Dehydration

Anyone can become dehydrated given the right circumstances. Children are more susceptible to dehydration because of smaller size and decreased ability to gain access to  fluids.  It is important for parents to
(1)  recognize dehydration because  it can be life threatening.
(2) know steps to take to avoid dehydration
(3) know when to call the office for evaluation
One of the most common causes of dehydration in children is vomiting and diarrhea.  The child is not only losing precious fluids from both ends but usually feels too sick to take in any replacement fluids. This type of illness can create a deadly domino effect.
Parents can try to break the cycle by giving small amounts of fluid every 15-30 minutes. Fluids like Pedialyte for infants and Gatorade for older children are preferable. It is important that replacement fluids have the proper electrolyte balance especially if the child is refusing to eat.  Fruit juices and other fluids high in sugar make diarrhea worse. Fluids like plain water and tea can upset the delicate balance of Sodium.
The urine output is a good indicator of hydration status. The urine output drops in order to preserve fluid. It is time to call the office when a noticeable drop in the urine output occurs. For an infant or small child no urine output in 4-8 hours warrants evaluation in the office or Emergency room. In an older child no urine output in 12 hours is worrisome.  A dehydrated child will also start to appear drowsy and have no energy.  Most children are active, energetic and alert normally. Dehydrated infants can often act irritable or have a sunken in soft spot
Prolonged or extremely high fever can also cause dehydration. Fever control and providing extra fluids is key in this situation.
Dehydration is treatable if caught early.  Don't hesitate to call the office or seek medical attention if you think your child might be dehydrated.

This post was originally posted at www.waytoknowkids.wordpress.com

SORE THROAT. Is it a virus or is it STREP?

Your child gets sent home from school complaining of a sore throat.  Yesterday She was feeling fine with no symptoms at all.  You look inside her mouth and see red spots like this:

Your next step is to call the office for an evaluation.  A throat that looks like this is most likely STREP. But what if your child's throat looks like this:

This is a  normal looking throat which is more often seen with a viral cause of sore throat.  Sometimes the physical exam is not so obvious for STREP and a rapid STREP test is performed in the office. This office based test is highly accurate and sometimes a follow up throat culture is sent to a laboratory for confirmation.

STREP THROAT usually presents with a sore throat, fever , headache and stomach ache. The throat pain usually persists throughout the day.  The symptoms usually come on rather quickly with the child often feeling fine the day before the main symptoms start.

A VIRAL SORE THROAT usually presents with runny nose, posterior drainage and sometimes a cough. The sore throat often is worse in the am and gets better as the day goes on.  Viral symptoms tend to creep up on a patient with each day adding a new symptom.

Another cause of sore throat can be MONO. This is usually associated with extreme fatigue but not always. Usually there are also upper respiratory symptoms and aches.  MONO tends to look like this:

We recommend coming in to the office for an evaluation to differentiate between the different causes of sore throat.

You can also find this post at www.WayToKnowKids.wordpress.com

Hand Foot and Mouth Disease

As fall settles in, certain viruses become more prevalent. Hand Foot and Mouth Disease is one of these viruses. It can affect any age but seems to have a preference for toddlers and preschool age children.  It usually starts out with low grade fever 100-101 and a sore throat.  A pre-verbal child is most likely to present with fussiness, crankiness and decreased appetite. The mouth sores usually develop either at the same time as the fever or shortly thereafter and then a distinctive rash develops. The palms and soles are affected with small red blisters.  Sometimes there can also be a more generalized body rash as well.
As with most viruses, this one needs time to run its course. Supportive measures are recommended such as increased fluids and pain control. It usually takes about a week to resolve. Children are considered contagious until the blisters have begun to fade. Contact your child’s doctor if the fever persists beyond three days or if your child is not eating, drinking or making urine.

SIDS Awareness Month

October is SIDS awareness month.

SIDS stands for Sudden Infant Death syndrome.   All infants under the age of one year are at risk. This is a difficult topic to broach with parents because it evokes fear, anxiety and sadness.   However just a few simple steps can dramatically reduce the risk of SIDS

Here are 10 simple steps to reduce your baby's risk
(1) Put your Baby on her back to sleep for every sleep even naps.  Even side sleeping has been shown to increase the risk of SIDS
(2) Make sure that your infant's bed is clear of all extra objects. Only the crib, mattress and a fitted sheet are appropriate. No quilts, stuffed animals, bumpers or pillows.
(3) Do not over bundle your infant.
(4) Do not smoke around your infant or allow anyone else to smoke around your infant.
(5) Do not cosleep with your infant. By all means nurse, cuddle and comfort your infant but when it is time for sleep, your baby should be in a basinette or crib.
(6) It is appropriate for to room share for the first 6 months but again your baby should be in his own bed next to your bed.
(7) Consider using a pacifier after breast feeding is well established. Studies have shown that using  a pacifier for sleep prevents the infant from falling too deeply asleep.
(8) Keep the room temperature comfortable.  The room should feel comfortable to you. It is okay to use a ceiling fan to help achieve comfortable temperatures and to promote air circulation.
(9) Only put your baby on a safety approved mattress. NO water beds. NO couches. NO sofa beds.
(10) Do not use sleep positioners. They have caused infant deaths due to suffocation and have been warned against by the FDA and consumer product safety commission.
Remember to talk to your doctor if you have questions about reducing your infant's risk for SIDS.

