A Dose of Dr. Gwenn

Now that cough and cold products are not available for infants and small children, and the FDA and American Academy of Pediatrics officially stating that similar products for older children simply do not work, many parents are left wondering how in the world they can help their kids feel better when a cold strikes.

The real issue at hand is that these medications were not helping kids at all. Time and old-fashioned remedies, which I’ll get to in a moment, are what has been helping all along. And, these medications are dangerous. They have often been misused and have actually caused serious harm to many children. So, the time has definitely come for them to just be removed from the shelves.

If you think back to your child’s last cold, what helped your child feel better had nothing to do with cold medication and are still available to you:

1. Keep your child hydrated.
2. Saline nose spray as often as possible.
3. Humidifier in the room. Cool seems to help loosen the cough more in my opinion.
4. Fever reduction with Tylenol (acetaminophen) or Advil/Motrin (ibuprofen). These medications are dosed by weight. Tylenol can be given every 4-6 hours and Motrin/Advil every 6-8 hours. Do not give them together or alternate as that combination can become harmful to your child’s liver. Also, ibuprofen is for kids over 6months of age.

Antibiotics do not help colds because colds are caused by viruses and antibiotics are for bacterial illnesses. Sometimes bacteria do creep into the picture with a virus. You’re pediatrician can help you sort that out because it can be tricky. The sign to you to call is something not progressing as it should: fever going away and returning, the development of focal pain such as ear pain or worsening of a symptom.

Other times to call your pediatrician include if your child refuses to drink or has GI symptoms preventing your child from staying well hydrated such as vomiting or diarrhea. Your pediatrician should also be called if your child appears very ill or if the fever is persistent beyond 3 days.

The only true cure for viral illnesses is time – 7-10 days of time, if not a few days more for a stubborn virus. While that may seem like an eternity early in the illness, it will eventually pass and your child will be back to full speed in no time.

With all the talk of the flu shot this time of year and how “best” to combat the flu, it can be confusing to figure out who in your family should get the flu shot each year. The bottom line boils down to this: if you are a household with kids under 5, every grown up and child over 6 months of age should get the flu shot annually unless a person has an allergy to a component of the flu shot such as egg. And, even if you don’t technically fall into this list, you likely come into contact enough with someone who would be at high risk if they contracted the flu, so getting the flu shot is a good idea still.

The flu is a very strong virus and we know from clinical experience that it hits the extremes of ages hardest: the kids and the elderly. Among the kids, the youngest of the kids and kids with chronic conditions are at most risk but just being a kid is a risk for the flu because their immune systems are still developing.

As for kids, there are two flu vaccines available: FluMist nasal spray and the traditional flu shot. Both work just as well in kids over 2 years of age and cost the same. So, for parents wanting to avoid another shot, the nasal mist is the way to go and is very well tolerated.

One question that comes up every year is why do encourage everyone to get a flu shot yearly. The flu virus changes yearly so our vaccine changes yearly. Luckily, most changes in the virus are not huge so the vaccine, although based on last year’s flu season, still work fine.

Here are the official CDC recommendations for who should get the flu shot each year:

1. People at high risk for complications from the flu, including:
o Children aged 6 months until their 5th birthday,
o Pregnant women
o People 50 years of age and older
o People of any age with certain chronic medical conditions (primarily chronic heart and lung conditions such as congenital heart disease, respiratory conditions, and those people on immunosuppressive treatment)
o People who live in nursing homes and other long term care facilities

2. People who live with or care for those at high risk for complications from flu, including:
o Household contacts of persons at high risk for complications from the flu (see above) – i.e. parents of kids under 5!!
o Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
o Healthcare workers

Your pediatrician can help you figure out if your child would benefit from the flu shot and help answer any other questions you might have. For more information, the CDC website is a great resources, and I post frequent updates on Pediatrics Now as the flu season progresses.

Finally, talk to your kids about some simple flu-avoidance measures that can keep all of you as healthy as possible this winter:

1. Wash hands frequently
2. Stay away from sick people – cancel playdates if you have to, don’t go to school, work or activities if feeling sick. This self-exclusion is very important to control the spread of illness.
3. If you have to cough or sneeze, use the crook of your arm – and wash your hands if you cough/sneeze in your hands.

So, be wise, immunize…and when in doubt, wash your hands!

It is a very scary diagnosis for parents and doctors, meningitis. And, this time of year it seems to make headlines somewhere in the country. Last year some hockey players from New Jersey shared water bottles and contracted meningitis, and this week two Bentley College students in Massachusetts have been hospitalized with meningitis.

