower to create steam in the bathroom, then sit with your child for 15 to 20 minutes. You may need to continue this every couple of hours overnight. Acetaminophen or ibuprofen can also help your child be more comfortable. Remember only children over 6 months of age can have ibuprofen.

Most children with viral croup recover with no complications. But if your child does not seem to be improving over the initial few days you should seek medical help. They may need steroids and a breathing treatment if they are having increasing difficulty breathing. If oxygen levels are low they may require oxygen briefly until they are breathing easier.  The symptoms that would indicate a need to call your pediatrician or go to the ER include difficulty breathing with the skin between the ribs pulling in, a pale or bluish color around the lips, lethargy or seeming exhausted from breathing, signs of dehydration such as dry mucus membranes, no tears, sunken eyes and no urine for several (6-10) hours. 

Concussions

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Beautiful weather has arrived; kids are out riding bikes, playing sports, jumping on the trampoline, skateboarding and multiple other activities. So lets talk about concussions, also called mild traumatic brain injuries. If your child falls on the playground or falls off a bike or falls on a sports field their brain, which is essentially soft tissue surrounded by spinal fluid, can bang against their bony skull causing injury.

If your child has a head injury you should watch them closely for any signs of a concussion. There can be behavioral changes such as increased crankiness, drowsiness, and trouble falling asleep or sleeping more than usual. Mental/cognitive changes include slowed reaction times, difficulty concentrating, difficulty remembering, confusion, and/or impaired learning. They may complain that bright lights or loud noises bother them. The physical symptoms include headache, nausea, vomiting, dizziness, any loss of consciousness, and impaired coordination.

Symptoms can occur within hours to days of the event. They usually do resolve within 1 to 4 weeks.

The important aspect in all this is to have your child checked by their pediatrician when they have had a direct or indirect hit to the head. MRI or CT scans are most often normal.  Your child’s pediatrician will do a thorough neurological exam and discuss the follow-up your child will need.

The first step after a concussion is physical rest and mental rest accompanies this. Your child should avoid any thinking activity that could make symptoms worse – this includes using a computer, a cell phone, watching TV, doing homework or playing video games. Teens should not drive or participate in any activity that requires quick decisions and actions.

Most children can return to school and normal activity within a few weeks, but this is very individual. You want your child to be healed completely before doing anything that could cause a second concussion. Talk to the teachers, counselors and the school nurse about your child and their symptoms. They may need a graduated return to learning protocol. This includes cognitive rest with slowly increasing cognitive tasks, and slowly increasing school attendance, limiting tests to no more than one a day, and limiting homework assignments to 15 to 20 minute blocks.

Once your child is back to school with full function, then the return to play for sports can be initiated.

Return to play is a six step plan that begins with no activity until symptoms subside and then slowly increasing activity without any body contact or jarring movements, weight lifting or resistance training, until the last stage when they can return to play their sport fully. The six-step plan applies to children over age 10. Your pediatrician will handle the return to school and play individually for children under age 10.

During all this, if your child has a headache that increases in severity over a brief period of time, becomes increasingly confused, lethargic or has frequent vomiting, you need to call your pediatrician or go to a pediatric ER as the symptoms could indicate a serious problem.  

As with any health issue prevention it’s best to remember sports specific safety gear for your child.

Bronchiolitis/RSV

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Respiratory Syncytial Virus (RSV) is another viral illness that causes lower respiratory tract infection, particularly in children under age 2 years.  You might also hear it called bronchiolitis because it causes inflammation in a young child’s small airways called bronchioles. It is not the same as bronchitis that affects the larger airways in older children and adults. Bronchiolitis can be a serious illness for young infants and infants/toddlers who have heart or lung disease.

Bronchiolitis is a common cause of illness and a leading cause of hospitalization in infants and toddlers. The inflammation that occurs in the small airways can partially or completely block the airway. Sometimes it can cause wheezing – a whistling sound that you can hear when your child breathes out. When the airways are swollen because of the inflammation and filled with mucus, less oxygen can get to the body. They may have fever over 100.4F. Days 3 to 5 of the illness are the worst, and your infant usually slowly improves after that. It can take up to 14 days for your infant to get back to their norm.