The Importance of Vaccines

This week is National Vaccine Week.  The purpose of this week being set aside is to remind us of the importance of vaccines. Fortunately, vaccines have been successful enough in decreasing the incidence of many horrible infections.  In fact vaccines have been so successful that people are questioning whether we need them at all.  However these infections have not been eradicated just suppressed by vaccines.
As a result of increasing numbers of people opting out of vaccines, these heinous diseases are occurring more frequently then in previous years. Often the infection will begin in one person who has not been vaccinated and then spread to others quickly. Just last month in Vancouver, there were 10 confirmed cases of measles.  In 2008, there were 839 people in San Diego who were exposed to measles by one person who contracted the disease while traveling in Switzerland. 11 of those people contracted measles and 3 of them were small infants too young to be vaccinated.  Every year there are outbreaks of Pertussis (Whooping Cough) and Mumps.
There are also some people who believe that it is better to just get the certain diseases naturally. Unfortunately there are some bacteria and viruses  that are so deadly that natural infection can kill in less than 24 hours or leave a child with devastating disabilities.
Many parents ask, "Are vaccines safe?" and "Why so many vaccines at a time?"
Vaccines are safe. Rigorous testing and research happens before any vaccine is allowed to be given.  To date millions of children have received vaccines. The reason vaccines are given in groups is to stimulate the immune system effectively and create antibodies against disease. 
Parents also ask about Autism and want to know if there is any link. Not only are vaccines rigorously tested before licensing but they are continually observed through the Vaccine Safety Data Link and the Vaccine Adverse Event Reporting System even after being released. These organizations continuously watch for adverse outcomes from vaccines.  Several studies have been done specifically looking to see if Autism could be linked to vaccines and the results have repeatedly shown no link. For more information check out www.cdc.gov and www.immunize.org
-----Dr. Trina

The Joy of Music

               Does anyone remember the dancing baby from the show Ally McBeal? While most toddlers can not dance that well, almost all of them can appreciate music. From infancy and onward your child can enjoy and respond to music. 

               Classical music is a good choice for newborns and older infants. When your baby is pleased with a particular song, she might be soothed, smile or laugh.  Your baby might show displeasure with a particular song by crying.  Singing or humming to a baby can be comforting for both parent and child. Toddlers and young  children can enjoy a variety of musical styles so don't be afraid to expose your child to different kinds of music. They also love to dance so show off your dance moves. Your toddler will try to imitate you and your school age child will show off her own moves.

The other day I was driving with my 21 month old son, when the song SHOUT by Otis Day came on the radio. Many people might remember this song from the movie Animal House. Immediately a twinkle appeared in my son's eyes as he smiled and started to move to the music. He threw both of his chubby little arms in the air, rocked to the beat and started kicking his feet. He even began to babble the words to the song. I laughed so hard tears came to my eyes. 

Teens listen to music a great deal and use it to help express certain moods. Take a moment and find out what kind of music your teen likes and which songs express which moods the best.  You may benefit from the information in other ways.  You'll know your teen had a bad day when you hear him playing his sad mood song or he has a new girlfriend when the love songs get played. Today so many songs that were popular decades ago are being redone by current artists, that you might even be surprised to find some common ground.
Lastly, don't discount the power of music to affect your mood. After a hectic day, a good song can elevate your mood, help you get through the evening and deal with the demands of your children on your time and person.

......Dr. Trina

The "Stomach Flu" Spotlight ---Norovirus

Contrary to popular belief the "stomach flu" is not caused by the influenza virus. It is usually caused by lesser known viruses. There is a family of these viruses called Noroviruses.

These viruses cause nausea, vomiting, diarrhea, stomach cramping, fever and body aches. The symptoms usually only last 1-2 days. Most healthy adults and children are able to get better from the illness on their own. However, if the vomiting and diarrhea are severe enough to cause dehydration then the illness can be life threatening. Unfortunately, since Noroviruses comprise a large group of viruses, it is very difficult to develop permanent immunity. As soon as you become immune to one, you will come into contact with another.

Norovirus is highly contagious and illness can start as early as 12 hours after becoming infected. Bodily fluids like stool, vomit and saliva are teeming with the virus and are especially contagious. Food handled by someone with the illness can become contaminated with the virus and it can spread like wildfire. You may have heard of this phenomenon occurring on cruise ships. Even after getting better from the virus, a person can still be contagious for days to weeks afterwards.

Protect yourself and family by:
(1) Good hand washing before preparing food, and after using the bathroom
(2) Raw foods like fruits and vegetables need to be washed before eating them.
(3) Do not share utensils, cups or food with someone who has the stomach flu.
(4) Someone with the stomach flu should NOT prepare food while ill and for at least three days afterward
(5) Surfaces that have come in contact with stool or vomit should be disinfected with bleach immediately.
(6) Clothing that has come in contact with stool or vomit should be washed in hot soapy water.

You should contact a doctor if your child has decreased urination, is unable to hold anything down, seems lethargic or does not seem to be getting better. Your doctor may prescribe a medication to stop the vomiting or may order intravenous fluids. Do not give immodium to your child unless directed to do so by your doctor. Anti-diarrhea medications usually allow the virus to increase reproduction and make the illness worse.
For more information visit the Centers For Disease Control website at www.cdc.gov

......Dr. Trina