Parents often wonder when their children complain of symptoms if those symptoms are "meningitis". Viruses and bacteria can cause meningitis, which is irritation of the lining around the brain. Like all illnesses, there is variation and there can be mild to severe degrees of illness. But, bacterial meningitis, the type that is making news this week, makes people very, very sick and very quickly. This isn't the type of situation where you wonder if your child is sick - you know it. These kids look and act sick. They have fever, often very high. They feel lousy. They are tired and often very sleepy. Some may feel very sick to their stomachs . Some may seem confused to those around them. They have severe headache and their neck becomes so stiff they truly can't bend it without their heads hurting more.

Antibiotics help when begun early but it is a serious illness and, sadly, can claim lives and leave survivors with horrible problems once they recover. For this reason, close contacts are also treated, and a vaccine has been developed for preteens and close contacts. But, what is important to remember is that only close contacts need to be treated because bacterial meningitis can only be spread by sharing saliva - kissing, sharing food utensils or cups. This isn't the type of illness that spreads by casual contact which is actually reassuring. Your kids won't get bacterial meningitis by being in the same room as a person with the illness - there has to be that direct contact with saliva. Breathing air or touching isn't a risk factor.

So, what should you do next time your child has fever, headache and complaints of a sore or stiff neck? Don't play doctor, call your doctor for advice. Keep in mind that true, serious illness like the type bacterial meningitis causes doesn't hide for long so if your child looks well and is acting well that is always reassuring. But, if your child is becoming sick before your eyes, your child needs medical attention right away. In fact, if that is going on, call your doctor on the way to the ER or call 911 if your child is horribly ill to you.

Here are some links for more information:
CHOP Meningitis Information
CDC Meningitis Information

Do your kids ever complain about stomach aches? How often? Do those aches seem to have a pattern to them or interfere with your child’s ability to get through the day and participate in school and social events? If so, your child may have IBS, irritable bowel syndrome. And, chances are other people in your family have this, too. This isn’t something many people talk about but it is much more common than you realize. Believe it or not, 6-14% of adults and kids have IBS so you are far from alone!

April being IBS awareness month is a great excuse for you to gather some information and really sort out if those “my tummy hurts” complaints deserve further attention. IBS isn’t your typical stomach ache – it is much more profound than that because it happens more frequently and more intensely than the typically upset stomach. While most people think of this as an adult condition, it actually affects more kids than you’d realize – in fact, to the same degree! And, from my own clinical experience, I can tell you this is very real in kids and teens and often comes in very predictable times – like State testing or moving or friendship issues or trouble at home. Just like us adults, the intestines of our kids are often the mirror of their minds and emotions.

The symptoms are often very, very uncomfortable with abdominal pain and sometimes bloating. The pain is often lessened when the child has a bowel movement. And, bowel movement patterns are often altered with some IBS patient’s having very hard stools or true constipation and others more loose stools. For these symptoms to be true IBS, they need to occur for 12 weeks during the year and not necessarily in a row.

What should you do if you think your child may have IBS? First, start keeping a log of your child’s symptoms and foods and stress. Second, call your pediatrician. There is a lot that can be done to help people with IBS but the first step is being open to the diagnosis, and getting your child to the doctor to get a diagnosis.

Keep in mind, that many kids have “nervous stomachs” that still warrant attention even if they end up not quite meeting the true criteria for IBS. So, still make that call if your child has symptoms that are interfering with any life activities at all. Even IBS- like conditions deserve attention and many kids have those as well. This is an unfortunate side effect of our busy life styles and perhaps even our unhealthy diets.

So, now you have some information to think about and can decided if you need to talk further you’re your child’s pediatrician. Better to call and have those tummy symptoms be nothing than to find out later there was actually something simple you could have done to help your child feel better. Act today so tomorrow can be a better day for whoever in your family has IBS.

For more information check out:
About IBS
About IBS Kids

Taking a child to the doctor is often stressful. To help make those visits go as smoothly as possible, here are a few tips that my experience has taught me really help make a big difference for everyone.

1. Please don’t use your cell phone in the exam room – to make a call or answer a call. It is distracting and delays us from seeing the next patient on time.

2. Please don’t let your child eat in the room. Food in the room is a risk for kids with allergies. It is hard to examine a mouth that has food in it.

3. If a child has been vomiting, don’t give your child anything to drink with out talking to the nursing staff first.

4. If your child has a particular worry, let us know so we can find a way to address it and you’re your child more at ease.

5. Remember your child is the patient, so please don’t interrupt us if we try and get the history from your child. You can fill in the blanks after we are done with that part of the history.

6. Both the history and the physical are important, and we need to do both at every visit.

7. Small children usually have to be restrained gently during parts of the exam. This is for the safety of your child when examining sensitive areas like the ears or mouth. This process goes best if you assist with it by following our cues.

8. If your child has a major medical problem, clue us in even if you think it is in the chart.

9. Be patient if there is a wait. If you have a time crunch, let the staff know to help find solutions if you need to be somewhere.

