Bronchiolitis or “Wheezy Bronchitis” and Kids

One of the more common illnesses that is encountered during the winter months in infants and young children is a respiratory problem referred to as Bronchiolitis or “wheezy bronchitis”. This is a condition caused by a viral infection that attacks the respiratory tree, both upper (nose and throat) and lower (the smaller airways leading to the air sacks in the lungs). It is most commonly caused by RSV or Respiratory Syncitial Virus. It can also be caused by other winter time viral infections but the exact cause is relatively unimportant as the symptoms are nearly the same.

Your child will usually develop signs and symptoms of a regular cold with sneezing, runny nose, mild cough, and sometimes a low grade fever. At this stage it will be impossible to tell if this will progress to bronchiolitis, but most of the time this will remain a cold and your “cures” are limited as your doctor will tell you. In a certain number of infants and young children, after a few days of the cold, the cough might progress to a more significant stage and the infant or young child may show some signs of having difficulty breathing; more rapid breathing rate than normal will usually be the first of such signs, but fever alone can raise an infant’s rate of breathing, and if you are unsure call your baby’s Doctor and he/she will help you figure that out.

Because the primary problem with bronchiolitis is swelling in the respiratory passages (lower and upper), air might have to begin to squeeze through narrower passages in the lungs and similar to what we have presented about asthma in the past, this may lead to wheezing. Wheezing is a whistling (musical) type of noise when your child breathes out versus noisy breathing in noticed in those infants with the upper airway cold. Admittedly this may be difficult to see by non- medical parents, but you can ask your Doctor how to do this in a reliable and repeatable manner.

Most infants and young children will remain in this stage and, as long as he/she is feeding well , does not have fever over 103, and seems fairly cheerful with his/her usual skin color, you do not need to worry, and all the symptoms will resolve as the cold goes away.

Occasionally, the situation can worsen with more difficulty breathing, now showing itself by your child using more muscles of his/her body to help force the air through the small airways in the chest: those muscles might include the abdominal, neck and intercostals (muscles between the ribs). At this stage your child should certainly be under the care of a physician, who might, depending on the appearance of your child admit him/her to the hospital so that more intensive care can be used to help him/her breathe.

The illness is self limited in that between 3 and 7 days normal resolution will take place. The worsening progression that I outlined above will generally not happen very fast and you will have time to see that your child is getting worse. Anywhere along the way, should you have doubts about your ability to adequately monitor your child’s status you should be talking to his/her Doctor.

I would like to stress once again that most bronchiolitis illnesses in infants and young adults remains mild and in fact may be indistinguishable from a normal cold.

Help Your Little Allergy Sufferer Breathe Easier This Season

For many kids, this time of year can be frustrating. They want to run outside and play, but the pollen count leaves them sniffling, sneezing and wheezing. What can you do to help? By minimizing their exposure to triggers, providing them with relief and offering some creative distractions, you can still make allergy season fun for the whole family.

Protect Them

There are a few simple things that can be implemented daily to reduce or prevent exposure to environmental allergens.

• Check your filters. Pollen and spores can get trapped in air conditioning filters, so set a specific day each month — like the day you pay bills — to change them.
• Schedule indoor activities. On days that the pollen count is significant (check the count here), keep kids inside during the early morning and dusk, when the air has the most allergens. Have fun games and projects in place.
• Do an outfit change. When kids come in from outside or come home from school, have them change their clothes immediately and wash off any residual pollen from their faces and hands.

Provide Relief

Allergy flare-ups are inevitable, so it is helpful to keep a few tricks in your parenting toolbox.

• Try saline solution. It can safely rid eyes and nasal cavities of allergens. (Just remember to keep a box of tissues on hand for the post-application drip.)
• Draw a warm bath. It can provide soothing relief to itchy skin, and the steam may relieve congestion.
• See your pediatrician. Check to see if a prescription or OTC medication can provide relief during the worst of the season.

Include Them

Kids live in the here and now, so trying to explain a concept like allergies can be difficult. In order for them to understand and take ownership of their allergies, involve them in the solution-making process.

• Ask for suggestions. After identifying specific issues — for instance, the pollen on shoes or higher count on windy days — ask your child to think of ways to combat the problems. He might suggest leaving a shoe bin at the door or closing windows in gusty weather.
• Assign a responsibility. After realizing weather plays a large role in the impact of allergens, your child can become the family’s meterologist. Every evening, have him report the next day’s weather, so you can prep together.
• Encourage him to share. Telling their friends why they can’t play outside at certain times can help empower your kids — and makes the situation feel less frustrating.

Distract Them

• Dress up their tissues. With so much sneezing and sniffling, a box of tissues will become a staple for your children. Have your child personalize the box with paint, glitter or stickers so it seems more fun.
• Build a fort. If your kids are stuck inside, make them a special place: Build an elaborate fort with sheets, blankets and furniture. This can be their haven for storytelling, homework and imaginative play.
• Schedule outings. Suffering from spring fever? Have your child choose a special place, like the mall, museum or gym, once a week. This will give him something to look forward to during allergy season.

Is Your Indoor Air Good for Your Family’s Health??

