Technical Name: Asthma

NickNames: reactive airways, wheezing

What is it? narrowing and swelling of the tubes of your lungs that occurs when trigged by a variety of stimuli such as viruses, allergens, season changes, pets, insect stings

How is the diagnosis made? Asthma is frequent wheezing and is a clinical diagnosis that is usually given after a child has wheezed on more than one occasion and responded to bronchodilators such as albuterol.

Typical Ages: infancy to adulthood

Treatment: when I think about asthma therapy, my goals are to:

1. decrease the severity of the episodes

2. maximize airway function

3. keep the child doing what the child loves to do

Some kids just have episodic asthma when faced with their trigger such as a cold or weather change. These kids may just need treatment of that exacerbation with:

1. a bronchodilator to get the airway big again: albuterol inhaler

2. an antiinflamatory medication to eliminate the swelling: a steroid – either oral or inhaled

For kids with frequent exacerbations or symptoms that are starting to interfere with the actitities they love such as sports, preventative medications are available: inhaled steroids and an immune mediator called Singulair.

How will I know what is best for my child?

Your pediatrician will help you develop an asthma action plan for your child so you’ll know what medication to use and when, including at school.

Can asthma be dangerous? The honest truth is that asthma can be very serious and can be fatal if not treated correctly. Any child having trouble breathing who has asthma needs to be seen right away – even in the middle of the night. So, if your child is having trouble breathing:

1. give your child a dose of albuterol by inhaler or nebulizer

2. go to the nearest emergency room or call 911

Will my child out grow asthma? May kids do “out grow” asthma meaning it is worse when they are younger but often asthma does persist in one way or another throughout a person’s life. Your child’s history over time will tell this story but keep in mind that there are many adults with asthma living full lives and doing great things!

Online Asthma Resources

1. KidsHealth Asthma Centers

• Parents
• Kids
• Teens

2. Does my baby have asthma?

Technical Names: RSV Bronchiolitis

NickNames: RSV, wheezing virus

What it is: viral infection of the small airways of the lung; can cause a true viral pneumoniaas well.

Typical Ages for Illness: All ages; most severe in young and premature infants and children with heart and lung problems including congenital heart disease and asthma. Interesting fact: all kids become infected by RSV by the age of 2 and many of us get it multiple times throughout our lives.

Typical Symptoms:

adults: bad cold symptoms

older infants and children: similar to a bad cold

young infants: lethargy, trouble eating, fast breathing, cough, wheeze.

Etiology: Respiratory Syncytial Virus

Seasonal Issues: occurs predictably between November to March

How’s It Spread? Direct contact with secretions – person to person or on objects.

Incubation Period: 4-6 days but can range from 2 to 8 days

Diagnosis: Usually clinical – based on symptoms and high index of suspicion given out breaks in community. Rapid assay test available in many offices and emergency rooms – most useful if a child needs to be hospitalized to control infection.

Symptom Duration: 7-14 days, as with most viral illnesses with the most intense symptoms early in the illness.

Treatment:

• cold treatment: saline nose spray and bulb syringe, humidifier
• +/- breathing treatments such as inhalers or nebulizers
• fluids
• tylenol or motrin for fever and discomfort
• some children do need to be hospitalized due to severe respiratory symptoms such as trouble breathing and needing oxygen, or due to underlying heart and lung problems.

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance
• trouble breathing despite treatment
• blue or gray color to lips or fingernail beds

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets
• a medication called Synagis before RSV season is available for kids under 2 years of age that are high risk – premature babies younger than 35 weeks and congenital heart disease children. This is usually given starting in November as RSV season begins. Your pediatrician will alert you if your child falls into this group.

School and After school Activity Issues

• may return to daycare when fever free for 24hours and able to eat and drink normally, and breathing normally
• avoid large groups of kids if cough is not controlled to prevent further spread
• if on antibiotics, needs to be on them for 24 hours before returning to school
• activities should be curtailed until the child has the energy to participate without becoming winded or fatigued.

Internet Resources For Parents

General Info on RSV (KidsHealth)

General Info on Bronchiolitis (Kids Health)

How Lungs Work (KidsHealth)

Technical Names: Streptococcal Pharyngitis

NickNames: Scarlet Fever, Strep Throat

What is it: infection of the throat involving the pharynx, tonsils or both

Typical Ages for Illness: school age kids and teens are the biggest population; can occur in adults; rare in children under 2 years of age.