Although RSV is now seen year round most outbreaks are from November to April. It usually peaks in January or February. By the time a child is 3 years of age they have had RSV at least once. You can get it more than once but subsequent infections are usually milder than the first. In older children and adults RSV resembles a cold with a lot of mucus and coughing. Infants who have had RSV will often wheeze every time they get any upper respiratory infection until they are 2 or 3 years of age.

There is no cure for bronchiolitis so we treat the symptoms, the difficulty breathing due to increased nasal congestion/mucus and the fever. One of the most important actions you can take is to suction your infant’s nostrils before they eat and before sleep. Place 5-6 saline drops or sprays in your infant’s nostrils then use the bulb suction to remove mucus. You may have to repeat the process a couple of times particularly when the mucus is thick. Always suction your infant before feeding, they can nurse or take a bottle better if they can breathe easy. Infants with specific types of lung disease, or who were born before 29 weeks or who have specific types of heart disease may be given a special medication called Synagis that helps protect the lungs from severe infection from RSV.

Things you can do to help prevent severe bronchiolitis include not smoking or allowing any smoking in your home. Exposure to secondhand smoke increases a child’s risk of respiratory illnesses. Keep your infant/child away from or at least limit contact with anyone with an upper respiratory infection. This is hard to do particularly if your child is in daycare. If you have a young infant always have anyone who picks them up, feeds them or plays with them wash their hands first. If your child is ill keep them out of daycare or school. Wipe down any toys or books or solid surfaces daily as the virus can live on surfaces for up to 72 hours.

When do you call your pediatrician or head to the ER? If your infant/child seems to be worsening, and the signs of a worsening condition include:  they are grunting, breathing rapidly, pausing in their breathing for more than 15-20 seconds, the skin between their ribs is sucking in with each breath, they appear to be tiring or if their lips, tip of their nose, fingernails or toenails are blue tinged. These are signs that your child needs urgent medical attention.

How do you know what your child has?

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BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Tis the season for stuffy noses, scratchy throats, fevers and in general not feeling well, so how do you know if your child has a cold or the flu? The symptoms can overlap which can be confusing and makes it hard to know what to do.

Colds are upper respiratory infections most commonly causes by the highly contagious rhinovirus. They can occur anytime during the year but typically increase in the fall and winter. Colds are a leading cause of missed school days, over 22 million a year according to the Centers for Disease Control. Symptoms are usually mild but can last for up to 2 weeks.

The flu, influenza, is another respiratory illness and is most commonly occurring from the fall to spring season. You can get the flu just as you do a cold, by coming in contact with droplets from coughs and sneezes in the air or on surfaces.

How do you know what your child has?

Colds are most contagious during the first 2-3 days, the best time to stay at home and not spread the germs. Remember not to share personal items such as utensils and towels. This is hard for young children to remember. Of course, the old stand-by hand washing is essential and when you can’t, then use hand sanitizer. The small individual sanitizer wipes are great for lunch kits so your child can clean their hands before eating. Teach your child from an early age to cough and sneeze into their elbow. Wipe toddler toys down daily with a sanitizing wipe. Let them dry for at least 1 hour before a child uses them again. Don’t keep your house too hot in the winter, it dries out nasal passages and increases the risk of getting upper respiratory infections.

Treating colds in infants and toddlers involves keeping their nose free of mucus by using saline drops then suctioning their nose with a bulb suction or the Nose Frieda. Do this before each feeding and before sleeping. Older children can use saline spray then blow their noses several times a day. Acetaminophen or ibuprofen can be used for fever or achiness. Have your child drink lots of fluids; this will help keep the mucus thin and easier to remove.

