Headaches (non-migraine)

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

Summer viral illnesses are in full force and headaches are often associated with them. We see this frequently when our children have a cold or the flu. Usually these headaches are short-lived and not unexpected with a viral illness.

Other types of headaches are those caused by muscle tension and/or stress. Your child will complain that their neck feels tight and sore, and there is a feeling of tightness around their head. Middle school and high school teens are very susceptible to these types of headaches, particularly during the school year. Hours spent hunched over a computer to study for exams or write a paper, create muscle tension and stress leading to a dual headache.

Your child grinding their teeth or clenching their jaw tightly during sleep can cause headaches. A visit to the dentist and possibly a bite guard may help. And sometimes a headache can simply be as a result of being hungry or overtired. The frequent coughing we see in children when they are having an asthma recurrence can also cause a severe headache. 

Sinus headaches are common in Texas, particularly if one has allergies with frequent sinus congestion. Frontal sinus headaches aren’t usually seen until after age 10 when the frontal sinus is fully formed. Your child will complain of pain in the forehead area between their eyebrows. If other sinuses are involved they may complain that their face hurts. Viruses cause most sinus problems, but you want to have it checked in case it is a bacterial infection and antibiotics are needed.

Then there are the more serious reasons for a headache, such as meningitis or encephalitis. These are scary illnesses. Your child will complain of a headache but also a stiff neck and there may be vomiting, fever and confusion. You should always call your pediatrician if your child has a headache with a stiff neck and is unable to touch their chin to their chest. When the headache first occurs they may be able to do it but as the headache worsens and causes significant pain they will not be able to bend their head forward. If your child has any confusion, slurred speech, is difficult to awaken or is unsteady walking call your pediatrician right away and be prepared to head to the hospital ER.

Anytime a headache lasts over 3 days, or if headaches are a chronic problem for your child, a visit to your pediatrician is warranted. Also if your child repeatedly awakens with a headache that initially improves and then you notice it lasts longer each day, see your pediatrician.

Mild headaches can be treated with acetaminophen or ibuprofen. Have your child lie down and rest with no TV, video games or books until they feel better. If they are able to sleep usually they will wake up headache free or improved. Teach your teen how to do neck stretches to ease tight muscles. If stress is the source of their headache help them to talk out their problems, stresses and concerns.

Headaches can be of mild concern or very serious, when in doubt it never hurts to call your pediatrician.

Enteroviruses Infections

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

Enteroviruses can strike at any time of the year, but summer and early fall are the main seasons for your child to get a virus from this group.  This virus family loves to be wherever a lot of people/children gather together. It loves camps and day care centers, or anywhere children are grouped together for play and activities. This family of viruses can cause a wide variety of illnesses because there are over 70 strains.

What does it look like if your child has an enterovirus? Most commonly children will have fever without any other symptoms. They have a fever for a couple of days, then they seem to get better and then the fever is back. This fever can be high, around 104F. If your child is over 6 months, alternating acetaminophen and ibuprofen is helpful.

Other symptoms children may have are loose stools or diarrhea, tummy aches, headaches in older kids, and/or muscle aches with or without fever. Enteroviruses can cause colds, sore throats and even pneumonia. One particular strain of the virus is responsible for hand-foot and mouth disease. These viruses may also cause rashes.

So what does this mean for your child? This group of viruses is spread easily from poop to mouth to skin and through the respiratory system with coughing and sneezing. They also live long, 24 to 48 hours, on objects and surfaces. This means good hygiene is a must: hand washing with soap and water after toileting, changing diapers and before eating. Wipe down surfaces and objects/toys with disinfecting wipes whenever an ill person is in contact with them. When hand washing is not available use hand sanitizer.

Antibiotics are not helpful since we are dealing with a virus. We try to relieve the symptoms/discomforts for children. Acetaminophen and ibuprofen are helpful for a fever. Lukewarm baths or showers can also bring a fever down a degree or two. Don’t let the child shiver as it blocks decreasing the fever.

Probiotics that contain Lactobacilli and Bifidobacterium are helpful in slowing diarrhea. They contain beneficial bacteria for the gi tract. Probiotics are safe for children and there are no significant side effects for children with normal immune systems. Always check with your pediatrician before giving a child under age 12 over the counter antidiarrheal medications.

The main concern with fever, diarrhea and vomiting is dehydration. Frequent sips of Pedialyte or watered down Gatorade are important to maintain hydration. Avoid sodas and anything with a lot of sugar, for example juices. They should be getting enough fluid to urinate at least every 6 to 8 hours. Don’t worry if they do not want to eat or are picky with what they will eat, children can go for a few days without eating as long as they are drinking. When their appetite returns start with bland foods, nothing fatty or high in sugars. If your child is vomiting and unable to keep anything down, call your pediatrician.