10. Make sure you have distraction toys to help pass the time. Books. Crayons. Your child’s favorite stuffed animal.

So, give these tips a try. I have a feeling you’ll find they’ll be just what the doctor ordered for making the next visit go better for your child, and for you.

It is difficult when experts seem to disagree on how to manage a child health problem. Early May, 2008,the American Heart Associationn(AHA) came out with a statement advising EKGs in kids about to start stimulant medication for ADHD. While this recommendation was the result of careful and thoughtful analysis of the data at hand, it was counter to current recommendations by the American Academy of Pediatrics (AAP) and American Association of Child and Adolescent Psychiatry. To help clear the waters, all the groups have come together again and made recommendations that make more sense. In fact, shortly after the initial May 6, 2008 AHA statement, a new statement was released by the AHA and AAP that was softer and more consistent with past recommendations to not screen all kids.

There are many issues to consider and it is a bit confusing:

1. There are no studies that actually support the original recommendations by the AHA.

2. The AAP has always advocated a thoughtful approach to heart screening that takes into account family history, review of the patient’s symptoms and physical exam.

3. Widespread screening is costly to all of us in the end and will yield few positive results. It is truly searching for a needle in a haystack.

4. Screening of any kind does place unnecessary anxiety on the majority of families who do not need to go through the procedure with their child and waiting game for the results.

So, how does the this particular screening work? Simple. If a patient has known heart disease, this discussion is moot. Those patients need to get annual screening and their cardiologists will help guide the right tests and the schedule for those tests. The cardiologists will often work with the pediatricians to help arrange these tests in the community near home.

For kids who have no known heart disease, which are the majority of kids being considered for ADHD medication or are already on ADHD medication, a good evaluation of family history, the patient’s history and physical exam are all that is needed. If during any of those evaluations suspicion is raised for heart disease, the option for screening becomes more important and will be discussed based on what information turns up. This isn't a one test fits all. It is a test if needed sort of thing.

So, whenever you are faced with a situation of “to screen or not to screen" with any test, the answer always lies somewhere with the patient and the family. Tests don’t help unless there is a reason for them to help.

If you want to fall back on an “official” statement for the question of "should kids on ADHD medications get EKGs?", fall back on this one:

“Medications that treat ADHD have not been shown to cause heart conditions nor have they been demonstrated to cause sudden cardiac death.”

When you learn of frightening headlines about medications and children, such as this one run recently on FoxNews.com, your initial reaction may be to panic and not give that medication to your child. Keep in mind that the press loves to sensationalize headlines and will over dramaticize a situation to draw you into their website with such stories. Such was the case recently with a very rare and serious drug reaction due to ibuprofen that left a little girl blind.

Ibuprofen, a common pain killer and fever buster, is a common medication for children in many medicine cabinets these days. And, it is safe when used at the proper doses. The problem with any medication, however, is that even at proper doses, there is always the chance of an allergic reaction in any of us – or our children. These reactions range from mild to serious and are due to an over reaction of a person’s immune system from that medication. Prior exposure to a medication is usually needed.

While this child has the most severe of drug reactions a person can have, fortunately most drug reactions are much less severe – typically a rash of some sort.

These reactions are not due to medication error from a physician or negligence on the part of a drug company but bad luck. I’ve had the misfortune of two drug allergic reactions myself and there was no warning and I have diagnosed a range of allergic reactions in children from medications. In all these cases, the one element the reactions shared was the element of surprise.

So, what should you do? Be on the look out for any symptom you don’t expect when any family member is on a medication – whether that medication be over the counter or prescribed. And, call your doctor’s office for advice at the first sign of trouble.

A quick word on Stevens-Johnson Syndrome, the type of reaction the child on the FoxNews.com story had. While often due to a medication, it can also occur from an illness such as a virus. Nonsteroidal antiinflamatory medications are known to be on the list as potential culprits, according to the MayoClinic. It is a type of drug reaction that involves a rash with target-like characteristics and some of the deeper mucous membranes such as the inner lining of the mouth and esophagus and the conjunctivae of the eyes. There’s usually flu-like symptoms such as fever, too. Needless to say, these patients are sick and require very intensive and supportive care to help their body curtain this reaction. This is very rare and occurs in 1 per 7 million cases of drug reactions a year when the target lesions develop.

I want to call your attention to this line on the MayoClinic info page:

“It's difficult to prevent an initial attack of Stevens-Johnson syndrome because you don't know what will trigger it.”

So, what does this mean for medication use in our children? Is ibuprofen safe? First, ibuprofen is safe – go ahead and use it. But, we all have to have a healthy respect for medication - and that is what this story means. We have to learn to use over the counter medications in the right dose and for the right situation so the benefit is worth any potential risk of a reaction. Any time any of us take a medication there is a risk. So, let’s make sure the risk is worth it before we put it into our bodies or our children's mouths.