The best way to treat the flu is to prevent it. The American Academy of Pediatrics recommends all children ages 6 months to 18 years receive the flu vaccine. If your child is unable to receive the flu vaccine for a health reason such as allergy to the vaccine, then it is important particularly with infants that everyone else in the home get vaccinated in order to help protect (cocoon) the infant.  If you suspect your child has the flu see your pediatrician for testing particularly if they are under age 2 years. Watch young children for labored breathing, irritability, and refusal to eat or drink, or trouble waking up or responding to you. This would indicate a more serious problem and means a call to your pediatrician or trip to a pediatric emergency room is indicated. A severe cough with a persistent high fever, over 101-102F, for 3 days could mean pneumonia.

Both colds and flu need lots of fluids, rest, and the fevers treated with ibuprofen or acetaminophen.

What about the “natural” products you hear about? Are they safe for children?

Zinc is often said to decrease the length and severity of colds if taken within the first 24 hours of the start of symptoms. Zinc taken orally in low doses daily for at least 5 months has been shown to reduce the number of colds in children. Check with your pediatrician before giving to your child. Intranasal zinc has been linked to irreversible loss of the sense of smell and should not be given to children.

Vitamin C even when taken regularly has not been shown to reduce the likelihood of getting a cold. But it has been shown in research studies that if Vitamin C is taken daily it can reduce cold symptoms. Do not give children high doses of Vitamin C, it can cause nausea and diarrhea.

Echinacea, an herbal supplement, has not been shown, in the few studies available with children, to prevent colds. In one large research study children who took Echinacea had an increased risk of developing rashes.

Probiotics, a type of beneficial bacteria, were found in a 2011 research study with children to help prevent colds if taken on a regular (daily) basis. But that study has not been replicated.

So what does all this mean? Be sure your child eats healthy, drinks a lot of fluids, washes their hands, gets good sleep and stays away from those who are coughing and sneezing. Not easy to do!

Sprains & Strains

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

School and sports are in full swing, and with them often comes injuries, the mildest being sprains and strains.

What is the difference between a sprain and a strain? A sprain is the stretching or tearing of ligaments, those bands of fibrous tissue that connect bones together. A strain is the stretching or tearing of muscle or tendon, the fibrous cords that connect muscle to bone. In other words the muscle has stretched too far.

Sprains cause pain, swelling, bruising, decreased ability to move the affected joint, and occasionally at the time of injury you can sometimes hear a pop in the joint. They usually begin to hurt right away, it may look bruised and it is difficult to move the joint.

Strains also cause pain, swelling, decreased ability to move the joint, and they cause muscle spasms. Because it affects the muscle it may hurt immediately or not begin to hurt for several hours – it may appear bruised.

How can you prevent this type of injury? Make sure your child has and uses the proper equipment for each sport. Warm-ups and cool-downs should be a part of your child’s routine. Warmed up muscles are more flexible and cooling down will loosen any muscles that tightened during the exercise. Know the safety rules for your child’s sport and teach them to your child. The coach should be an active participant in having children use equipment wisely, know and enforce safety rules and have knowledge of first-aid. Often as children get older or are in organized sport programs there are athletic trainers on site who pay attention to any child’s injury and make sure they get the care they need. It is also important for your child not go back to sports until cleared by their physician.

But what about when it happens at home or the park when your child is just playing normally? The initial treatment for both sprains and strains is to limit activity, then rest, ice, compression and elevation (RICE). Ice/cold is important in the first 24 hours, as is decreased activity/rest. Apply the ice/cold pack for 20 minutes at a time. Always keep a towel between the ice and your child’s skin to prevent damage to the skin.  An elastic compression bandage, or splint can help with the swelling and provide support to the injured area. It is very important that it is not too tight; you don’t want to cut off the circulation. Elevation means raising the injured area so it is higher than their heart. After 24 hours you can usually use warm compresses or a heating pad for short periods of time, this helps aching muscles.