Don’t let summer fun be sidelined by a virus, keep up the hand washing! 

Insect Bites

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

We live in the south, and this year, so do an increasing number of mosquitos. We hear cautions daily for West Nile virus (causing flu-like symptoms, skin rash & swollen glands and rarely encephalitis) and Chikungunya (another mosquito borne virus characterized by fever and joint pain), scary stuff.

Remember, when it comes to mosquito bites, prevention is best, but what about the DEET in the repellants? The American Academy of Pediatrics has said DEET up to 30% concentration is safe for children. It should not be used in infants under 2 months old though.

You can apply insect repellant to exposed skin, clothing, and shoes. Be careful not to apply it to the hands or face on young children or on any skin areas with cuts, scrapes, or eczema.  If your child is going to be outside for over an hour apply repellant with 30% DEET as it lasts longer, but if your child is going to be outside for an hour or less they only need 10% DEET.  When your child comes back inside to play wash off the insect repellant with soap and water, then reapply later when they go out again.

What are the alternatives if you don’t want to use DEET containing repellants? There are two that the CDC (Centers for Disease Control) has said are effective: those repellants that contain Picardin, a chemical compound, or Oil of Lemon Eucalyptus, a plant based compound. They have been used in Europe, Asia and Australia for years. The main precaution is that Oil of Lemon Eucalyptus should not be used in children under age 2.

How do you know what is in your insect repellant? Those repellants containing DEET will say DEET and the percentage or N,N-diethyl-m-toluamide. Picardin’s chemical name is KBR3023, and Oil of Lemon Eucalyptus may be listed as PMD or P-methane diol.

What do you do for insect/mosquito bites? Most bites are irritating but they disappear in a day or two. There may be small bumps that are red and itchy. Minor reactions can be first washed with soap and water, then apply a cool pack or a cool wet cloth to the area. Calamine containing lotions can help decrease the itching. If there are many bites your pediatrician may recommend a non-sedating antihistamine. It is not recommended to use an antihistamine skin cream or spray over large body areas – children’s skin absorbs large amounts and they can have a toxic reaction particularly if you also give them an oral antihistamine. Also, these products can cause contact sensitivity after being in the sun.  If the bite area keeps swelling, has increased redness, and becomes hard and tender, then it is time to call your pediatrician.

Remember to limit outside activity at dusk and dawn when mosquitos are most active, wear loose light colored clothing outdoors, remove all standing water around your home, use insect repellants whenever you are outside, and you will be defending yourself against those pesky mosquitos.

Swim & Water Safety

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

Summer and swimming go hand in hand. Going for a dip is a fun treat in the Texas heat! 

The serious side of lakes, rivers and pools is that drowning is the #1 cause of death for children age 1 to 4. So, lets talk about what to do to change this. Babies can be introduced to water around 6 months of age. There are water safety classes for very young children to learn to float and tread water and not to panic around water. By 3 years of age children should be in swimming lessons. All children should learn how to tread water and float. But, despite swimming and water safety, a good rule is that anyone under 5 years has to wear a life jacket when playing around or in the pool.  Remember that water wings, noodles and inner tubes are fun toys but they will not prevent drowning. The most important part of drowning prevention is for kids to have constant supervision. You cannot depend on lifeguards at public pools and waterparks. Kids in the water should always have an adult watching them. If a child is missing always check the pool first.

What about dry drowning sometimes called secondary drowning? They are frequent news items lately and although very scary, they are rare and occur in only 1 to 2 percent of all drowning incidents. In dry drowning, a child inhales a small amount of water thru the nose or mouth causing a spasm in their airway – this causes it to close up. The water has not reached the lungs. In secondary drowning, a little water gets into the lungs causing inflammation and swelling. This decreases the body’s ability to take in adequate oxygen.  

How will your child behave when this happens? Coming out of the water after getting water inhaled, your child may cough a little then seem to be fine. Sometimes hours later they will have increased coughing, seem to be working hard at breathing, nostrils flaring or the skin between the ribs pulling in with each breath. They may not cough, but one minute they are actively playing and then they are extremely fatigued. They may feel “sick” or unsteady on their feet or have vomiting with persistent coughing. What do you do? Call your doctor or head to the ER.

And then, there is always the issue of pool hygiene.  Young infants and children that are not potty-trained should wear waterproof diapers that are changed frequently. Have timed bathroom breaks for the older kids where everyone gets out of the water – this teaches good habits.

