Kids and Enteroviruses (Gastrointestinal Tract Illnesses)

Enteroviruses: Now you see the word that describes those viral infections that affect the gastrointestinal tract to one degree or another. These become more prevalent during the warmer months of the year, and therefore may affect a lot of children of early school age during the beginning and end of the school or nursery year.

Your child or toddler may experience vomiting, diarrhea, abdominal pain and fever in one combination or another, but these illnesses, as a rule, tend to be short and mild. In general the diarrhea usually does not contain blood or mucous as these are found in the diseases that are usually caused by bacterial agents. The stools are usually clear to yellow/brown and may be watery or just very soft. Vomiting, fever, and diarrhea usually occur simultaneously but the vomiting is first, followed in rapid order by diarrhea and possibly fever. There are literally hundreds of named viral illness that can cause these symptoms including an enterovirus that you are familiar with; poliovirus is an enterovirus that is usually mild but until the advent of polio vaccine, this virus was capable of infecting the brain and causing any number of disturbing and sometimes permanent symptoms. It should be said at this point that even though these are usually mild illnesses they are all capable of very rare brain invasion.

I have spoken of the symptoms of these illnesses and it is now important to help parents decide what are the symptoms that should be evaluated by a doctor. The younger the child or infant, the shorter period of time with these symptoms are needed to cause dehydration.

Signs of dehydration in an infant or child are (but not limited to): fussiness, decreased volume of urine or frequency of urination, dryness of the tongue surface- not necessarily the lips, a lack of interest in his/her surroundings and listlessness.

In other words parents always know when their child is acting really sick. A short talk with your Pediatrician will determine whether your child should be seen in the doctor’s office or things may be managed at home.

Certainly severe dehydration is very rare and has very significant symptoms that probably will not be missed by a parent.

As with all viral illnesses, the best way to prevent spread in the home starts and ends with good vigorous hand washing. Children will probably be contagious about one day prior to symptoms (you can’t know) and a day after any fever decreases to normal. If your child is in diapers, you will want to keep him/her at home until the diarrhea at least slows, and your child is acting normal with normal temperature.

Kids Get Headaches Too. What To Look For…

Children certainly are capable of getting headaches at all ages; the younger the child the more difficult it is to know these are occurring. Under age two it may be impossible to know if your child has a headache but whatever the age, it is important to answer certain questions regarding the overall health of your child.

• Mild Infection: If we are talking about a single headache that is non repetitive in nature, the most common reason is usually a concurrent mild infection (usually viral). Your child might also have signs and symptoms of a cold or mild fever, and is otherwise normal in behavior and activity. It is always good not to use medicines unless absolutely necessary for the cold symptoms as well as the headache, which is merely another symptom like runny nose, cough and low grade fever. Acetaminophen or ibuprofen can be used short term in appropriate doses if you child seems very uncomfortable.
• Sinus infections can also cause headaches: this is usually in older children and tends to be in a facial or forehead distribution. Again your child will generally not be very ill but the complaint might occur during or after a cold.

Of course, there can be more serious reasons for headache in all children. The next two are less common, but still important to note:

• Brain Tumor: Headache due to a brain tumor can occur but there are usually other findings and symptoms. But if your child is complaining about headache that is getting worse over time and might be associated with vomiting, weight loss, unusual behavior, and might very well be worse first thing in the morning you will want to take him or her to the Pediatrician as soon as you can.
• Meningitis (inflammation of the membranes covering the brain and occasionally the brain itself) is a very serious and rapidly progressive illness associated with severe headache, and changes in level of consciousness, with fever and possibly seizures occurring in rapid progression. Your child may start off only mildly ill but in a very short time will be rapidly get worse. Go directly to the emergency department.

While most headaches are mild and due to mild concurrent illnesses, if your child is acting very sick with or without fever, call your Doctor for instructions.

• Concussions: Of course a topic of relevance for quite some time now is concussions and this is another discussion to be taken up in the future. Concussion however can result in recurrent headaches for some time (occasionally measured in months) after an injury as part of a post-concussion syndrome.
• Migraines: Chronic or long term headaches also occur in children and if there is a history of migraines in the family, your child is having severe headaches on one side of his/her head, associated with vomiting or nausea, and followed by a period of sleep after which the child feels fine, he/she might very well have migraines and should be seen by your Doctor- if only to rule out some of the illnesses mentioned above.
• Tension and/or anxiety: In older children a very common reason for recurrent headaches of a benign nature is tension or continued anxiety. Still other illnesses (like those mentioned above) must be ruled out and communication with your child is required to delve in to the reasons for a tension type headache. Most of the time a diagnosis of tension headache is made after ruling out other causes

Springtime Agonies for “Allergy Kids”

My son HATES spring. It’s absolutely bottom of his favorite season list – despite the Mid-West’s frigid winter temperatures. But he has good reason: seasonal allergies (aka hay fever, nasal allergies, allergic rhinitis, etc); and though the term encompasses all seasons, spring is often one of the worst for allergy sufferers.