When should you see a doctor: if your child can’t walk more than 4 steps without significant pain or if they can’t move the affected joint, or they have numbness in any part of the injured area.  If you notice your child limping without having an injury, or if they have a limp after an injury that is not improving, a visit to their pediatrician is in order. Your child should also be seen by a pediatrician if the pain is intense and out of proportion to the injury, or if there is pain directly over the bones in the area – an x-ray may be indicated to check for a fracture.

A strain can take at least a week to heal and a bad sprain can take up to 3-4 weeks. Be sure to give a sprain time, or it is easier to re-injure.

 

Back to School Health & Safety

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Another school year is beginning; here are some tips to get off to a great start.

 

Health & Wellness:

  • The most effective way to avoid catching or spreading germs is with hand washing.
     
  • When hand washing is not available hand sanitizers are a good alternative.  But after using the restroom hand washing is essential since some bacteria such as Clostridium difficile are not removed with hand sanitizers.
     
  • After using hand sanitizer 3 times in a row the next time should be to wash hands.
     
  • One of the dirtiest areas in school according to the Center for Disease Control is the water fountain and the next is the non-disposable lunch tray. It is a good idea to pack hand sanitizer wipes in your child’s lunch box.
     
  • Children who are ill with fever should be kept home until fever free for 24 hours.
     
  • Be sure the school nurse and teacher are aware of any conditions your child may have such as asthma or a seizure disorder, and that the nurse has a written plan of action for any problems.
     
  • If your child who has always been attentive at school suddenly seems to not be following the teacher have their eyes checked.
     
  • Teach your new kindergarten child to cough in the crook of their arm.
     
  • Good sleep is essential to good school performance Elementary school age need 8-10 hours a night and teens should have 9 to 10 hours.

 

Backpack Safety:

  • Backpacks should have wide padded shoulder straps and a padded back.
     
  • They should not weigh more than 10-20% of your child’s body weight when full.
     
  • Your child should always use both shoulder straps; using one can strain muscles.
     
  • For older children check into a rolling backpack if they carry a heavy book load. Check to see if your school allows this and if the locker will accommodate it. Also remember it might have to be carried up stairs which is awkward with a rolling bag.

 

Car Pooling:

  • All passengers should wear a seat belt.
     
  • Children should ride in a belt-positioning booster with a harness until the car seat belt fits properly – usually when your child reaches 4 feet 9 inches tall and is between 8 and 12 years of age.
     
  • All children under 13 years of age should ride in the rear seat of a vehicle.
     
  • Be aware of your state laws for teen drivers and consider a parent-teen driver agreement. A sample parent-teen driver agreement can be found at: www.healthychildren.org/teendriver

 

School Day Nutrition:

  • Children who eat a nutritious breakfast do better in school, are able to concentrate and have more energy.
     
  • Check out your child’s cafeteria menus so you can anticipate any days when you or your child feels that the meal is not what either of you prefer. Then you can make a lunch.
     
  • Know what is in the vending machines at your child’s school. Work through your PTA and school administration to promote healthy selections in the vending machines.
     
  • Remember a soda a day increases a child’s risk of obesity by 60%. Sodas contain 10 teaspoons of sugar.

 

Bullying:

  • According to the Academy of Pediatrics bullying is when one child picks on another repeatedly, verbally, physically or socially. It can occur anywhere – at school, in the neighborhood, on the Internet or through their mobile device.
     
  • Teach your child to ask a trusted adult for help.
     
  • Make sure the school principal, counselor and teacher are aware of the problem and can look out for your child.
     
  • If your child is the bully be sure that they know that bullying is never okay. Set firm and consistent limits on your child’s aggressive behavior.

 

Healthy habits keep children’s immune systems strong; that includes exercise, healthy diet and adequate sleep.

PediaQ: Now Accepting Insurance!

PediaQ is now accepting insurance! For a limited time, during our back-to-school special, we are waving the convenience fee! That means that your only cost for a pediatric urgent care house call is your urgent care co-pay! We encourage every parent to download the app, help us spread the word, and give us a chance to earn your business! We guarantee 100% satisfaction or the visit is on us!

