Tuesday, January 22, 2013

VIRAL INFECTIONS -DR. ALLISON GROEBS






Do your eyes roll when your pediatrician says,” it’s just a virus”?  School-aged children will have on average 5-6 Upper Respiratory Tract Infections (URI or “colds”) per year.  And if they are otherwise healthy, they usually get over their symptoms in 1-2 weeks.  Still, we do want to be cautious with exposures as these respiratory infections are rather contagious and can cause more severe disease in infants and toddlers.

Bronchiolitis can be caused by a handful of different viruses, the same viruses that can cause common colds in older children.  These kids can have low grade fevers, harsh and hacking coughs, nose symptoms, eye redness and irritation, scratchy throat and sometimes croup with a barky cough.    Bronchiolitis is primarily a disease that is most noticeable in children under the age of 2 years.  It is not the same as bronchitis.  Bronchiolitis affects the small airways deep inside the lungs making it difficult for the infants and toddlers to breathe in and out.  They will often have a wheezing sound which is a “grunt” heard when the child is exhaling or breathing out.  Typically bronchiolitis will start with some nasal congestion for a day or two, then progress to wheezing and labored breathing which tends to worsen on days 2-5 of the illness.  This second period is usually the worst as the infants do not feed well and struggle to breathe and clear the mucous plugs from their airways.   Not all infants with bronchiolitis will have to go to the hospital.  Oftentimes infants are kept hydrated by feeding with more frequent and smaller volume feeds.  For those days when the cough, gagging and wheezing are at their worst, the infants may just need a little help with a daily visit to the office to have suction performed to clear out the nasal and throat passages.   RSV (Respiratory Syncytial Virus) is the most notable of these viruses because of the severity of disease which can occur.   RSV infection can also cause viral pneumonia, which involves the alveoli (air exchanging parts of the lungs).  Since RSV is viral, antibiotics will not help.  Another virus which can cause bronchiolits, is the Human Metapneumovirus (“met-a-new-mo-virus).  Like RSV, HMPV is common in late winter and early spring.  RSV and HMPV can cause ear infections, asthma exacerbations, croup and in adults they can complicate COPD.  Respiratory viruses can be shed (i.e. considered contagious) for up to 1-2 weeks beyond resolution of symptoms.  So practice good hygeine with covering  mouth when coughing and sneezing and frequent hand-washing.

Pertussis is not a virus and can be treated with antibiotics.  However, this treatment needs to be initiated early in the course of disease when symptoms are non-specific and similar to any cold.  Pertussis is spread by droplets with sneezing and coughing in proximity to others.  The time from exposure to the onset of first symptoms can be 1-2 weeks.   During the first stage of illness, the kids can have mild fevers, cough and nasal symptoms.  This first stage can last 1-2 weeks.  The next stage, the Paroxysmal stage, can last from the second week up to the sixth week of illness.  During this time is when one hears the classic “rapid fire” cough spasms.  As many as 5-10 uninterrupted coughs occur in succession, followed by a “whoop” as the patient rapidly draws in a breath.  If you are interested in hearing what this sounds like, you can go to http://www.pkids.org/diseases/pertussis.html.    These paroxyxms of cough can occur several times an hour and can be severe enough to cause vomiting, pneumothorax, or turning blue.    Infants under the age of 6 months may not have the classical “whoop” yet they may still have gasping, gagging and even apnea where they stop breathing.    If antibiotics are started during the first stage, the course of the illness can be shortened.  Even if a child has progressed to the paroxysmal stage,  using antibiotics will not shorten the course of that child’s illness,  however it will help prevent spread of the illness to other family members.  Kids are no longer considered contagious once they have completed 5 days of antibiotics.  It is also important to note that immunized individuals can still get pertussis and have mild disease, yet they can spread the disease to those individuals/infants who are at greatest risk for infection.

Influenza is making its presence known this year.    Influenza causes primarily respiratory symptoms with cough, nasal congestion, high fevers, body aches, head aches, sore throats and sometimes red eyes or eye pain.  Influenza can cause some upset stomach/ nausea but should not be confused with the “stomach flu”.    Influenza is different from a cold in that symptoms tend to occur all at once – often within a couple hours.  These symptoms often will persist for 7-10 days.  The best defense against severe Influenza infections is vaccination.  Influenza is a virus, yet there is anti-viral medication in this instance which may shorten the course of infection.  In order to shorten the course, the anti-viral medication needs to be started within the first 48 hours of  illness.   Another drawback is that nausea and upset stomach are a common side effect with these anti-viral medications.   Once again, think seriously about the flu vaccine.
If it is just a cold, what can you do to help comfort your child?  Generally,  over- the- counter cough preparations are not indicated for children under the age of 2 years. 