Given the terrible winter weather this year, I had begun to think spring would never arrive in our region. But in the past couple of weeks it’s definitely made its presence known: sneezing, runny nose, itchy eyes and dark under-eye circles (allergic shiners). If you’ve never had allergies you might think, “so what?” However, for people with serious allergies, these symptoms can become a major issue. The agonies started when our son was a toddler, originally with severe nose bleeds – so bad that the upstairs bathroom looked like a scene from an episode of CSI. It turned out the nosebleeds were triggered by allergies which caused inflammation in his nose. We’ve since had the prick test on his back and he is sensitive to many indoor and outdoor allergens, but spring’s flowering trees and bushes really bring on the agonies.

Unfortunately, the little guy didn’t have much of a chance for an allergy-free life. Both my husband and I have allergies, and since the condition has a genetic component his likelihood of also getting them was greater than 70% (if only one parent has allergies the chances of children also having them are about 1 in 3). And to make matters worse, we compounded his genetic disadvantage by moving into an allergy-prone environment.

All Hail Knoxville, TN

Local allergists told me that we live in a particularly bad area of the US for allergies. The spring flowers and grasses are beautiful but, as my son sees it, they also have an evil side. When I checked into this recently I found that my city actually rates #43 (out of 100) on the list of 2011 Spring Allergy Capitals (see the Asthma and Allergy Foundation of America) or about three-quarters of the severity of the #1 city, Knoxville TN. But given the symptoms we still have I’m not sure that gives me much comfort, especially since if I were to drive 115 miles east or south I would hit the #7 and the #2 cities (Dayton, OH and Louisville, KY respectively). I think just being on the list should give pause to any allergy-sufferers considering a move to one of these locations. At least don’t be surprised if your child didn’t have allergy symptoms before but develops them once you move into an area with high pollen levels.

Managing the Multiple Symptoms

Since his diagnosis we’ve been able to mostly stave off the nosebleeds through daily use of allergy medication during the most challenging seasons, along with occasional application of a nasal lubricating cream. But spring allergy symptoms continue to be an issue: frequent sneezing and runny nose; eyes so itchy and swollen he couldn’t see and had to come home from school.

We’ve tried all the major brands of allergy medicine: Claritin, then Zyrtec, and now Allegra. They all seem to work fairly well, though some doctors feel some are more potent than others. Since they didn’t completely manage his symptoms during the peak spring pollen season our pediatrician added Singulair last year, which works differently than the other medicines. I’ve been taking Singulair for my allergies for a few years with good success, so this seemed like a great idea for him. However, everyone responds differently to medications and, unfortunately, my son showed behavior and mood changes after going on this drug. Since these effects had previously been reported with Singulair we decided to take him off it and the changes subsided. As with any medication, just watch your child for any unusual or reported side effects after starting a new medicine. For his eye issues we’ve been using Pataday, which has been excellent. It’s quite expensive but we went with it anyway due to the severity of his symptoms. He was so miserable that he didn’t even resist having drops put in his eyes!

An Ounce of Prevention

Since there’s currently no cure for allergies, experts recommend that we work to limit exposure to problem allergens such as pollen, dust mites or pet dander. The following sites give comprehensive allergen prevention strategies: Asthma and Allergy Foundation of America and AskDrSears. The latter helpfully breaks the strategies down by both convenience and expense.

A number of strategies have worked for us, particularly during springtime:

• Keeping our 2 dogs confined to the lower floor using an indoor invisible fence pod (plugs into electrical outlet – you can buy from your invisible fence company)
• Using a portable HEPA air filter in the “dog zone” – and a filter on the central air system
• Keeping windows and doors closed during high pollen periods
• Cutting our son’s hair shorter during allergy season – and washing it before going to bed
• Changing his clothes after coming in from playing outside
• Having school keep him indoors during recess and after school when symptoms are very bad

The process continues to be a challenge and we probably have to visit the allergist again as he started breaking out in hives on occasion over the past few months, which apparently is often caused by reaction to foods or medication. On to a new chapter in our allergy saga!