There is one other area that is of concern. I’m sure we can all remember playing games to see who could hold their breath and stay under water the longest when we were kids. And many team swimmers have experienced swim training drills where you had to purposely hyperventilate for up to 10 breaths then hold your breath for extended periods while swimming under water to improve lung capacity. We now know these behaviors can have serious consequences. So what happens?  Kids take several rapid deep breaths and then hold the last one before jumping or diving into the water. The problem is that they have breathed out a large portion of carbon dioxide, the gas that makes you want to breathe. When underwater the carbon dioxide levels fail to rise quickly enough to signal the brain to breathe, oxygen levels fall and the child faints underwater and drowns.  These games are best not played at all. Most swim coaches know that this is not an acceptable way to increase lung capacity anymore.

With the right care for safety, swimming in the summer can be a fun family experience!

Summer Heat & Dehydration

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

We’ve had a mild summer so far, but as we all know the heat here in Texas can be intense. Last week sunscreens were the topic, this week I’d like to share with you some information about summer heat and dehydration.  Infants, young children and teen athletes are at highest risk for heat related illnesses.

So how do you recognize heat exhaustion?  When they are suffering from heat exhaustion a child will have lost large amounts of salt and water. They may complain of severe thirst, fatigue, headache, nausea, vomiting and sometimes diarrhea. They may feel slightly dizzy and their skin may feel cool and clammy.

If the child is out of doors move them to the shade or indoors’ right away. Alternate between giving them frequent small sips of water and a sports drink. Have the child lie down and apply cool wet towels to their head, neck, chest & legs. Or you can place them in a tepid shower, but stay with them in case of weakness or fainting. If this occurs seek medical attention.

What about heat cramps? Those of you with child /teen athletes be on the lookout for these muscle spasms that can affect the legs or abdomen and also can cause generalized aching. Have the child sit or lie down in the shade or move indoors. Give them water alternating with sports drinks. Have them slowly and gently stretch the affected muscles. If your child is not better within 1 hour seek medical attention.

How can you avoid these heat related illnesses and dehydration? Avoid being outside between 11am and 3pm as much as possible. Always have your child drink more water than you think they need. Have them hydrate before, during and after activities. Avoid fluids with caffeine as they increase the dehydration risk. When playing actively in the heat a child should be drinking fluids every 10 to 20 minutes and you should expect them to have to urinate every 4 to 6 hours. If a young child has not urinated every 6 hours they are not drinking enough fluids. Plain water is fine if they have been in the heat for less than 1 hour, but alternate water and sports drinks if they are in the heat over an hour. Also, remember adolescents beginning sports training during the hot summer should have a 14 day heat acclimatization process to reduce heat related illness risk.  

Using these simple tips can help you and your child beat summer heat and dehydration. Stay tuned for the next blog about swimming safety in my summer series.

That Hot Summer Sun!

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

Let’s talk about sunscreens and sunburn. Sunscreens are essential, but an SPF of 30 is sufficient. Current research has not proven an SPF greater than 30 gives any more protection. You should pick a sunscreen with UVA and UVB protection.  Avoid sunscreens with oxybenzone for children, as there is concern over mild hormone properties.

How much sunscreen should you use? 2 tablespoons for a small child and up to 4 tablespoons for a larger child, per application. If you use a spray type it still has to be rubbed in. Don’t forget to use a zinc or titanium oxide sunblock on your child’s ears, nose & cheekbones. It even comes in fun bright colors.

If your child is under 6 months of age try to keep them out of the direct sun. If you are unable to keep them out of the direct sun or have them covered with protective clothing, including a hat, then use sunscreen sparingly on exposed areas. For children over 6 months of age apply sunscreen to all exposed areas. Remember with infants and young children to be careful around the eyes, and keep hands free of sunscreen as an infant or very young child may put their hands in their mouth or rub their eyes.

Clothing should be loose but have a tight weave to help block the UV rays. Hats with a 3-inch brim to shield the face, ears and neck are helpful. Sunglasses that are labeled to have UV absorption to 400nm should be worn by all, including infants. Avoid the sun during the hottest part of the day from 11am to 4pm when the UV rays are the strongest. Teach children the shadow rule: seek shade when your shadow is shorter than you are tall.

Remember, sunscreen needs to be applied 15 to 30 minutes before going outside. Application should be repeated every 2 hours, or after swimming or heavy sweating or toweling dry.

Sunburn can occur in as little as 30 minutes after exposure. Some medications can increase sun sensitivity, so always read the package insert on medications to check for the side effect of photosensitivity. Children are at increased risk of sunburn since they usually spend an increased time outdoors, and also due to structural and immunologic skin differences in those under age 20.