Following are tips from the American Academy of Pediatrics (AAP) to help calm your child’s cough and cold symptoms so the whole house can sleep soundly.
Sweet dreams
Buckwheat honey was found to ease nighttime coughing and sleeplessness in children ages 2 and older, according to a 2008 study.
Honey can be fed safely to children over age 1, according to the AAP Nutrition Handbook. The AAP does not recommend giving honey to infants under 12 months of age because it could contain a bacterium that causes infant botulism.
The AAP advises starting with ½ to 1 teaspoon as needed. If honey is not available, corn syrup may be used.
Saline solution
Saline solution offers a way to keep the tiniest noses clear. Babies can benefit from nasal washes prior to nursing or bottle feeding. Make saline solution by combining ½ teaspoon of table salt per 1 cup of warm tap water. Put two to three drops in the nostril and use a bulb syringe to suction it out.
Older children also can gargle saline solution to ease sore throats.
Vapor rubs
For children older than age 2, topical vapor rubs can help ease chest and nose congestion. A 2010 study found that vapor rub containing camphor, menthol and eucalyptus oils relieves symptoms and aids sleep in children with colds.
Rubs never should be given by mouth or rubbed under the nose. Follow instructions on the label and rub on the chest.
If all else fails
Consult your pediatrician if your child’s symptoms last longer than a week, he or she has a mild fever for more than two to three days (call the pediatrician right away if your infant under 2 months has a fever), your child has severe ear pain that does not go away or has a sore throat accompanied by fever and swollen neck.
If you want to see which viruses are predominant in our community each week, you can check the Germ Watch website from Primary Childrens Hospital.
https://intermountain.net/IHC/edwbi/MicrobiologySurveillance/Germ%20Watch%20Weekly%20Surveillance-%20PCMC%20Resp%20Virus-en-us.pdf

Wednesday, October 10, 2012

FLU CLINICS



We have received our flu vaccines!



Call the office today and get your children scheduled for one of our flu clinics!

Thursday, October 4, 2012

Child Safety Seats. Do You Know the Law?


Child Safety Seats.  Do You Know the Law?
By Jacqueline K Giannini, MD


Did you know that Utah law requires your child to be in some form of booster seat until 8 years old?  Did you know that legally your child needs to be in a rear facing car seat until 1 year AND weigh 20 pounds?  Did you know that the American Academy of Pediatrics (AAP) recommends that a child remain in a rear facing car seat until 2 years of age?

Infants need to be placed in their carrier or convertible car seat every time they are in the car. DO NOT make an exception because it saves time on a long trip to nurse the baby without stopping.  DO NOT put a child on your lap because they are crying or they don’t like to be in their car seat.  That is just asking for a tragic accident to happen.  The driver can be distracted by a baby in the front seat or the person holding the child can be startled by a sudden change in direction, enough that the child could be released and become a projectile.  I always ask the kids when they come in for a well visit: “If you are not in your seat belt and the car suddenly stops, how fast is your body still going?”  You got it!  The same speed that the car was previously going.  And that is the projectile speed of the body into the back of a seat or even the windshield.  Teach your children from the very beginning.  EVERY time you get into the car, a proper seat restraint is used.  Even if you are just driving around the corner!

Statistics have shown that children 1-2 years old placed in a rear facing car seat are almost 5.5 times safer than those riding in a forward facing car seat.  And all children less than 2 years are 75% less likely to have a severe injury from an accident if rear facing.  Their legs may seem too long and hit the seat behind them, but they still have a natural tendency to cross them when at rest.  The head, however, is not as tolerant of the rapid back and forth motion that may occur when you stop very suddenly. This whiplash effect can produce effects that are similar to what occurs when a baby is shaken violently.  When put in that perspective, it should become more obvious that the risk of permanent brain damage from a whiplash injury ANY day you stop short is much greater than the possibility of a leg injury that MAY occur IF you are actually in an accident.

