Author Archives: mbswriting

Ticks

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Ticks and spiders are both arachnids, but their method of attacking the skin is very different. While a spider merely bites, a tick burrows under the skin to gorge itself on blood. Sometimes ticks on the body can go unnoticed for a few days, which is why it is important to do a body check of your kids when they have been playing outside in the spring and summer. Ticks like hiding places— under your child’s hair, between the toes, etc. After it is finished feeding, the tick will drop off the body.

How to remove a tick? Very carefully! See this brief description from the Centers for Disease Control and Prevention (CDC) about safe removal.

There are a few tick-borne diseases that can be very serious.

Rocky Mountain spotted fever (RMSF) is carried by the dog tick or wood  tick, which is usually about a quarter inch long. The disease is caused by a particular type of bacteria, and the symptoms, according to an American Academy of Pediatrics ( AAP) article, include: “Flu-like symptoms such as fever, muscle pain, severe headaches, vomiting, nausea, and loss of appetite. A rash develops in most cases of RMSF, typically before the sixth day of the illness. This rash tends to appear first on the wrists and ankles, but within hours it can spread to the torso. It can also spread to the palms of the hands and soles of the feet. The rash is red, spotted, and raised. Other symptoms may include joint pain, stomach pain, and diarrhea. In severe cases, the blood pressure can drop and the patient may become confused. As the infection spreads, many organs, including the brain, can be affected.”

If your child has any of these symptoms and you suspect a tick bite, call your pediatrician immediately.

Lyme disease is most common in the Northeast, North Central, and West Coast states. It is spread by deer ticks. The most common symptom is what is sometimes called a “bull’s-eye” rash. This rash is a pink or red circle that can expand over time, even to a diameter of several inches. Another AAP article lists further symptoms:

  • “Headache
  • Chills
  • Fever
  • Fatigue
  • Swollen glands, usually in the neck or groin
  • Aches and pains in the muscles or joints.”

Lyme disease is very treatable in most cases, but if left untreated can cause long-term health problems.

There is also another tick-borne disease that presents itself a little like Lyme disease. It’s called STARI (Southern Tick-Associated Rash Illness) and is most prevalent in, as you may guess, more southern states like ours. The organism that causes this disease is, as yet, unknown, but it is carried by the lone star tick. The rash is similar to the one caused by Lyme disease (see above) and other symptoms according to the CDC include “fatigue, fever, headache, muscle and joint pains.” If your child presents with any of these symptoms and you suspect she has been bitten by a tick, contact your pediatrician immediately. For easy-to-read information about STARI, there is a good series of short articles from the CDC here.

Use insect repellent and avoid places where ticks live, when possible. Have a safe and enjoyable rest of the summer and fall!

© MBS Writing Services, 2015, all rights reserved

Spider bites

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Both spiders and ticks are common in our area. We’ll deal with ticks next time.

While most of their bites aren’t dangerous to most people, it’s good to be informed about different types of spiders, their bites, and diseases that might result from some of them.

Spiders use a venom to anesthetize and paralyze their tiny prey. The venom from most species is not dangerous to most humans (see below for exceptions). Watch for signs of infection and report those immediately to your pediatrician. If you are concerned that a bite is getting much larger, note the edges with a Sharpie marker so you can see if it’s continuing to grow.

The female black widow spider can be extremely poisonous to humans, sometimes even fatal. She has an hourglass shape and is dark colored with yellow or red on her abdomen. Symptoms can be severe muscle cramping and pain. Call EMS if you think someone has been bitten by a black widow spider.

The brown recluse spider is fairly common in Kentucky, and can also be fatal at times. People often don’t know they’ve been bitten until the bite starts to swell and get painful. Reactions greatly vary. Call EMS if you are concerned about a brown recluse bite.