Typical Symptoms:

sore throat and pain with swallowing; swollen neck glands

+/- abdominal pain and headache, common in school-aged kids

+/- fever

+/- sandpaper-like rash: when present, the illness is termed Scarlet Fever

+/-swollen tonsils with pus covering them

Etiology: Group A beta-hemolytic streptococci (Streptococcus pyogenes)

Seasonal Issues: outbreaks can occur year round but are more common from Fall to early Spring when people are more in doors and in close contact.

How’s It Spread? Person to person usually through direct contact or respiratory secretions (cough, sneeze)

Incubation Period: 2-5 days

Diagnosis: rapid strep test or throat culture at a doctor’s office

Symptom Duration: symptoms can go away without treatment in a few days; with treatment, improvement typically occurs within 24-48 hours of starting antibiotics.

Treatment:

• antibiotics once diagnosis is confirmed
• fluids
• rest
• tylenol or motrin for fever and discomfort
• popcicles, throat lozengers
• other medications as determined by your child’s doctor

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets

School and After school Activity Issues

• may return to school when fever free for 24hours and able to eat and drink normally
• needs to be on antibiotics for 24 hours before returning to school
• avoid large groups of kids if cough is not controlled to prevent further spread

Internet Resources:

For Parents From KidsHealth

Strep Throat Information

Scarlet Fever Info

For Kids and Teens From KidsHealth

The Scoop on Strep

Teen Info on Strep

“Back to schoolitis”…All our kids experience this – it is really a form of stress. Kids handle transitions differently from each other and many do just fine but the start of a new school year is a transition and you should expect the other shoe to drop as expectations and work increase. Each Fall, Pediatricians and school Guidance Counselors see an increase in kids of all ages having vague symptoms including:

• Fatigue
• Sleep issues
• Stomach complaints: aches, constipation, diarrhea
• Nervousness to frank anxiety
• Headaches
• Anger
• Feeling overwhelmed
• Depression

What should you do? First, reassure your child that he or she is doing just fine and feeling the same way as every other kid at school this time of year. If your child is in elementary school, talk to your child’s teacher. Find out how your child seems at school. It is very normal for a child to get through the day at school and “let their hair down” at home showing you their true feelings. If all is fine at school, I would worry less. If your child is in middle school or high school where many teachers are involved, the school guidance office is the place to start. School typically assign a student to a guidance counselor who can talk to your child and see if there is anything going on beyond expected school transition issues.

If your child’s symptoms begin to interfere with home, social or school functioning that’s the time to call your child’s pediatrician to intervene. Medication may help with the physical symptoms. If stress is the issue, counseling may help. If school is causing issues, the school should get involved and help form an action plan based on the root cause.

Education is complicated and issues in school from academic to social do manifest with physical issues at times. So, keep an eye out and let your pediatrician know if you are concerned.

(updated September, 2011)

Technical Names: Lyme Disease

Lyme Map: Lyme has a definite geographic distribution. According to the CDC you’ll find Lyme in these three areas:

• Northeast: Massachusetts to Maryland.
• North-central states: especially Wisconsin and Minnesota.
• West Coast: especially northern California.

Nicknames: Lyme Disease, Lyme

What it is: tick-borne infection from ticks of the Ixodes genussed by the bacteria borrelia borgoferi

Typical Ages for Illness: any

Typical Symptoms: Lyme Disease has three stages.

• Early: is a characteristic rash at the site of the tic bite called erythema migrans. Its main property is an expanding, red circle.
• The second phase is more disseminated: multiple erythema migrans patches occur in 15% of patients, other symptoms that can occur during this phase are arthritis, conjunctivitis, nerve palsies, headache and fatigue. Other uncommon issues can develop during this phase if untreated.
• Late disease is chronic arthritis of the large joints, usually knees. This is very, very uncommon in kids who have been treated.

Etiology: Borrelia burgdorferi , a spirochete bacteria

Seasonal Issues: spring and summer when tics are out; geographic distribution includes New England, eastern mid-Atlantic states, upper Midwest in Minnesota and Wisconsin.