Traffic accidents are still the number one cause of death for children ages 6-14 years.  50% of fatalities in the 4-7 year old age group are in children restrained in a seat belt only, not a booster seat.  It is best if children stay in the actual 5 point car seat restraint until they are too tall for it (their shoulders are above the highest slot for the harness strap) or weigh more than the manufacturers recommendations.  Then they can then move to a booster seat system to be used with the car’s own seat belt. A booster with the back should be used until the child is at least 40 pounds and can wear the shoulder strap properly without the adaptor that is attached to the back of the booster.  A lap belt alone should never be used with a booster seat.  A shoulder harness should always be worn and needs to rest on the child’s chest wall and extent up and over the mid shoulder – not the neck.  It should never be tucked under the arm or behind the back.  The lap portion of the restraint should be over the bony hip area – not the soft belly.  The way restraints help prevent injury is by combining the strength of our bones with the harness straps.  A strap across the chest will protect the internal organs as well as keep the body from extensive whiplash injury.  Likewise, the lap portion when worn properly over the bony pelvis keeps the trunk back in the seat without injury to the liver, spleen and other internal organs.  Finally, always be sure there is a head rest behind the child’s head.  If your car does not have headrests, they should remain in a booster seat with a tall back to prevent whiplash injury.

Utah state law now requires a booster until age 8, but the AAP recommends 8 years AND 4’9”.  When that standard is used, there are many kids that should be going to junior high in a booster.  The reason for the recommendation is again proper placement of the shoulder harness.  The strap should be maintainable at the mid chest to mid shoulder area AND they should be able to sit on the seat with their legs bent at the knees while sitting all the way back against the seat.  If a driver is pulled over and there are unrestrained children in the car, the driver (not the parent) will be fined for every child under the age of 19 that is not properly restrained. 

These laws are meant for maximum safety.  We understand that there may be a time when your child cannot fit in the required car seat.   We have had children with unusual medical conditions, unusual casting or even obesity that prevent them from sitting in a conventional car seat.  If your physician has not been able to help you find an appropriate restraint system, please contact Primary Children’s Medical Center (PCMC) at (801) 662-CARS (2277).  They have car seat inspection specialists can help you special order unusual car seats that meet your specific needs.  There are also programs to help low income families purchase appropriate car seats so all children can ride safely.  Call your local health department, the Utah Highway Safety office at (801) 957-8570 or go on line to www.highwaysafety.utah.gov. 

All restraint systems must be installed properly, and every car seat is different.  Infants need to be in a carrier seat until they reach manufacturer recommended maximum height and weight (check the sticker on the side of your seat).  If they are still younger than 2 years they should then be placed in a rear facing convertible car seat.  Always be sure that the seat belt that you use to install any seat is pulled all the way out until it locks. If your seat belt does not lock, a locking clip must be used to lock the shoulder belt to the lap belt.  If your car has a LATCH system, attach the appropriate LATCH compatible car seat straps to the LATCH hooks in the car.  Any belt system must be tightened enough that there is no more than one inch of movement when the seat is moved side to side.  It is also recommended that children not be placed in the seat with winter coats or other bulky clothing.  A quick test to see if they are too bundled: latch a child in with the bulky clothing, tighten the straps, remove them and the bulky clothing and re-buckle.  If you need to tighten the straps more then the clothing is too bulky.  It is recommended that you put something over them after buckling to keep them warm, like a blanket or even their coat on backwards.  More than 75% of people actually do not install their car seats properly.  Get your seat inspected.  Call the Utah Safety Counsel at (801) 746-SAFE (7233) ext 303.  You can make an appointment to have them inspect your seat or you can have them find a fitting station near you.  PCMC has its own inspection station as above and some of the local Fire Departments have a car seat specialist. 

Keep up on recalls that may have been made on any of your safety seats.  If you registered your seat when you purchased it, you will likely get mail or electronic notification of any safety issues that have come up.  If not then call the Auto Safety Hotline at (800) 424-9393 with your seat manufacture name and model number to see if there have been any recalls.  Do not use any car seat that has been in a moderate or severe accident.  Call your manufacturer with details of the crash or have it inspected to see if there has been any breakdown in the integrity of the seat. Be prepared for them to tell you to replace it.  Hand me downs are great for clothes but never use a car seat that is more  than six years old.  Consider recycling it at one of the local car seat recycle centers.

Finally sitting in the front seat should be reserved for children ages 13 and older.  An airbag deploys at a speed of 200 MPH.  Anyone who sits in that seat should be at least 20 inches away from the airbag.   NEVER place a rear facing car seat up front if there is an airbag – that has an almost 100% fatality rate if the bag deploys.  While it is more convenient to have kids in the front with an airbag deactivated, it is still not as safe as having them in the back seat.  Again studies have shown that children and smaller adults are actually safer if they ride in the back seats.