According to this article by the American Academy of Pediatrics (AAP), here are things to watch for after a spider bite, and a signal to call your pediatrician or EMS:
• “Tiny fang marks
• Pain
• Pain begins as a dull ache at the bite site
• Pain spreads to the surrounding muscles
• Pain moves to the abdomen, back, chest, and legs
• Blister at the bite site
• Mild swelling and a blue-gray mark at the bite surrounded by lightening of skin color
• Progressive soft tissue damage; the skin becomes dark blue and then black (necrotic).”

Wash the affected area with soap and water, and treat a bite with an ice pack (make sure you put a layer of cloth between the ice pack and the skin) Another resource for your questions about spider bites is the Poison Control Center.

As with anything, whenever you have a concern, call our office.

© MBS Writing Services, 2015, all rights reserved

Stinging insects

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Nothing quite puts a damper on outdoor fun like a sting from a bee, yellow jacket, hornet, or wasp.

Art by Corinne

Art by Corinne

While most stings, though annoying and painful, aren’t dangerous, sometimes they can be severe in certain cases.

First things first – how to avoid getting stung:

  • Check the spots where your child plays for nests of stinging insects. Nests can be in trees or bushes, on structures like houses and barns, under picnic tables or by the porch. If you see an unusual number of the same type of stinging insects in one area, it’s possible there is a nest nearby. Once you’ve located a nest, you should consider calling an exterminator. If it is a honey bee hive, locate a beekeeper who will almost certainly be interested in collecting a new hive, and who knows how to do that safely. On rare occasions you might see a honey bee swarm. This occurs when a hive has gotten too large and is in the process of dividing. Be very careful to avoid the swarm and call a beekeeper immediately.
  • Wear shoes outdoors. Even sandals or flip-flops are not good protection from stinging insects hiding in the grass.
  • Wear light-colored clothing, and don’t wear anything with a floral pattern. Bees can be attracted to that as if it were a real flower!
  • Watch what you eat outside. Insects are attracted to sweet foods and beverages and other food items like peanut butter.
  • Don’t allow your child to touch even a dead stinging insect; the stinger still contains venom.
  • As difficult as it may be, don’t swat at an insect because that may make it attack.
  • Read about these and other preventative measures in this article by the American Academy of Pediatrics. The article contains this additional warning: “If you have disturbed a nest and the insects swarm around you, curl up as tightly as you can to reduce exposed skin. Keep your face down and cover your head with your arms.”

So, what to do after a sting?

If the child or adult is highly allergic to stings, watch closely for signs of anaphylaxis. Another article by the AAP describes an anaphylactic reaction like this:

  • “A severe life-threatening allergic reaction is called anaphylaxis.
  • The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting.
  • Anaphylactic reactions to bee stings occur in 4 out of 1,000 children.
  • The onset of widespread hives or facial swelling alone following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis. Your child’s doctor will decide.”

In the case of anaphylaxis, administer epinephrine in the form of an EpiPen or AUVI-Q, if available, and call 911.

More common reactions to stings are redness and swelling, pain and itching.

If the stinger is in the skin (only honeybees leave their stingers behind), scrape it out with your fingernail, or if it’s completely under the skin just leave it alone and it will be shed naturally.

Here are the AAP’s recommendations for care after a sting:

  • “Meat Tenderizer:
    • Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (EXCEPTION: near the eye). This may neutralize the venom and decrease pain and swelling.
    • If not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes.
  • Local Cold: For persistent pain, massage with an ice cube for 10 minutes.
  • Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen immediately for relief of pain and burning.
  • Antihistamine: If the sting becomes itchy, give a dose of Benadryl. (See Dosage chart)
  • Hydrocortisone Cream: For itching or swelling, apply 1% hydrocortisone cream to the sting area 3 times per day (No prescription needed).
  • Expected Course: Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The redness can last 3 days and the swelling 7 days.
  • Call Your Doctor If:
    • Develops difficulty breathing or swallowing (mainly during the 2 hours after the sting) (call 911)
    • Redness lasts over 3 days
    • Swelling becomes huge or spreads beyond the wrist or ankle
    • Sting begins to look infected
    • Your child becomes worse
    • And remember, contact your doctor if your child develops any of the “Call Your Doctor” symptoms.”