What strategies have worked for you in managing your children’s allergies?

Another Ear Infection…What Can I Do – Part II??

Since we now understand how ear infections occur (see Ear Infections – Part I), it’s time to deal with the child who seems to get repeated ear infections. Ear infections, particularly the middle ear type, are responsible for providers ordering more prescription antibiotics than any other childhood disease.

There are a certain number of children who just seem to get an outer ear infection (otitis externa) every time they get their ears under water, usually during the warmer months of the year. There are even some who get this when they do not get their ears under water, but usually these episodes are also in the warmer months. I spoke about the treatment of the sudden or acute ear infection, but what to do about the repeated episodes. The best answer to this is using either a prescription medication or better yet, one not costing you anything at all. Mix ½ to ½ mixture of white vinegar and rubbing alcohol and place a couple drops of this into your child’s ear as soon as they get out of the pool or lake or ocean and try to limit the time those ears remain submerged. This has a way of drying out the external ear canal and helping to change the acid content of the eardrum. Ear plugs may be effective under certain circumstances but in general if you force a plug into the ear it may just irritate the skin which is exactly what we wish to avoid.

Middle ear infections (otitis media) are a different matter entirely. Remember that these are primarily due to a blockage in the normal valve system of your middle ear, with resultant pressure, fluid and infectious results. (Please refer back to part I if this is confusing). These changes happen in a progression that can occur suddenly or can develop over time.

While the obvious answer would be to use a “cold medicine” early on in the process this does not seem to influence the course of events as outlined, when looked at in controlled studies. The other end of the spectrum for treating the occurrence of multiple recurrent middle ear infections is to alter the normal anatomy in such a way as to prevent buildup of pressure in that small space which can then lead to fluid accumulation and bacterial secondary infection. This is accomplished through the use of very small tubes that can be surgically inserted through the eardrum and will serve to equalize the pressure on both sides of the eardrum. The system will calm down and the incidence of new infections will drop tremendously.

But that is a surgical procedure under some type of anesthesia, and even with tubes in the proper place, there can still be fluid production which then drains out of the ear chronically. Also, the mere act of making a hole in the eardrum through which a tube can be put in place, can slightly damage and scar that eardrum. Depending on the type of tube implanted in the eardrum, it usually comes out by itself after six to twelve months and the eardrum heals. Occasionally, the ear drum fails to heal completely and there is a perforation that might need to be surgically repaired in the future.

We treat middle ear infections for one of several reasons: to control the pain, to prevent any further extension of the infection into sensitive areas, and to preserve speech and hearing in your child.

Fortunately there are other approaches to the treatment of recurrent middle ear infections. Each significant ear infection should recognized and treated appropriately and the fluid buildup behind the eardrum monitored for resolution.

• Fluid constantly in touch with the ear drum will dampen the usual vibrations and dull the hearing while it is there. Hearing testing can be run routinely to follow any changes in hearing.
• All types of medications have been tried at one time or another: preventative doses of antibiotics have and still are being used for several weeks to months in an effort to prevent the bacterial infections, but the increasing number of bacteria becoming resistant to common antibiotics have caused physicians to re –think the use of long term medication.
• Cortisone preparations by mouth have been tried to help with the middle ear inflammation, with varying results.
• Occasionally, when all forms of treatment fail it is up to the ENT surgeon to place those tubes and let the middle ear system calm down.

So, there are many things to consider in finding a course of action for your child with recurrent ear infections and your Doctor will be familiar with each of the methods and can discuss them with you.

How did my child get an ear infection – Part I ??

Ear infections come in two basic varieties; external, commonly occurring in the warm weather and referred to as “swimmer’s ear”, and internal or middle ear infections occurring mainly in the colder weather. The designation of external or middle is dependent on which side of the ear drum the infection is located. The outer ear canal, seen from the outside if you try to get a look in an ear, is a narrow bony channel covered with skin leading to the eardrum which is totally air tight and seals the chamber. On the other side of the ear drum lies the middle ear cavity containing specialized bones and small organs that allow sound frequencies entering the outer ear to be converted to impulses that eventually reach the brain and are interpreted as sound. This space would also be a closed space if it were not for the Eustachian tube which goes from the back of the nose to the middle ear cavity and keeps the pressure the same as the external canal.

