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.
My Child Has a Mouth Sore – What Can I Do?
Mouth sores come in many different forms and are quite common in people of all ages, including young children. These irritating lesions usually aren’t a cause for concern, but can be quite annoying and painful. They can make eating, drinking and brushing teeth uncomfortable. However, there are several steps you can take to relieve your child of pain associated with a mouth sore and even help prevent sores from occurring.
Types of Mouth Sores
The first step in knowing how to treat a mouth sore is to figure out what type of sore it is. Most types of mouth sores can be distinguished by how they look and where they appear. The most common mouth sores to look for include:
- Cold sores – Also called a fever blister, this type of sore is usually found on the lips and around the mouth. It is a red, raised blister caused by the contagious herpes simplex virus type 1 (HSV-1). A child can contract the virus by kissing, sharing utensils or even a slobbery toy with an infected person. So as you can imagine, toddlers and preschool-aged children as especially susceptible to the virus.
- Canker sores – Canker sores are ulcers that occur inside the mouth and have a white or yellowish, concave center with a red border. They can form inside the cheeks, lips, the base of the gums, and on or under the tongue. Unlike cold sores, cankers sores are not contagious, but are brought on by a variety of causes. Biting the lip or cheek, diet, poor immune system, and stress are all factors that can contribute to a canker sore.
If your child has one of these types of sores, there are several things you can do to help remedy any pain or discomfort associated with the sore. Over-the-counter topical medications such as Abreva, Zilactin, Anbesol, Orajel or Orajel Baby, and pain relievers like ibuprofen or acetaminophen can usually do the trick. Check the label on medications for age recommendations, and consult with your doctor before using it for a younger child. Ensure that your children are brushing their teeth with care and using a soft bristle toothbrush. Additionally, monitor what type of food they eat, as chips and other abrasive foods or spicy foods can irritate the sore even more. Common mouth sores will eventually heal on their own within a few days to a week.
While it can be difficult to prevent your child from getting a mouth sore, discouraging them from sharing cups and utensils or putting toys in their mouth can help prevent cold sores. Likewise, discouraging lip biting and ensuring your child has a well-rounded diet can help prevent canker sores.
If you find that your child’s mouth sores reoccur frequently, aren’t going away after several days, or are occurring with a fever, consult a dentist or doctor. A prescription medication or mouth rinse may be given to help progress healing and prevent more sores from returning.
Kids Will Get Sick: 5 Facts a Pediatrician Wants You to Know
The warnings you were given as a child about not going out with your hair wet or you’d catch pneumonia, don’t sit too close to the television or you’ll damage your eyesight – it’s probably safe to say what they lacked in accuracy they made up for in good intentions. But as we enter into the time of year when colds and other infections seem to thrive, it seemed like a good opportunity to set the record straight, debunk some of the myths and provide you with some useful information to get you through the worst of it…just in case you or someone else in your family starts to feel sick…
Fallacies vs Realities:
- Being out in the cold or wet weather can lead to a “cold” in a child. A “cold” or an upper respiratory infection is almost always due to a viral infection which, aside from certain colds being more prominent during certain seasons, is unrelated to the outdoor temperature. A cold happens when a viral agent attaches to the inside of the mouth nose or eyes. The viral particles enter the very specialized cells in these areas and replicate in to more of the same particles and even fever which then can invade further causing the associated symptoms. The same is true for the fear of “catching pneumonia” when one gets cold and/or wet.
- When the mucus in one’s nose green it automatically signifies the onset of sinus infection or contagious disease. A sinus infection is not contagious for the same reason that it occurs. Inflammation or possibly bacteria works its way into the sinus cavities, set up shop and cause the symptoms of the resulting pain and sometimes swelling. The reason, as with ear infections, that these are not contagious is that both of these occur in fairly small closed spaces and the inner contents cannot get out; concurrently antibiotics have a difficult time getting in, so it usually takes c little longer to cure these infections. For a frame of reference, consider the rapid “cure” that occurs when one contracts strep throat, an easily accessible area, after antibiotics are used.
- Once the fever is down after the use of acetaminophen or ibuprofen during an illness, that illness is over and the concentration should be placed on “breaking” the fever. In fact each illness has its own symptoms, including how high the fever goes or how long it lasts. Some fevers do come and go within the same illness and the use of medications to” cure” the fever and hence the illness is fallacious. Certainly one will want to give their child some relief from the symptoms and these medications are good for that reason.
- A child who has a “high” fever will get brain damage. In fact, fever itself is merely a symptom of an illness such as other symptoms; runny nose, cough, headache, etc. While high fever itself is seldom ever responsible for brain damage some very rare but very significant illnesses for which the fever may be an accompanying symptom may result in brain damage: e., meningitis, encephalitis and others. But to be complete, and fair to all parents worrying about their child with fever, fever by itself is not the only symptom one sees with such serious illnesses. If there is a very high fever, contact with your Doctor will help sort through the causes.
- High fever will cause seizures in my child. There is a small population of children who will, in fact, develop a mild, non-harmful seizure during the initial rise in that fever. Although these seizures are not harmful to your child, it is important to know if there might be another reason for such seizures, and your child should be seen by a physician immediately- usually an Emergency room Doctor. Also a little known fact is that the seizure will only seldom repeat itself during the same illness. Again the parents will want to use a medicine for fever because of the discomfort your child will have and the fact that another seizure is possible.
These are just a few; more to come down the road…
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.
Time for Colds and The Flu: What Can You & Your Family Do?