With PediaQ, there's no more long waits in waiting rooms, no risk of infection from other sick kids, and no more expensive urgent care or ER bills for after-hours common illnesses.

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Reflux in Infants

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Reflux, seems like something only adults would have but it also occurs in infants. You feed your infant breast or formula, and either halfway through the feeding, or after the feeding he/she regurgitates what seems to be all that they ate. You may notice arching with or after feeding, or even gagging. Occasionally infants will begin to refuse their feedings – they may lose weight and are often irritable.

So, what is reflux (also known as GER, or gastroesophageal reflux)? The muscle between the esophagus and stomach called the esophageal sphincter should tighten after food comes down the esophagus into the stomach, but with reflux the sphincter doesn’t tighten and it allows gastric acid and formula to enter the esophagus. This is common in infants particularly in the first month of life. Since infants have increased intra-abdominal pressure, as they are unable to sit upright, spit-ups are frequent and common.  This is normal. But when your infant arches, acts fussy, and very uncomfortable after eating it is not considered normal. The good thing is that most children have resolution of their symptoms by the time they are 12 to 24 months of age.

What can you do? Most important is to have your pediatrician evaluate your infant. There are diagnostic tests that may be done or if your infant has classic symptoms they may be treated based on those symptoms. Once you have a diagnosis there are several actions that can be taken to help your infant.  One of the first is to not put your infant down to sleep until at least 30 minutes after eating, and when you do, have the head of your infant’s crib raised to at least 30 degrees.  This can be done with a foam wedge or by placing pillows under the mattress. Never place your infant on pillows, as this can increase the risk of suffocation. The pediatrician may start your infant on a 4-week trial of acid suppression to decrease the trauma from stomach acid to the esophagus. There are several different medications for acid suppression that can be used for infants – sometimes your pediatrician may trial one and then switch because your baby is not responding as well as expected.

Your pediatrician may change your infant’s formula or have you add rice cereal to thicken the formula. This frequently helps the regurgitation but may not eliminate it. Smaller more frequent feedings are helpful. Large volumes increase regurgitation and irritability. Hold your infant upright for 30 minutes after each feeding. Swings, car seats, or bouncy chairs, compress the infant’s stomach and can increase the risk of regurgitation.

In summary, healthy infants may regurgitate with no other symptoms, often called the “happy spitter”, it occurs frequently in the first month of life, decreases significantly by 5 months of age and is usually gone by one year.  If your infant has reflux that is being treated by your pediatrician and it has not resolved by the time your child is 18 to 24 months you may be referred to a pediatric gastroenterologist. Your infant may be referred earlier if they are very irritable, have a chronic cough or are gaining weight poorly.

Colic

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Colic, the name makes parents of infants cringe. No one wants his or her baby to have colic. No one wants to see a baby so upset that nothing seems to console him or her. Colic starts around age 7 to 14 days, lasts over 3 to 4 hours a day for more than 3 days a week for over 3 weeks. How is this different from normal infant crying? On average infants cry for a total of 2 to 3 hours a day but with colic it is usually over 3 to 4 hours a day. The crying with colic is inconsolable; it is loud and high pitched. Parents can tell the difference with this cry very early on. Infants will also draw up their knees, clench their fists, grimace, and appear very distraught. When this first occurs it is a good idea to have your infant checked by the pediatrician to be sure there is no other underlying problem/medical issue.

What causes colic? No research has come up with one definite cause. There are multiple causes that contribute to colicky behavior. There are several research studies that show infants with colic have altered gastrointestinal microflora and this causes their intestines to not move as efficiently, nutrients are not absorbed as effectively, and there is a build-up of gas. A few studies have shown increased stress in the home, exposure to second- hand smoke and overstimulation can all contribute to colic. But there is no known single cause.