The frequency of sounds represents a pulsed pattern and each frequency has its own pulse pattern. As the sound, usually consisting of different frequencies, reach the ear drum they set the eardrum vibrating at different rates; these vibrations are transferred from the outer ear to the middle ear by way of the eardrum, and then picked up on the other side by a connected series of small bones or ossicles that transmit the information to the auditory nerve and then on to the brain.

Now that we know how the ear works as relates to the anatomy we can discuss more fully what ear infections are all about:

External otitis is caused by a damp, warm environment in the outer ear canal which breaks down the skin and causes irritation leading to possible mild bacterial infection. There is swelling in the skin lining that narrow canal and very little space to allow for that swelling. As a result there is more irritation and resultant pain which can be quite severe at times. As this occurs there is a change in acid content of the external ear leading to more discomfort.

The first thing to do is to prevent any further fluid or moisture from entering that ear canal, no swimming or diving for several days. If there is mild pain a ½ to ½ mixture of vinegar and alcohol can be used in that ear for several days, along with mild pain killers such as Tylenol or Advil. If the pain is severe go to see your Doctor who may prescribe further treatments. In general this is not a dangerous problem even though it can be very painful.

A middle ear infection starts with a pressure change in the middle ear cavity from congestion and narrowing or complete blockage of the Eustachian tube. AT this point the child may say he/she cannot hear well or the ear “feels full”, or even hear the sloshing of fluid. After some period of time there is a collection of clear fluid with more pressure buildup and resultant pain. As the fluid builds up, bacteria can migrate into that space and begin growing leading to more pressure, pain, discomfort and sometimes fever. Your Doctor will suggest treatment methods that will greatly decrease pain and help heal the infection.

Some children tend to get repeated episodes of ear infections and I will deal with that problem in Part II of this post.

Kids and Rashes: Should You Worry??

One of the most frequent reasons children are brought to their Pediatricians, the most frequent cause of parental concern, and sometimes the most difficult to diagnose, rashes can be caused by a laundry list of issues. For that reason rashes must be divided up by characteristics: is it raised or flat, can you feel it, is it itchy, is it small bumps, large welts, water blisters, or big flat areas, is it painful, are there accompanying symptoms, is it localized or generalized, what color is it, does it blanch to touch, and the list goes on.

Diagnosing the problem takes into consideration all of this plus an exam by your Doctor.

• Some rashes are symptoms of a minor illness – most of the time viral, but a symptom nevertheless , just like runny nose and fever for a cold. The presence of a rash does not necessarily imply that it is contagious although it can give an indication of cause and an idea whether the underlying illness might be contagious. Certain rashes are terrible looking and the people who have them are very symptomatic; such as poison ivy with its open weeping sores – this rash contrary to popular opinion is not contagious and you cannot catch poison Ivy from person to person unless the first person has not yet washed off the resin from the poison ivy leaf on their skin that caused the problem. [In short: both rash and illness “may” be contagious, but like any viral cold, are not typically serious]*
• Certain rashes are characteristic of some more significant illnesses, such as the rash of Chicken Pox along with typical symptoms and course of illness. In this case, although the vesicles in the rash of chicken pox holds the contaminated fluid- you still don’t catch the rash only. Again, it’s not the rash that is contagious, but contact with someone with chicken pox can produce the illness and subsequent rash. Small Pox, now nearly extinct has a typical course and rash. And that list can go on and on. [In short: the illness is contagious, the rash is only contagious in that it can cause spread of illness]*
• The rashes we see in allergic responses are also not contagious. [In short: uncomfortable, but not contagious]*
• On the other hand the rash of impetigo (a skin infection with staph or strep) can be very contagious. This eventually appears as weeping, scabbing lesions and is more common in the warm months. [In short: rash itself is highly contagious]*
• Probably the most common type of rash seen in the Pediatrician’s office is the fine pink, pimple like rash associated with mild viral illness. Nothing can be done about these and they usually do not cause any symptom; they go away by themselves. [In short: typically minor symptoms, neither rash nor illness is contagious]*

The bottom line is if your child is acting sick and has a rash call your Pediatrician to weed through the various symptom and signs so as to get an idea as to causation. If your child is not sick this can wait until the next day or two.

Note – there are a myriad of topics that would include the presence of a rash and if anyone has a particular area of interest and can let me know, I will narrow the post down next time.

Photo credit: Auntie P; CC license

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