© MBS Writing Services, 2015, all rights reserved

Sports physicals – it’s time

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Your kids are on the move – literally, and all the time! If they are involved in a fall sport at school, then it’s time for their sports physical. Don’t forget that there is tremendous benefit to getting these physicals at your child’s pediatric office, rather than at a clinic or a school-sponsored physical day. The pediatrician has all your records including vaccinations, allergies, and your individualized and family medical history. He or she can discuss important sports information with you, including nutrition. And, of course, follow-up is always readily available, whether one week or six months from now. We are delighted to be working, with you as our partner, to make a medical home for your family here with us. If your child has a physical at a clinic or the school, that physical is not a part of our records, and we end up with an incomplete picture of his or her development and needs. Read our previous blog post for more reasons on why it’s wise to bring your child to the pediatrician when it’s time for a physical.

© MBS Writing Services, 2015, all rights reserved

Bug bites

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It’s summertime. Mosquitoes and other bugs are in hot pursuit of you and your family. What’s the best way to keep from being bitten? When should you be concerned about a bite?

If your kids spend any time at all outside— which they should, for the exercise and fresh air— they will be bitten from time to time. “Bugs,” of course, is not an accurate scientific term. Even so, we’re using it here as an all-inclusive word to refer to insects (mosquitoes, bees, wasps, chiggers, biting flies, etc.) and arachnids (spiders, ticks, etc.).

Most bites on most people are relatively harmless, causing irritation, itching, and redness. Different bug bites can result in different types of skin reactions, and not all people react the same. Rarely, even serious allergic reactions or illness can result.

The best medicine, as always, is prevention. Avoid times and places where mosquitoes and other biting bugs congregate.

Mosquitoes are most active around dawn and dusk. They love standing water in puddles and ponds. You are more likely to attract mosquitoes if you’re wearing dark clothing, including socks. They are attracted to your perspiration and sometimes to a scent to you may be wearing. Biting flies may be most common in wooded areas and around animals or garbage.

Repellents can be very helpful, especially against mosquitoes. However, you need to be cautious when choosing a repellent, especially for children. DEET is particularly effective against mosquitoes and some other bugs, but should be used with caution (see below). This is also true of permethrin, which is effective against ticks. Insect repellents should not be used at all on children younger than two months old.

There is terrific information in this article from the American Academy of Pediatrics. Here is their list of do’s and don’ts when you use insect repellents:

“Dos:

  • Read the label and follow all directions and precautions.
  • Only apply insect repellents on the outside of your child’s clothing and on exposed skin. Note: Permethrin-containing products should not be applied to skin.
  • Spray repellents in open areas to avoid breathing them in.
  • Use just enough repellent to cover your child’s clothing and exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless needed.
  • Help apply insect repellent on young children. Supervise older children when using these products.
  • Wash your children’s skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again.

   “Dont’s:

  • Never apply insect repellent to children younger than 2 months.
  • Never spray insect repellent directly onto your child’s face. Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth.
  • Do not spray insect repellent on cuts, wounds, or irritated skin.
  • Do not use products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often.”

To treat a bug bite, you may apply ice for a few minutes every hour or two. Calamine lotion may be applied to stop the itching. Some people also find that baking soda mixed with water decreases their itching.

When should you seek medical attention for a bug bite? If anaphylaxis (a severe allergic reaction, which may include difficulty breathing – see definition from the Mayo Clinic here) occurs, get to an emergency room immediately.  Sudden hives are also a cause for concern and could be a sign of anaphylaxis. Otherwise, if the bite begins to look infected, or the reddened area around it is increasing in size larger than a quarter, keep an eye on it and check with your pediatrician’s office. You can use a Sharpie to mark the edges of the red area in order to note its progression.

Next time, more about stinging insects.

© MBS Writing Services, all rights reserved, 2015

 

Diabetes testing and prediabetes

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Our last two blogs have been about diabetes, types 1 and 2.  Now, let’s look at risk factors, testing, and what is called prediabetes.