Let’s clear the air: Dry indoor air during cooler months may be contributing to your seasonal sore throats, congestion and other respiratory infections. To be sure, cranking up the thermostat causes the humidity level in your house to drop. When it falls below 35 percent, mucous membranes dry out, making you more susceptible to inhaling fine particles that may carry viruses. But a humidifier can be a breath of clean air for your health — and your home. First, buy a quality hygrometer (available at hardware stores, from $5) to constantly monitor your in-house humidity level, which should stay between 35 and 50 percent. Too much can contribute to mold-spore growth and be bad for your health, too. If the humidity is too low, consider purchasing a room humidifier.

Which Type of Humidifier Is Right for You?

Evaporative cool-mist humidifier. The most widely available and least expensive among humidifiers, evaporative humidifiers use a fan to pass dry room air through a water-soaked wick filter in the base of the unit. The water evaporates into the air while the wick filter traps any impurities and minerals in the water. The cool air lowers the room’s temperature, making it easier for you to breathe, which is why evaporative humidifiers also tend to be a physician favorite. “Think about it this way: When you go outside on a cold day, your nose usually runs because the cold shrinks your mucous membranes,” says Dr. Amy Guiot, a clinical instructor of pediatrics at Cincinnati Children’s Hospital Medical Center. “The cool air from an evaporative humidifier has a similar effect.”

Warm-mist humidifier. Quieter than evaporative humidifiers (there’s no fan), warm-mist models heat water to a boil and disperse a hot, impurity-free steam into the air, making a cool room feel considerably warmer. But Guiot says she wouldn’t recommend warm-mist humidifiers to those suffering from any respiratory infection, since heat causes mucous membranes to swell rather than shrink and drain.

Ultrasonic humidifier. Often dubbed the quietest humidifier around, ultrasonic models use high-frequency sound waves and a demineralization cartridge to break down water into an ultrafine, mineral-free vapor. Some ultrasonic humidifiers are also equipped with a heating option.

Features to Think About When Shopping for a Humidifier

1. Tank size and shape. A humidifier should be sized appropriately for the room. Typically, removable tanks range from 1- to 4-gallon capacities (which refer to the gallons of moisture the humidifier will expel into a room daily). Humidifiers are rated for square footage, so measure your room before settling on a model. If the humidifier is too large for the room, condensation will appear on the interiors of the windows and invite bacteria and mildew to grow. Too small, and you won’t reap any of its benefits. If you want to avoid the fuss of lifting and carrying potentially heavy refill containers, opt for a unit with an easy pour-in feature.
2. UV anti-microbial humidifiers. Some humidifiers — both cool- and warm-mist models — now feature UV light designed to kill 99.9 percent of bacteria, germs and viruses in the water before they enter the air you breathe.
3. Indicator lights. Look for a model equipped with a light to signal when the tank needs to be refilled or — better yet — a humidifier that automatically shuts off when the refill container is empty.

Maintenance

Once you have a humidifier, make sure to take care of it! It needs to be cleaned and dried regularly. Follow the manufacturer’s instructions for filter changes and cleaning guidelines; improper care could pump bacteria and mold spores into the room.

10 Secrets to Helping Your Kids Breathe Better With Allergies

Warmer weather triggers trees, flowers and grasses to bloom, beckons kids back outside and sets off seasonal allergy suffering for 40 percent of those kids. Pollens, which have been dormant all winter, are abundant from spring to fall. These irritants gang up with existing indoor allergens (such as dust mites, pet dander and mold) and bully your child’s immune system, causing itchy, watery eyes, runny noses, sniffling, sneezing and coughing.

“While allergens are unavoidable, there are things you can do to reduce your child’s exposure to them,” says Dr. Rebecca Gruchalla, professor of internal medicine and pediatrics at the University of Texas Southwestern Center in Dallas.

Try these tricks for keeping allergens to a minimum:

1. Make plans based on pollen counts. Plan indoor activities when outdoor pollen counts are highest – every day before 10 a.m., on windy days and after it rains. Check pollen.com for the daily allergy forecast in your area.
2. Control the spread of allergens. After a day of fun outside, have the kids take showers, wash their hair and put on clean clothes before they’re allowed to play in their rooms. You don’t want them tracking pollen into their bedrooms since allergy symptoms are often worse at night.
3. Manage indoor air quality. Keep windows closed during pollen season and crank up the air conditioning to help filter the air in your home. An indoor air temperature between 68 F and 72 F inhibits mold and dust mite growth and helps the indoor humidity level stay at an ideal 30 to 40 percent.
4. Keep bedding healthy. Dress your child’s bed using linens made of cotton or synthetic materials as opposed to bedding filled with feather or down, which can trap moisture and invite dust mites to spread. Dust mites produce a protein that can irritate the nasal passage and cause sneezing and a runny nose. To get rid of them, wash your child’s sheets once a week. Wash the comforter, mattress pad and blankets once a month. And never hang linens or clothes to dry outside, where they can gather pollen.
5. Clean stuffed animals and toys. Only buy washable stuffed animals and throw them in the laundry with the bedsheets every week. And when they’re not being loved, store stuffed animals — and all toys — in sealed, dust-free plastic containers.
6. Use allergen-resistant covers. Wrap the mattress, box spring and pillows in allergen-resistant covers to reduce your child’s exposure to dust mites by as much as 80 percent.
7. Keep floors free of irritants. Vacuum the floors in kids’ rooms twice a week using a cyclonic machine or one outfitted with a high-efficiency particulate air (HEPA) filter. Keep kids out of the bedroom for at least 30 minutes afterward, since vacuuming kicks up allergen-filled dust that can irritate allergies.
8. Move moisture out of the bathroom. Bathrooms tend to accumulate water around the shower, tub and sink areas, keeping the room moist and susceptible to mold growth. Control moisture by making sure wet towels and clothes are hanging so they’re able to dry. After showers, allow the curtain or door to air-dry before pulling it closed. And to keep air flowing and remove moisture, leave a fan on after showers and baths.
9. Prevent pet allergens. Pets produce more allergens than the great outdoors. Don’t let your furry friends into the kids’ rooms. Wash and brush Fido — outside — once a week to decrease the dander inside.
10. Equip bedroom with a HEPA air filter. If your child has severe allergies, consider putting a HEPA air filter in the bedroom. Check the CADR (Clean Air Delivery Rate) label, which indicates the size of room it’s best for.
    