How’s It Spread? Via tick bite of infected tic

Incubation Period: 1-55 days with a mean of 11 days. Late symptoms occur months to years later.

Diagnosis: clinical if rash present; quick lab assay that will remain positive for life – so it can be used for diagnosis but not to confirm if treatment was effective.

Prevention: REMOVE THE TICK if you remove the tic with in 2 days, Lyme will not get transmitted from the tick to the person its attached to. So, the sooner than better. How to remove? Take a tweezers and grab the tick on the head. Gently pull up and the tic will release. Don’t worry if the tikc’s small pincers stay attached to the skin – those don’t carry disease and will not cause harm.

Treatment:

Antibiotics for 14-21 days orally for early disease. More complicated disease and late disease needs to be treated longer and sometimes by IV antibiotics.

Call Your Pediatrician if your child has: A tick bite where a characteristic rash began to form.

School and After school Activity Issues: no restrictions. This is not contagious person to person.

Internet Resources For Parents

CDC Lyme Page

Tick Management Handbook

Tick Bite Prevention

Internet Resources for Kids and Teens

Lyme Info For Kids

Lyme Info For Teens

What is it? The inability for Seniors (typically) to focus due to a feeling that “they are done”. However, this can occur in all kids at various stages.

Symptoms:

Not applying as much effort in school work

Loosing interest in activities

Grades slipping

Lackadaisical attitude

What you should do as a parent:

• Talk to your child
• Talk to the school

The goal is to uncover from your child what is driving your child’s thinking and motivation. Your job is to be helpful and to be a good listener. The school is your best ally in helping you talk to your child and explaining the big picture.

The Cure

GRADUATION! And, staying busy and involved well before then.

However, your Senior needs to understand that some colleges and universities are not as forgiving if grades slip too much. Scholarships and awards have been revoked so it is important to keep GPAs respectable. Many schools have helped by keeping kids busy with projects and fun class activities.

See Resources for more information and tips.

Resources For Parents

What to do about Senioritis (College Board Association)

PedsNow article March 2006

Common Household Pets:

Hamster, cat, dog, guinnea pig, ferret, gerbil, rabbit, mouse

Do these pets carry a rabies risk? No.

Can I get infected from being bitten by my pet? Yes. Mouths of pets have bacteria and can infect you. As with all bites and cuts, you want to do the following:

1. Clean well with warm soapy water.

2. Apply antibiotic ointment.

3. Cover with bandaid/dressing and change when needed.

4. Keep a close eye on the bite site for signs that active infection is forming which include:

Redness

Warmth

Tenderness

Pus

If your pet or a friend’s pet has bitten you, find out about the health of the pet:

• How has the pet been acting?
• Is the pet up to date on shots? This applies to dogs and cats.
• When in doubt, contact a vet to see if the pet needs to be evaluated for infection. Often a vet can tell you over the phone if a type of pet needs to be seen or will put a person at risk from a bit.

What animal bites do I need to worry about for rabies risk?

Wild animals and unimunized cats and dogs.  So, if you don’t know the ownder of a cat or dog, those are the  cats and dogs to worry about. Also, all dog bites need to be reported to the local police by law.

Bites from the following animals need to be evaluated right away for rabies shots: bat, skunk, raccoon, fox, coyote, or large wild animal. Keep in mind that for bats, a bat in the house counts as a bat bite since bats often leave no bite marks.

Links For More Information

Dog Bite Law Site

University of Michigan Pet Bite Information

Technical Names: Allergic Rhinitis

Nicknames: Hayfever, Allergies

What it is: allergic reaction to something in the environment such as pollen, dust, molds, animal hai. It is an overreaction of the immune system – a “normal” reaction on overload. People can grow in and out of allergies throughout their lives. Genetics determines some predisposition but environmental factors can also overload the immune system.

Seasonal Issues:

Many people have season allergies particularly around season change times. Some people are allergen specific and others have year ’round allergies.