All the bugs and bacteria that plague human kind are essentially trapped indoors over the cold winter months: windows seldom get opened and cars are sealed shut with the heat on, schools harbor a variety of illnesses and are also sealed shut with temperatures way too high. It’s no wonder that this is a perfect season to share whatever cold or Flu with your closest neighbor. Young children, especially, are not the poster kids for hygiene, and touching and tasting the environment gives infants and toddlers a window on the world. Illnesses that get started in your child can spread rapidly to all members of the family.
Viral infections and Flu are composed of minute particles that are just waiting for an opportunity to invade the next host. The easiest way to gain entry to the human body is through the mucous membranes that we all have – moist skin that you seldom think about; inside your nose, throat, lining your eyeballs, etc. Once they gain entry they invade normal cells and begin to replicate, reproducing themselves and in so doing, alter or kill the host cells. Whichever cells are involved and how your body reacts to the invasion will dictate the symptoms that you will experience. Most invasions are short lived and most for the purposes of this post are in the respiratory tract, upper (nose and throat) and lower (trachea and lungs).
How to cure a “cold” has been a mystery for scientists forever, but since they are short lived and generally do not produce major problems it has never been worth the resources to attempt multiple and complicated testing to nail down a cure. So viral colds live on and disrupt many lifestyles along the way. The favorite medicines in the world to attempt to cure just about anything are antibiotics, but to do so will not only have no effect on the cold but can cause problems of their own – resistances by bacteria to the antibiotic and reactions to that medicine. So we are left with “taking care” of the cold with various simple measures. Over the counter cold medicines have been shown to have very little effect on the symptoms or length of a cold and also have unwanted side effects.
How to prevent a cold or Flu, or viral illness from spreading is the main issue. Since these particles gain entry through mucus membranes, and are usually carried to that area by contact with your own colonized hands, it is very important to wash hands regularly and completely. Too often this is a cursory act of applying soap and washing it off, but scrubbing the hands for about 20 seconds (enough time to sing “Happy Birthday” twice) is usually necessary to do an adequate job. Avoid touching your face as most mucus membranes are in that area, especially your eyes. Of course the group that is most important (children) is not usually compliant with these issues, so you must teach this at home. Spread can also occur by droplets pushed into the air by coughing and sneezing and then transferred to others on your hands. Sneeze into the inside of your elbow and avoid spreading droplets into the air around you.
Unfortunately simple apparent cures, taking extra vitamins, etc. have been shown to have very little if any effect on a cold.
So, bear with it, it will be over soon, and do your best not to share it with anyone. And remember to get Flu immunization for your entire family (age six months and older) as soon as it comes out on the market, and since some Flu seasons can last into April get that Flu vaccine even in early March if you missed it at the end of last year.
Pneumonia, Bronchitis and Kids – More Common Than You Think
Pneumonia in kids is probably more common than we all realize. It represents an infection of the lung tissue which can be caused by viral illnesses, bacterial illnesses or a type of organism that is somewhere between a virus and bacteria called mycoplasma. The most common cause of pneumonia is usually viral, but viral illnesses can predispose lung tissue to become infected with bacteria. Other ways of acquiring pneumonia are by inhalation (this is unusual but certain illnesses such as
tuberculosis and anthrax may be acquired in this manner).
The best way to diagnose kids with pneumonia is through a thorough history and physical exam that your doctor will perform on your child. Another way that can be used to diagnose pneumonia is through the use of a chest X-ray, but small areas of pneumonia or early pneumonia might not show up on X-ray. Your Doctor will be able to diagnose this early on by piecing together what you tell him and his observation and examination of your child.
One thinks of pneumonia as an illness with high fever and severe productive cough but this is not always the case and sometimes all that is seen are the symptoms created by the body to help compensate for the changes occurring in the lungs. If a large amount of lung tissue is involved and it becomes difficult for the gas exchange (oxygen in and carbon dioxide out) to take place then a signal is sent to the brain to increase the rate of breathing so that more air is forced in and more oxygen can be extracted. When it is even more difficult to breathe the child may use muscles not ordinarily used to help with breathing such as abdominal muscles and neck muscles and one can observe this. With further progression of the disease less oxygen will reach the body and mild blueness or cyanosis will be seen in the skin.
OK we’ve talked about the more severe problems with pneumonia but let’s get back to the beginning and restate that most pneumonia is mild and might very well be a natural progression of a cold. In a considerable amount of children with mild pneumonia the diagnosis might never be made because it is not severe. And because most of these are viral in nature, they will clear up as the cold clears without the use of an antibiotic, and the child never exhibits the signs and symptoms mentioned in the previous paragraph.
If your Doctor pieces together the parts of the history and physical exam and decides your child might have pneumonia, and if your child appears sick or ill, he might very well begin an antibiotic because the exact nature of the pneumonia might be difficult to determine. Most of the time pneumonia can be adequately treated at home without the need for hospitalization and he/she will recover fully without any subsequent problems.
Bronchitis is a wastebasket term describing what is thought to be inflammation and mucous collection in the tubes that lead from your nose and mouth down into your lungs due to many causes- again usually viral. Any cold with a significant loose cough probably represents some degree of bronchitis or tracheitis (higher up). Generally, it also does not necessarily need an antibiotic to “cure” it because bronchitis, like mild pneumonia, will also go away as the cold resolves. There are instances, again, when your child’s doctor might very well decide to use an antibiotic for your child and those would include when your child looks sick or ill (because significant bronchitis and pneumonia can look exactly the same) or if your child has any sort of chronic lung condition such as asthma or cystic fibrosis where the chance of bacterial infection is increased.
So, especially during the winter months, if your child is diagnosed with pneumonia or bronchitis, you needn’t panic or assume the worst. Just follow your child’s doctor’s advice and he/she will be just fine.
