Category Archives: infections

Help your child want to wear a mask

A year ago, no one could have guessed that a back-to-school list would include face masks, but that’s definitely where we are in 2020.

The school year is starting soon, with some huge changes. Many people are more than a little anxious about what the classroom will be like, and how students and their families, faculty, and staff will be able to navigate this new landscape of social distancing, extra hygiene, and mask-wearing.

A recent article from the American Academy of Pediatrics discusses the whys and hows of wearing masks.

Here are some guidelines.

Follow school rules. You always teach your child to respect the teachers and staff, and to obey school rules. Rules about mask wearing are no different. You may not agree with every rule, but it’s important that you support mask wearing if the school requires it.
Make sure the mask fits well. One that is too tight, too loose, or doesn’t cover both nose and mouth is not very effective.
Practice wearing at home. The whole family can wear masks for an hour, making everyone more comfortable with the sensation. Wear when you go into a store, and keep masks by the door so you don’t forget to take them when you go out.
Use age-appropriate talking points like, “Masks help us keep our germs to ourselves.” For teens, remind them that they are part of the solution for keeping themselves, their friends, and their families safe—they are being good citizens.
Avoid creating fear and anxiety. For young kids, here’s a great song video with Sesame Street characters about how we care for each other by wearing masks, washing hands, and keeping social distance.
Make mask-wearing fun. For younger children, put masks on their favorite stuffed animals. Give the child a gift of a mask you know they’ll enjoy.
Consider your budget and provide your child or teen with masks they’ll love showing off at school. Even though spending $10 or $15 for a mask sounds like a lot of money, think of it as an article of clothing. A purchase of two masks allows you to rotate them through the laundry each day. Buy masks that are washable, reusable, and that demonstrate individualism. From Amazon to Old Navy, there are masks that show support for your favorite team, are in a special color or design, or make you into a super hero. Your child or teen doesn’t like masks? Consider a neck gaiter instead; they also come in a variety of designs.
Find more ideas here from Norton Hospital in Louisville.

It takes all of us working together to keep our children, teens, and adults as safe as possible until a vaccine is widely available. We know you care about your family and your community, and we’re here to help you navigate this uncharted territory together. Call us if you have questions.

Measles

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You’ve almost certainly heard about measles outbreaks in the news lately. Also called rubeola, measles is a highly contagious respiratory disease caused by a virus. It causes a rash over the entire body, a fever and runny nose. According to the Centers for Disease Control and Prevention, “About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia.” Encephalitis is another severe complication that can occur. Measles can also, rarely, be fatal. Between one and two children in 1000 who get the disease will die from it. The disease can also strike adults.

Measles, as you can see, is more than just an annoying rash. It can be quite dangerous.

If you thought measles was a disease left in the past, think again. Outbreaks this year in New York and other states have health departments all over the country concerned, because such an event can happen anywhere. Over 1000 cases in nearly 30 states have been reported, the most cases since 1992—and this year is only half over. In 2000 the US was declared free of endemic measles, but this designation will soon be lost if the current epidemic is not brought under control.

Outbreaks typically begin when unvaccinated people travel abroad to places where measles is more common because a larger percentage of the population is unvaccinated.

It’s no coincidence that we used the word “unvaccinated” twice in that last sentence. The reason measles is spreading again in the United States is because of a drop in MMR (Measles, Mumps and Rubella) vaccinations.

Those who decide not to be vaccinated (or to have their children vaccinated) put themselves, their families and their communities at risk for dangerous diseases. As with most diseases, those at highest risk are the very young, the very old, and those with compromised immune systems.

The MMR vaccination is required for students in Scott County Schools, and HIGHLY recommended for all other children. The State of Kentucky requires two doses of the MMR vaccine before your child can enter school.

If you have concerns about vaccinations, talk to your pediatrician.

Remember that the extremely rare risk of a reaction to a vaccination is much smaller than the risk of being unvaccinated against a dangerous illness.

What you need to know about Hepatitis A

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If you’ve been listening to the news lately, you may have heard about the Hepatitis A outbreak in Kentucky. Over 300 people have been affected in an area that comprises several counties. Other states have also seen outbreaks. The source has yet to be confirmed, but some other recent outbreaks have been linked to tainted food.