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?

The Last Time I Checked My Child’s Allergy Supplies Was…. ???

As summer approaches and families begin making plans for long-postponed vacations, for our family, it means beginning a summer check up for our allergy needs. Especially since vacation time can also make us forget about other details, summer is a yearly reminder to clean out, update and refill.

Cleaning Out A few months ago, something prompted me to check my son’s asthma inhaler. Upon examination, I was horrified. At some point, the inhaler must have discharged while it was enclosed in the holder and had “grown new friends”- yuck! Worse yet, I realized that my son had used the inhaler recently (which means all of what was hanging out in his inhaler was also having a party inside of his lungs too). In times of being a normal mom who worries about her son’s asthma, I was fast forwarded into dry-heave mode quickly followed by recycling the old case and getting a brand new one altogether. I sent the stretchy outer case through the washing machine and let it completely air dry.

The food allergy mom in me sent an email to the wonderful people at the Allergy & Asthma Network. With a tinge of embarrassment for feeling like I was the world’s worst allergy mom, I sent a picture and asked if they had any words of wisdom for me as well as to others on how to prevent a dirty inhaler from entering our lives again. They quickly responded with some helpful information from their Understanding Asthma Guide: “Clean your inhaler following the manufacturer’s instructions, usually once per week. Clean the actuator — not the metal canister — with warm water and leave time for it to air dry before another dose is needed. Holding chambers also need to be washed, especially when the unit becomes cloudy or filmy inside. Replace disposable parts as recommended to avoid bacterial growth. Talk with your doctor if there’s any uncertainty about cleaning your inhaler or holding chamber.”

Updating During my frantic summer allergy cleaning binge, I also noticed my son’s emergency contact paperwork was faded and torn. This is something that I consider to be an extension of safety for him in the event that he is unable to speak for himself. It contains a copy of my son’s Allergy Action Plan. I also updated his picture because, gosh, don’t all children seem to change overnight?! This is also helpful when your child is with people they normally aren’t around (such as a substitute teacher) so that they have immediate confirmation that the person with the food allergy pack matches up with the listed allergens and contact information. Never assume, always overdue. Nobody ever died from too much information, only not enough.

I also checked expiration dates on his medications both inside his allergy pack and the extras that we keep on hand in the house and made sure our stock was full. It only took one bad asthma night with just a few counted doses available in his inhaler for me to realize that expiration dates on these life-saving medications are something that cannot be forgotten. Again, as a mom of an asthmatic child, the last thing that you want to tell your child who is gasping for breath is to not use their inhaler unless they have to because it might run out. I’m not proud of that moment but it happens to the best of us and teaches us new organization and safety techniques to avoid future repeats.

Refilling Because of the discount cards available the past few years, this is one area that is super easy and non-stressful. Both EpiPen and Auvi-Q have continued to provide copay assistance, which means one less expense. Nothing can beat refilling a prescription for twin packs of epinephrine and seeing a giant $0 on the receipt. Don’t get me wrong- my son’s safety is priceless and I would gladly pay to keep him that much safer at all times but not having to spend that money each year is a food allergy parents dream.

I do recommend discussing how to write out the prescription correctly with your child’s pediatrician or allergy specialist. This will ensure full benefit of the copay discounts, additional epinephrine to have on hand and for the next school year and ultimately, it will save you time going back and forth to the pharmacy for repeat refills. Also discuss correct dosages of medications for your child’s height, weight and age to prevent wasting a refilled prescription (ex: filling an Epipen Jr prescription and finding out after the fact that your child is now considered to be within the EpiPen adult dosage range…then what to do with the wasted medications?)

Allergies can be tricky but each year brings new techniques and better ways to come up with a strategy on what works best for your child and family. Just remember to be accepting of what might not work in the beginning, or even the year after and always give yourself more than enough time to be ready for school. The better prepared and calm that you seem, the less stressed your allergic child will begin another school year.

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