Let’s go over some common strategies that have been used for treating colic. One of the most effective treatments based on research has been supplementing the infants diet with probiotics. They have been shown to significantly decrease the number of episodes and the length of crying. They also help to decrease gas. Ask your pediatrician what brand they would recommend.

Swaddling and use of white noise are somewhat effective as is rhythmic activity such as rocking, swinging, and walking with your infant. And for some infants the car ride works like a charm.

Gripe water is recommended on some web sites, but usually not by physicians. This is a mixture of herbs and herb oils. Some infants do get relief from gas with this, but it is temporary. Always read the label and avoid products with alcohol or that are made outside the USA as they may contain herbs not safe for infants.

If your baby is formula fed your pediatrician may change the formula, as some infants with colic have been shown to have difficulty with milk based and sometimes soy based formulas. One of the researched baby bottles that have been found to decrease fussiness and crying in infants with colic is Dr. Brown’s Natural Flow bottle.

Breastfeeding should not be stopped if your infant has colic. Mothers can begin by eliminating foods such as cow’s milk products, eggs, peanuts, tree nuts, wheat, soy, fish, cruciferous vegetables and chocolate from their diet.  Do this for one week and see if there is a change in the crying and fussiness for your baby. Then slowly re-introduce the foods one at a time while watching for changes in your infant’s behavior. You can then avoid the offending foods.

Some parents find it helpful to keep a log of their baby’s crying, fussing, sleeping, and eating so they can see if there is a pattern, or if one activity is more helpful than another in calming the infant.

Parents who have an infant with colic can feel very frustrated, anxious, overall stressed, depressed, and even anger.  You may be sleep deprived. You may even question your parenting skills. It is so important that you seek help from supportive, trustworthy family and friends, and have time away from your infant. This helps you stay refreshed and able to be a good parent. When you feel you can’t take any more crying, call for help.

Remember colic is time limited and you will have your sweet baby back usually by 3 months of age.

Skin Infections – Impetigo

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

It’s summer, and with it comes lots of outside play, and with that comes cuts, scrapes, bug bites, and itchy allergic rashes. Kids scratch and pick at the sores and scabs and the next thing it’s red, slightly swollen, and there is clear yellowish drainage and honey colored crusting on the area. Your child now has a common contagious superficial skin infection called impetigo. It is usually caused by Staph aureus, a bacteria we all carry on our skin.

Impetigo is most common in children ages 2 to 6 years but can also occur in teens and infants. It spreads easily in schools, daycare, and camp. Sports that involve skin-to-skin contact such as football and wrestling increase the risk of developing the skin infection.

Impetigo occurs more in the summer months and in warm humid climates. A child is more likely to develop impetigo if their skin is irritated or open, such as with eczema, poison ivy, bug bites, cuts or scrapes. It often appears as red sores on the child’s face, arms, legs and sometimes the perineum. The sores develop into fluid filled vesicles that burst and then honey colored crusts develop. They are itchy, and cause discomfort in mild cases.

Impetigo is not dangerous, but if left untreated, cellulitis can develop – the infection can spread to the lymph nodes, bloodstream, and it can become serious. So, if you suspect your child has impetigo see your pediatrician.

Antibiotics are the mainstay of the treatment plan for impetigo. Your pediatrician will decide if your child needs oral antibiotics, or if the lesion is small enough to be treated with topical antibiotic ointment, or both. Always finish the course of antibiotics to prevent recurrence of the infection and decrease developing resistant bacteria. When applying antibiotic ointment you will need to apply wet compresses to the lesions to help gently remove the crusting and scabs first. This is important, as the ointment will not be able to be absorbed thru the scabs and crusts.  Your child will be considered contagious until they have been on antibiotics for 24 to 48 hours.

The best prevention for skin infections is hand washing and not scratching bites or picking at scabs or touching the face with dirty hands. Easier said than done depending on the age of your child.  Wash all cuts, scrapes, and bug bites when they occur, and keep them clean as much as possible. And, as always, see your child’s pediatrician for any concerns.