Risk factors are slightly different for the two types of diabetes (see our previous two blogs to learn more about those types).  We’ve gleaned these sets of factors from an article by the Mayo Clinic.  Check out that article for more detailed explanation.

Type 1 risk factors

  • Family history
  • Environmental factors (such as exposure to certain illnesses)
  • The presence of damaging immune system cells (autoantibodies)
  • Dietary factors—though studies don’t show a direct cause and effect, there seems to be some relation to things like early consumption of cow’s milk and cereals, for example
  • Geography—people who live in some northern European countries have greater risks

Type 2 and prediabetes risk factors

  • Being overweight or obese
  • Inactivity
  • Family history
  • Race—it’s unclear why certain races (including blacks, Hispanics, American Indians and Asian-Americans) are at higher risk
  • Age—although type 2 diabetes is increasing at alarming rates among children and youth, risk increases with age
  • High blood pressure
  • Abnormal cholesterol and triglyceride levels

Other risk factors in the article pertain to adults.

Prediabetes is a condition that means your blood sugar levels are higher than normal but not yet in the “diabetic” range.  It also means that you are at an increased risk of developing type 2 diabetes.

The American Diabetes Association has an online test you can take to determine possible risk.  If you believe your child is at risk, talk to your pediatrician.

Please note that the top two risk factors for type 2 diabetes are things over which you likely have a great deal of control.  A healthy diet and age-appropriate activity are your best tools for prevention, for your child and for you.

© MBS Writing Services, 2015, all rights reserved

Diabetes overview, type 2

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Last time we reviewed some general information about diabetes in children and adolescents, and focused in on type 1.  Today we look at type 2.

Type 2 diabetes has become much more prevalent in teens and children over the age of 10 in the last few decades.  This is believed to be directly related to the increasing number of young people who are overweight, obese, and/or inactive.

This diabetes type often comes from insulin resistance, meaning that the body does not effectively use the insulin produced by the pancreas.  (Insulin is the hormone that regulates glucose levels in the blood.)  If insulin resistance is detected early enough, type 2 diabetes may be prevented or forestalled with appropriate action.

According to this article on the National Institutes of Health website, from which we’ve drawn material for this blog, insulin resistance is tied to such things as inactivity and obesity, including belly fat in particular.  Losing excess weight and increasing activity to age-appropriate levels can help to prevent or delay the onset of type 2 diabetes.

Another NIH website article states, “A youth may feel very tired, thirsty, or nauseated and have to urinate often. Other symptoms may include weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some youth may present with vaginal yeast infection or burning on urination due to yeast infection. Some may have extreme elevation of the blood glucose level associated with severe dehydration and coma.”  Others may have no symptoms at all.

If your child has diabetes, his pediatrician will have recommendations for an exercise regimen, diet, and medication.

If you think your child is at risk for diabetes, she should be tested by the pediatrician and you should be alert for symptoms.  Both types of diabetes are serious, with symptoms that can come on quickly, and possible problems that can last a lifetime.  While hoping for a cure, today we rely on good management techniques.  Call on us if you have questions or concerns.

© MBS Writing Services, 2015, all rights reserved

Diabetes overview, type 1

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Diabetes is a disease that can hit at any time of life from childhood to old age.  It can be a scary diagnosis, and it’s certainly not one a parent wants to hear.  Even so, new medical advances are constantly being made that can limit the bad effects of diabetes, and early diagnosis and treatment are always important.

Diabetes is not uncommon among children and teens.  According to the National Institutes of Health (and the National Diabetes Education Program—NDEP) article from which we have drawn much of the information for today’s blog, “About 208,000 young people in the US under age 20 had diabetes in 2012.”  Those numbers are growing.

The disease is classified into two categories, called type 1 and type 2.  Both types mean there is an elevated glucose (sugar) level in the blood, which is caused by problems with insulin production in the pancreas, and/or how that insulin acts on the body.