Though it’s a highly contagious viral infection, Hepatitis A can be fairly easily prevented by getting vaccines and practicing good hygiene, like washing your hands.

There are several types of hepatitis. Here is a good article from the American Academy of Pediatrics that discusses Hepatitis A infections in children. According to the article, “Hepatitis symptoms tend to be similar from one virus type to another. Many of these symptoms are flu like, such as fever, nausea, vomiting, loss of appetite, and tiredness, sometimes with pain or tenderness of the liver in the right upper abdomen. A hepatitis infection is also associated with jaundice, a yellow discoloration of the skin and a yellowish color to the whites of the eyes. This is caused by inflammation and swelling of the liver with blockage and backup of bile (bilirubin) into the blood. This backup also usually causes the urine to turn dark orange and stools light yellow or clay colored. However, many children infected with the hepatitis virus have few if any symptoms, meaning you might not even know that your child is sick. In fact, the younger the child, the more likely she is to be symptom free. For example, among children infected with hepatitis A, only about 30% younger than 6 years have symptoms, and most of them are mild. Symptoms are more common in older children with hepatitis A, and they tend to last for several weeks.”

From the same article about how the virus is transmitted to children: “Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has close contact with a person who is infected with the virus. Hepatitis A is present in the stool as early as 1 to 2 weeks before a person develops the illness. The infection can be spread in child care settings when caregivers do not wash their hands after changing the diaper of an infected baby or from infant to infant because most very young infants do not wash their hands or have their hands washed for them.”

Here’s the good news: Hepatitis A vaccines work! As a matter of fact, beginning with the 2018-19 school year, Kentucky will require all students K-12 to have received two doses of the Hepatitis A vaccine.

If your child is a patient at Georgetown Pediatrics and is at least one year old, we’ve already discussed this with you.

Are you unsure if your child’s vaccinations are up-to-date for the next school year? Give our office a call and we can access your vaccinations records.

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!

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.

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.

Fifth disease: What is it? When to call the doctor.

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Fifth disease was given its name because it’s the fifth in a list of viruses that can cause rashes in children (the other four are chicken pox, rubella, measles and roseola). Its other name is Parvovirus B19. This might sound a little scary to you, since you may have heard of a canine parvovirus that is very serious for dogs. While in the same family as the canine virus, Parvovirus B19 is only a human virus and cannot be transmitted either from dogs to people or from people to dogs. In children, Parvovirus B19—fifth disease—is relatively common and generally quite benign.

Fifth disease in children is not usually dangerous, unless the child has anemia or an autoimmune disease. It’s contagious through the droplets of coughing and sneezing or through saliva (or from a pregnant mother to her fetus), and can show up 4 to14 days after exposure. Frequent hand washing is the best way to reduce the spread of viruses.

The first symptoms are similar to those of a cold: runny nose; mild fever; itching; soreness; headache. A few children experience achy joints.

After a week or so, a red rash may appear on the cheeks. It may, over the next few days, also appear on the torso and arms, buttocks and thighs. Within another week, the rash will likely fade. It might return, even months later, when the child gets overheated. By the time the rash appears, the child is no longer contagious.

When should you call our office? If your child has anemia, especially sickle cell anemia, or an autoimmune condition, call right away. Fifth disease can be dangerous for these patients. Also, if your child develops joint swelling or if symptoms worsen over time instead of improving, call us.

In normal cases, we treat symptoms with acetaminophen to reduce fever, or antihistamines to control itching. However, sickle cell patients and some others may need to be hospitalized because the blood counts can be seriously compromised. A pregnant woman with fifth disease should also be seen by a physician, because serious complications can occur.

Most of the information in this article came from the American Academy of Pediatrics article on the subject, which you can read here.

Fifth disease is more common late winter through spring, so you may want to keep an eye out for it this time of year. The good news is that most children will develop only mild symptoms that will go away without treatment.

Appendicitis

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Do you ever wonder whether abdominal pain warrants a call to the doctor, or even a visit to the emergency room? How can you tell?