Symptoms:

Symptoms are different person to person but include some of the following:

• runny nose
• sneezing
• itchy skin
• watery eyes that may appear red
• wheezing or cough

Treatment:

Symptoms specific and may include:

• avoidance if possible of offending allergen (eg. if allergic to cats, avoid cats)
• antihistamines: over the counter and prescritpion
• expectorant for nasal congestion
• saline nose spray
• eye drops
• other medications as indicated by symptoms

When to Call Your Doctor

• symptoms interfering with activities
• symtpoms interfering with sleep
• trouble breathing
• worsening itchy rash

Internet Resources for Parents

All About Allergies (KidsHealth)

Internet Resources for Teens and Kids

For Teens

Common and Technical Names:

Poison Ivy: Toxicodendron rydbergii

Poison Oak: Toxicodendron diversilobum

Poison Sumac: Toxicodendron vernix

Plant Identification: see this link: Cornell Poisonous Plants Information Database)

What it is: Allergic reaction to urushiol oil from the poison ivy/oak/sumac leaves. The rhyme “leave three let them be!” can help kids remember to avoid clusters of three leaves together. 85% of kids can have allergic reactions to the oil.

Exposure Issues:

• Plants: poison ivy, oak and sumac leaves
• Non-plants: oil on toys and shoes that had been in contact previously with the oil; the oil can actually remain active for 1 year!

Typical Ages for Illness: any age in a susceptible person, someone who is sensitive to the oil

Typical Symptoms: rash and itching in the areas of skin in contact with the oil. This can be from direct contact with the plan or by fingers who touch the oil on the skin

Seasonal Issues: The plants are perennial but have different appearances as the seasons progress. See KidsHealth for great pictures of poison ivy through the seasons.

Incubation Period: rash typically starts 1-2 days after exposure to the plant oil

Diagnosis: by the distinctive appearance of the rash which has a bubbly look. For a typical appearance of the rash click here.

Symptom Duration: the rash can take 2 weeks to clear. It is not contagious.

Treatment:

Symptomatic! Stop the itch!!!!

• over the counter products such as calamine lotion
• oatmeal baths and lotions: Aveeno is the name brand to look for
• antihistamines such as benadryl or claritin
• 1% hydrocortisone cream to small areas 2 times a day but do not use to large areas of the body or the face, or more frequently, without consulting your pediatrician
• local cold compresses

If these simple measures do not work and your child is very uncomfortable, call your pediatrician for further advice.

Exposure Prevention:

• Teach your children to recognize the poison ivy plant.
• Wear long pants, long sleeves, gloves and boots when in suspect areas.
• Use barrier creams such as Ivy Block.
• Remove plants if necessary (this should be done with caution—do not burn the plants since inhaling the smoke can lead to very serious reactions).

Call Your Pediatrician if your child has:

• wide spread areas of rash
• rash near the eyes or mouth
• any areas or the rash that appear infected, have frank push or appear red or angry looking, are tender, have red streaking, or the child has a fever

Internet Resources For Parents

American Academy of Dermatology Poison Ivy/Oak/Sumac Page

Children’s Hospital Boston Information on Poison Ivy and After Care Instructions

Lucile Packard Children’s Hospital

Internet Resources for Kids and Teens

American Academy of Dermatology Pesky Poisonous Plants Page

KidsHealth Information for Kids on Poison Ivy

KidsHealth info for Teens on Poison Ivy

Bug has many definitions that all apply to your family’s health. Bug can mean an illness, such as the flu, or a pesky problem, such as an injury or allergies or social or psychological issues. Both types of bugs are most certainly part of life and impact all of us. What fascinates me is that most bugs are seasonal and there are many that go about all our towns as if on a road trip!

Bug Of The Month will highlight what’s going around your community, and what ones to look out for!  You’ll get the nuts and bolts, issues to monitor for and resources for more information. Of course, your pediatrician is still your best resource but having a heads up can give you an invaluable peace of mind and help you decide if you need to call for more advice.

Some of the Bugs included on the BugRoll include:

• Animal Bites
• Asthma
• Back-To- School-itis
• Croup
• Ear Pain
• Fifth Disease
• Food Poisoning/Salmonella
• Hayfever (Seasonal Allergies)
• Hives
• Lyme Disease
• Meningitis
• Mono
• MRSA
• NoroVirus
• Pertussis
• Pneumonia
• Poison Ivy, Oak or Sumac
• RSV (Respiratory Syncytial Virus)
• Senioritis
• Sprain and Strains
• Strep Throat and Scarlet Fever
• Swine Flu
• The Flu (Influenza)
• The Stomach Flu (gastroenteritis)

More Bugs are added all the time so check back often!