Great websites for more information:
www.slvhealth.org  (look for upcoming free car seat inspection points)

Davis County inspection stations:
Davis County Health Department (801) 451-3586
Layton Fire Department Station #51, 52, 53 (801) 336-3940
South Davis Metro Fire, Bountiful (801) 677-2400
Syracuse Fire Department (801) 825-4400

Tuesday, July 10, 2012

Bedwetting - By Dr. Earl Judd

Many families wonder: When should I be concerned about bedwetting? Older children and teens may be very embarrassed if they continue to have accidents at night. The truth is that this is pretty common and usually not any great problem though it may take a while to overcome. It almost always goes away over time.

Enuresis is the fancy doctor word used to describe bedwetting. It occurs in about 40% of 3 year olds, 5% of 10 year olds, and 2 of every 100 teens. Generally it reflects either an undeveloped bladder that can’t hold urine overnight or poor signaling to awaken and visit the bathroom. Rarely, it may indicate infection, a urinary problem or even more rarely diabetes. Prolonged bedwetting runs in families, is more common in boys, and is often associated with ADHD, anxiety or similar problems. The recurrence of bedwetting after more than several weeks of dryness is often related to stress or other problems and should be investigated sooner.

There are simple ways to approach this problem. First, realize it is common and be reassuring. Never tease and make sure the child understands it is not their fault. Always be positive about dry nights. You may consider using rewards or sticker charts for both cooperation and having dry nights. Prepare before bedtime for an accident so it is simple to clean up. Always involve the child in clean-up, not as punishment but as training or reinforcement. Restrict liquids for 2-3 hours before bed and make 2-3 visits to the bathroom during this time. Avoid sodas, caffeine and consider reviewing any medicines that might play into the situation with your doctor.

Sometimes these simple steps do not work soon enough. In these cases most pediatricians will recommend the use of a bedwetting alarm. These are quite effective but it is important to realize that they may have to be used for several months. Alarms are the method most likely to help over time or “cure” the problem. There are also medication options including pills and a nasal spray that can help. Most of the medicine options will work while they are given and some work immediately, but they do not really “train” the brain to produce lasting change. They are often an option for older kids or teens who want to go spend the night, go camping or otherwise need to have a dry night.

As always the best idea to help is to have a conversation with your pediatrician about these options.

Thursday, February 9, 2012

Attention Deficit/Hyperactivity Disorder


Attention Deficit/Hyperactivity Disorder-By Dr. Kathleen Liou



The school year is half over; the second term report cards have come home.  Parent teacher conferences are happening at many schools this week.  Maybe as a parent, you are hearing wonderful things about your child.  Maybe you are hearing things that have you concerned.  You’ve known that your child is always on the go and has a hard time sitting still, but maybe now it is affecting his performance at school.  Maybe you are wondering, “Does my child have ADD?”



Attention Deficit/ Hyperactivity Disorder (ADHD) is a behavioral disorder characterized by inattention, impulsivity, and hyperactivity beyond that expected at a given age.  Symptoms must affect a child’s ability to function in two or more settings, last for more than six months, be present before the age of seven, and not be caused by another medical condition.  ADHD is estimated to affect 5-8% of children and, although symptoms change over time, often persists into adulthood.  ADHD can present as predominantly inattention (ADHD, inattentive type formerly called ADD), predominantly hyperactivity and impulsivity, or a combined type in which both inattention and hyperactivity are present.  



There is no simple test to diagnose ADHD.  If you or your child’s teachers suspect ADHD, your child will need a comprehensive evaluation.  This evaluation often starts in the school with questionnaires to be completed by both parents and teachers, direct observations in the classroom and testing by the school psychologist.  Often anxiety, depression or learning disabilities can accompany ADHD or can be the primary diagnosis causing symptoms that look like ADHD.  The school psychologist’s evaluation will help to figure this out.  Your child should also be evaluated by a physician to determine if any medical conditions are present that can caused symptoms of ADHD and to discuss treatment options if a diagnosis of ADHD is made.  For the school age child with ADHD, the best treatment is usually a combination of behavioral management and medication.



If you are looking for information about ADHD, some good places to start are chadd.org or healthychildren.org.  If you are calling our office to schedule an appointment for your child with concerns about possible ADHD or other behavioral problems, please let our scheduling staff know your concerns.  We want to give you and your child adequate time to discuss all the issues.  Be sure to bring any evaluation done by the school.  Better yet, drop it by our office before the day of your appointment so your pediatrician can review it ahead of time. 