Type 1 diabetes, though only 5% of all diabetes cases, accounts for nearly all diagnoses in children under age 10.  It’s actually an autoimmune disease, in which the child’s own immune system destroys the beta cells of the pancreas that produce insulin.  (Insulin is the hormone that regulates the metabolism of carbohydrates, including sugars, and fats.)

Usually, symptoms of type 1 diabetes don’t appear until the disease has destroyed most of the beta cells.  According to the same article cited above, “Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired.”  If you are suspicious that your child has type 1 diabetes, seek medical attention immediately.

So far, there is no cure, but type 1 diabetes is managed through careful monitoring of blood sugar levels, and insulin administration by pump or injection.  The amount and timing of insulin doses is determined by taking into account food and beverage intake, physical activity, and the presence of any illness.  This management must be under the care of a physician who understands diabetes.

There are many ongoing studies into type 1 diabetes.  Perhaps in the not-too-distant future there will be a cure, or at least a way of pre-determining who is at risk and finding ways to treat the disease before it has destroyed the body’s ability to produce its own insulin.  The future is promising.

© MBS Writing Services, 2015, all rights reserved

Roseola

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Let’s say this first: anytime your infant or young child has a fever of 102°F for twenty-four hours, call the pediatrician.  The issue may be minor or serious, and the doctor should help you determine what it might be.

One possibility is roseola, usually not a series condition, which is yet another in the herpes family of viruses.  (It is not the same as the herpes strains that cause genital herpes or cold sores.)  It’s human herpes virus 6 (HHV-6) and is relatively common in children aged six months to two years.

Symptoms, in addition to the fever (which may last up to a week), may include a cough and runny nose, less appetite and mild diarrhea.  Finally, after the fever is gone, generally a slightly raised red rash will appear.  It usually starts on the torso before spreading to the rest of the body.

Roseola is contagious, and a child with a fever should be kept away from other youngsters until the fever is gone.  Once roseola is at the rash stage the child is no longer contagious and can return to daycare.  The incubation period is one to two weeks.

If the pediatrician suspects roseola in your child, you might be asked to treat the fever with age-appropriate doses of acetaminophen (always be sure to check dosing instructions and note that they have changed in the last few years) and keep him hydrated.  The doctor may want to talk to you again to make sure the child isn’t sick with something more serious.

You can find out more about roseola in the two articles from which our research was drawn, here and here.  Both articles were published by the American Academy of Pediatrics.

© MBS Writing Services, all rights reserved

Younger children—don’t just focus on one sport

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Summertime is just around the corner, and it’s time for kids to be outside enjoying themselves.  Organized sports are often a part of that.  Whether you have big dreams for your child’s sports future (college scholarship, pro career) or she has dreams for herself, it’s important not to push too hard too soon.  Doing so can cause injury and, perhaps more importantly, can decrease the all-important fun factor.

Most children love to play with a ball even before they can walk.  As their bodies mature, they’ll enjoy learning to swim, running short distances, playing physical games like tag in the backyard.  Activities like these are great for children’s physical health and for helping them grow into well-rounded people.  Staying active prevents obesity, gives a boost to the immune system, improves mental outlook, and fosters the development of social skills (learning to play fair, settling disputes, taking turns, sharing).

Parents should be cautious by not encouraging a child to play one sport to the exclusion of others.  Focusing on one sport, whether it’s swimming, soccer, baseball, gymnastics or something else, can lead to specific injuries.  Swimmers may develop shoulder problems; gymnasts can damage joints; runners might get shin splints.  Keeping a variety of physical activities in a young child’s life enables the whole body to develop, get stronger and more flexible, and decrease the risk for injury.

Eventually your child may decide to specialize in one sport, but doing so too early goes against the recommendations of the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness.  There’s a great article on the subject here.  It’s best for your child’s physical, mental and social development to generalize, try a lot of different sports and activities, and to simply have fun.

 

© MBS Writing Services, 2015.  All rights reserved.