One worry with children and teens is appendicitis. The appendix is a small, tubular-shaped organ in the lower right abdomen, that has no known function. Sometimes it can become inflamed and needs to be surgically removed. If left alone, an inflamed appendix can rupture and cause very serious illness.

Appendicitis can occur at any age, and is often difficult to diagnose.

The American Academy of Pediatrics has a great article here about appendicitis. The main symptom is pain, which begins as a “vague stomachache near the navel,” and then is described as a combination of a sense of fullness and pressure on the lower right side. Here is the complete list of symptoms they give, some of which are similar to stomach viruses, and some of which are different:

“Persistent abdominal pain that migrates from the midsection to the right lower abdomen
Nausea and vomiting
Constipation
Gas pain
Diarrhea
Low fever, beginning after other symptoms
Tenderness in the right lower abdomen
Abdominal swelling
Elevated white blood cell count
Appetite loss.”

Call your doctor immediately if your teen or child experiences these symptoms. Have him lie quietly and “don’t offer water, food, laxatives, aspirin or a heating pad.” Any movement can increase her pain. If appendicitis is suspected, a blood test (to determine white blood cell count) will likely be taken, possibly with other diagnostic tests.

E. coli and other nasty things: how to have good food safety for your cookout or picnic

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The holiday weekend approaches, with plans for picnics, cookouts, reunions, and fun! At the same time we’re hearing about a recall of nearly 2 million pounds of ground beef that is possibly contaminated with E. coli bacteria. How can you be sure about the safety of the food you’re serving your family?

You are right to be cautious. Foodborne illnesses can be very serious, even deadly. E. coli, in particular, can cause organ failure, and children may be especially vulnerable.

Here are some basic rules to keep in mind.

Cook ground meats ALL the way through. Pink interiors mean raw meat, and when that meat is ground, microbes that used to be on the surface of the meat can now be deep inside it. If the meat is fully cooked, any E. coli should be taken care of.
Cook poultry completely through. Chicken, in particular, can be contaminated with Salmonella.
Don’t reuse the plate that held raw meat or poultry. It must be washed before being used to hold cooked meat or other foods. The same goes with knives and other utensils.
Keep food separate. Fruits and vegetables shouldn’t be stored in the same container with uncooked meat and poultry, for example.
Chill leftovers soon. This is important when you’re at a picnic and far from your refrigerator. Take a cooler and ice packs.
Keep your hands clean. Wash them often. Take hand sanitizer on your picnic. Don’t change a baby’s diaper while preparing food.
Wash your fruits and vegetables. When you clean poultry in the sink, be sure to sanitize the sink afterwards so that you don’t contaminate food, dishes and utensils.

More information is available here from the Centers for Disease Control and Prevention.

A fun holiday is a safe holiday. Enjoy the time together and have a great weekend!

Stomach virus recovery

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“Stomach bugs” are making their rounds right now. Rotavirus, in particular, is quite contagious and may have even made the rounds through every member of your household. It causes diarrhea, vomiting, stomach pain, etc. Sound a little too familiar?

What to do?

According to the American Academy of Pediatrics, usually, the virus goes away on its own. Watch, though, for dehydration and high fever. Dehydration can be serious in a small number of cases. Give small amounts of fluids until the vomiting ceases. Water is fine, but fluids like Gatorade can add electrolytes. Stay clear of acidy drinks (like orange juice) and milk.

Be watchful regarding dehydration. Pay attention to the frequency of urination. The urine will become more concentrated and less frequent, but child should still be urinating.

While your child is sick, give a very bland diet: avoid dairy, fried foods, fast foods, hot dogs, etc. Some good foods are bananas, rice, applesauce and toast (BRAT).

However, it’s recommended that as soon as the stomach is settled, you should return to a balanced diet of fruits, vegetables and protein (meat, yogurt).

Call the pediatrician if diarrhea and vomiting don’t subside within three days, if there’s been no urine output for 10 hours, or if the fever is high or doesn’t subside. See our blog about when to be concerned about a fever.

As always, stay healthy!