Tuesday, January 10, 2012

RSV

  RSV- By Dr. Clark Loftus

Respiratory Syncytial Virus (RSV) is an infectious disease that causes upper respiratory symptoms (runny nose, nasal congestion, and cough) in individuals of any age. It is a very common illness in the winter. It typically reaches its peak in February and extends into the early spring. Essentially everyone gets RSV within the first few years of their life. RSV can cause bronchiolitis (inflammation of the small airways in the lungs) in young children as well. This occurs in up to 20% to 30% of infected infants and toddlers, but usually does not begin until at least a few days into the illness. Symptoms of bronchiolitis may include wheezing or difficulty breathing. Some children may develop an associated ear infection or pneumonia. In infants, lethargy, irritability, and poor feeding are symptoms that may be caused by RSV. Young infants, especially those that are born prematurely and those with chronic medical problems, have a higher risk of becoming more seriously ill with RSV. Most healthy infants who develop RSV bronchiolitis do not need to be hospitalized. Those that do are usually able to be released from the hospital after a few days.
RSV is usually spread by direct or close contact with contaminated secretions from the nose or mouth, typically when we touch such secretions with our hands and then touch our eyes, nose, or mouth. The incubation period may be anywhere between 2 and 8 days, but most commonly is 4 to 6 days. The best way to prevent RSV is to practice good hand washing or to use hand sanitizer.
There is no cure for RSV, but supportive measures can be quite helpful. These include nasal saline spray or drops, nasal suctioning, use of a humidifier or vaporizer, and encouraging fluid intake. Bronchodilators, such as Albuterol, are helpful in only a small percentage of children with RSV.
Most infants and young children recover from RSV within 2 weeks, although the cough can last longer. Please contact our office if your infant or child develops any of the more serious symptoms that can be associated with RSV such as difficulty breathing, poor feeding, lethargy, excessive fussiness, or prolonged fevers.

Monday, November 28, 2011

Whooping Cough/Pertussis

The Cough that whoops and why we should immunize

Pertussis, commonly referred to as “whooping cough”, is a highly contagious bacterial infection usually spread by coughing and sneezing.  Many infants who get pertussis are infected by parents or siblings who might not even know they have the disease.  Symptoms of pertussis usually develop within 7-10 days after being exposed but may take as long as 6 weeks. 
Early symptoms last 1-2 weeks and  are non-specific  including  a runny nose,  a low-grade fever, mild cough, and pauses in breathing (apnea) may appear in infants.  As the disease enters the next phase, the classic paroxysms of coughing and inspiratory whooping and vomiting begin.  The coughing fits can last up to 10 weeks and are associated with exhaustion.  Infected people are most contagious during the early stages and the first two weeks after the whooping cough starts.  Recovery from pertussis can be very slow and coughing fits can return with other respiratory infections for many months.
Why do we start immunizing our infants for pertussis at such an early age?  We do this because infants younger than 1 year of age and especially under 6 months of age are the ones most likely to get seriously ill or die from the disease.  More than half of the identified infants in this age group will need to be hospitalized.  Also
·         1 in 5 will get pneumonia
·         1 in 100 will have seizures
·         Half will have apnea which can lead to death
·         1 in 300 will have encephalopathy (disease of the brain)
·         1 in 100 will die

We have to immunize them multiple times at 2, 4, and 6 months of age because they have immature immune systems that do not respond as well as older kids and adults to single immunizations.  Check out this website to see and hear the cough of pertussis http://www.pkids.org/diseases/pertussis.html. http://youtu.be/fAkDrcZoWwQ.
Here are some other statistics that may startle you:
·         In 2010, 27,550 cases of pertussis were reported in the U.S. but many more go undiagnosed
·         Worldwide, there are 30-50 million cases of pertussis and about 300,000 deaths per year. In the US 30-50 infants die a year from pertussis
·         The incidence of pertussis being reported in this country is rising due to gaps in immunizations
The best way to prevent pertussis is by vaccination.  The current recommendation is that all kids get a series of 6 DTap vaccines starting at 2, 4, 6, 12-18 months and then at 4-6 years of age.  We then repeat a booster at 11-12 years of age with the Tdap.  The Tdap is also recommended for all adults and especially those with children and all adults over 65 years who care for children.  It is important for pregnant mothers to receive the vaccine during later pregnancy or as soon as the new baby is born to protect their infants from pertussis until the primary immunizations are completed.  We do not form lifelong immunity to pertussis so to protect our loved ones and those around us we must keep up on our immunizations.  The treatment for pertussis includes isolation and antibiotics.  The best prevention, although it is not 100%, is vaccination.  Vaccines are safe, pertussis is not.