Cool compresses can ease the discomfort of sunburn, along with acetaminophen for a child under 6 months of age or ibuprofen for a child over 6 months. A skin emollient such as aloe vera gel is often helpful. Avoid local anesthetic sprays with benzocaine due to the risk of sensitivities. If your child has a blistering sunburn see your pediatrician for care.

 

What is it like from a parent’s perspective to call PediaQ when you have a child who is sick?

BY LINDA STEVENSON, PhD, RN, FNP-C, PediaQ Senior Nurse Practitioner
 

You are not sure if you want to use PediaQ, you have read the reviews from other mom’s on Facebook and it sounds wonderful. You can stay at home, you don’t have to put your sick child in the car and head to an urgent care center or the ER; you don’t have to wake your other children up (if they were sleeping) to come with you; and you don’t have to expose your sick child to other illnesses.

The very qualified and experienced Q Certified nurse practitioner will call you within 10 minutes of making a request. You tell the nurse practitioner what is happening with your child and after hanging up they arrive within 30 to 45 minutes. Usually the practitioner will give you an estimated time for arrival. You get to wait in the comfort of your home, while keeping your child comfortable and feeling secure.

When the practitioner arrives they are very professional, know how to interact with a sick child and listen to what you tell them about your child’s condition. They come into your home for a brief period, assess and diagnose your child and then they are gone. You’ll know what to do to get your child well, have a prescription if necessary, or know what over the counter medicine to purchase.

One of the things the Q Certified nurse practitioner can do is to go and pick-up the prescription for you.  This is a great service and makes such a difference if you are unable for one reason or another to get the prescription yourself. This is particularly helpful at night if you have a spouse who travels, or if the weather is awful and you don’t know when you will be able to get to the pharmacy but you want your child to be treated as soon as possible.

Still not sure, talk to your pediatrician. PediaQ is there to support the individual pediatrician’s practice when they are not open. Many pediatricians recommend PediaQ to their parents. They are sent a summary of the visit so they are aware your child was ill and the treatment they received. PediaQ also recommends that you follow-up with your pediatrician after the visit.

What about the nurse practitioners that work for PediaQ? Who are they? What kind of experience do they have?

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

The Senior Nurse Practitioners at PediaQ have a combined experience as practitioners in pediatrics of over 15 years and pediatric nursing experience of over 30 years.  All PediaQ nurse practitioners must have over 2 years of practitioner experience in pediatrics and 5 years is preferred. All of the practitioners have Masters degrees and several have doctoral degrees.

What sets the PediaQ nurse practitioner apart is the love of pediatrics and the competency level. All practitioners are screened through vigorous background checks and the Nurse Practitioner Database (NPDB).  They are also Pediatric Advanced Life Support certified (PALS). In addition, PediaQ certified nurse practitioners receive an intense orientation and skills training to become Q Certified.

The best part of being a PediaQ nurse practitioner is having the time to be thorough in assessing the children, having time to educate the families, and having a flexible schedule. 

PediaQ nurse practitioners have a supervisory physician they can call for questions at any time, and who reviews their care according to Texas Medical Board guidelines. PediaQ works closely with the medical community and your pediatrician will receive a summary of each visit.

In summary, having a highly educated, competent and fully vetted nurse practitioner come to your home to care for your child is an easy decision for any parent to make.

Why as a parent should you be interested in this service?

By Linda Stevenson, PhD, RN, FNP-C, PediaQ Senior Nurse Practitioner
 

PediaQ offers just the concierge urgent care service you need. You weigh your options and they are: an urgent care clinic or the ER. You now have to think about what to do with your other children if you have them, bundle a sick vomiting child into your car and think about waiting in the ER or urgent care for possibly hours, along with worrying that they are being exposed to all the other sick people in the waiting room. This is while you are trying to make arrangements for another child to get to a ballgame or dance class or to be picked up from one.

This is where PediaQ comes in. It is a concierge urgent care in your home. A certified nurse practitioner with years of pediatric experience will come to your home, assess your child, prescribe medications if necessary and give you the information you need to be able to take care of your child. You don’t have to leave your home, disrupt routines, and expose your child to other illnesses.

How does it work? It is somewhat similar to Uber in that you download the PediaQ app, put in the information requested then you can request a certified nurse practitioner. The nurse practitioner on call will accept your request and call you for brief information. She will ask you questions about your child and their illness. She will then give you an estimated time of arrival. You can see which NP accepted your request, her qualifications and how she was rated by other families. Now, that’s pure convenience for parents in a busy world.

Fun facts: Linda has taught pediatric nursing and was a tenured professor at Baylor University for more than 20 years.