Spotted on the horizon: Roseola

Your toddler wakes from his afternoon nap a tad grumpy and with flushed cheeks. You grab your thermometer and see that his temperature is… 104F! But, because you have read our prior posts about fever Part 1 and Part 2, you do not panic. He has no cough, no runny nose, no vomiting, no diarrhea, no rash. He is fully immunized. In fact, considering how well he was acting before his nap, you are very surprised to find fever. You give him Tylenol and and hour later he becomes a happy toddler. This pattern continues for three days. He has fever, but no new symptoms, and he continues to run about energetically. On the fourth day, the fever breaks. A rash pops up, and your pediatrician diagnoses your child with roseola.

A viral illness seen in kids typically between six months and two years of age, roseola usually runs a course similar to your toddler’s illness and requires no specific treatment. Many kids remain relatively cheerful despite the fever, and those who become fretful regain their good moods after a fever reducer medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) is administered. The associated light-pink rash may cover a child from head to toe as seen in our photo. The rash does not itch or hurt. Once the rash appears, the child is no longer contagious. If you press on the rash and lift up, the redness will momentarily turn white (blanches). It lasts for hours to a few days, and then fades. Up to 50% of affected kids never even get the rash.

My twins had roseola at age 18 months. I remember one had fever for three days, the other had fever for two days, and both acted quite well despite their high temperatures. I kept waiting for more symptoms, dreading what I thought would turn out to be twin colds or worse, twin stomach viruses (double diarrhea really stinks), but no other symptoms emerged. When one broke out in a rash, I remember thinking “Oh finally, I know what you both have… roseola.” My other twin never did get the rash. Thus, I suppose my family shows that 50% of affected kids really don’t get the rash.

What else causes fever for a few days and no other symptoms in a young child? In girls and uncircumcised boys, we mainly worry fever alone can be the sole sign of a urinary tract infection.

In general, if your child seems especially ill, refuses to drink, becomes difficult to console, has any new rash WITH FEVER, or has fever alone for MORE than a few days, then you should call your child’s doctor. For more information on when to call your child’s physician, please see our “How sick is sick” post.

Now that you’ve learned about the symptoms, if you recognize Roseola, you’ll be “spot on”.

Julie Kardos, MD with Naline Lai, MD

Chatting with Janet Zappala: Food for Thought Episode-help for overweight kids and picky eaters

In case you missed the live internet radio show- hit the arrow to tune in here:

http://www.voiceamerica.com/content/swfs/jw-player-licensed-5.2.swf

Newborn eyes: blocked tear ducts, crossed-eyes, vision, and eye color

This post was inspired by a newborn whose mom asked me about his eyes. “Here’s looking at you, kid!”

What is this goop in my baby’s eye?

Blocked tear ducts: About 25 percent of infants, by the second or third week of life, develop some slightly yellow or clear eye discharge from one or both eyes. The discharge looks worse when the infants first awaken. At this age, they start to produce some tears (although they do not “cry tears” until closer to three months old). But because newborn tear ducts, the drainage system for tears, are not completely open, tears either spill over, causing a watery discharge, or accumulate in the eyes during sleep and become slightly thicker “goop” that wipes away easily.

Babies with blocked tear ducts have normal appearing sclera (the whites of the eyes) and normal vision. Blocked tear ducts are not painful. Fortunately, the tear ducts open up spontaneously in most babies without intervention. This process, which is usually complete by three month of age, can take up to one year of age. An infection in the eye causes a baby’s eye to become painful, red on the inside, and sensitive to light. The discharge becomes pus-like and increases in amount. If you are not sure if your baby’s eye discharge is from an infection or a blocked duct, consult your pediatrician.

Why do my baby’s eyes cross?

Young infants’ eyes may cross as they gaze at an object. This crossing is a result of an immature nervous system. By three to four months of age, a baby’s eyes should always move in concert when she gazes or follows an object with her eyes. If your baby’s eyes cross after this age, alert your child’s pediatrician, who will likely refer your baby for an exam by an ophthalmologist who is comfortable examining babies. It is important to make sure the eyes are both seeing equally and adequately, as well as to make sure the eye muscles work properly. See our previous post on crossed-eyes.

What is normal vision for a newborn?

Babies are born nearsighted. They see clearly the distance to a face when being held. Some newborns will stick out their tongues in response to seeing their parents do the same. So, be sure to look at your infant when you are feeding or rocking her. Far vision develops gradually over months to years. A child’s vision is not 20/20 until about five-years old.

When will my baby’s eyes change color?

The color of a baby’s eyes generally becomes established during the first year. Some stay the same color from birth. My own children were all born with either blue or grey eyes but now all are brown, much to the delight of their blue-eyed grandmother. My oldest was nine months before his eyes turned brown. Some of my patients did not develop their permanent eye color until two years.

Here a few more eye facts: The part of the eye with color is called the iris. The hole in the center of the iris is called the pupil. Pupils should always look black. In a photograph they can look red from a flash. However, if you ever see white, yellow, or grey reflected in the pupils, alert your baby’s doctor.

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®

What you need to know about Whooping Cough

Pertussis is “whooping cough,” also known as the “100 day cough.” In children and adults, the disease starts out looking like a garden-variety cold, complete with runny nose, runny eyes, and mild cough. Sometimes fever is present, sometimes not. However, after a few days, coughing spasms emerge – severe, persistent coughing spasms that go on and on and on. In between coughing fits, children may appear okay.

There is no treatment except to “ride it out” and the cough can last up to three months. Doctors prescribe antibiotics to a child with pertussis because antibiotics can decrease how much a person with whooping cough will spread it to others. Close contacts of kids with pertussis may also receive antibiotics to reduce their chance of getting pertussis.

Whooping cough gets its name from the “whoop” noise kids make after a coughing fit. The fits leave them so breathless that it’s difficult to take a breath in again after the coughing spell. To hear the “whoop” with coughing fit, visit www.whoopingcough.net.

Teens and adults with whooping cough don’t tend to make the whoop sound because their airways are bigger, but the coughing spasms can leave them feeling like they might throw up or pass out. Some in fact do end a coughing fit with vomiting or fainting.

Babies don’t make the whoop either. Instead, babies with pertussis simply cannot catch their breath and stop breathing. That is why babies are the ones who tend to die from this illness. Dr. Lai and I both have watched over hospitalized infants blue from pertussis.

Thankfully, we have a vaccine that is effective at preventing pertussis. The “P” in pertussis is the “P” in the DtaP vaccine that children receive as babies, usually at two, four, and six months of age. The DtaP vaccine is then next given after the first birthday, another between ages four and six years old, and another at age eleven years. Teens who have not received the pertussis vaccine since they were in preschool, and adults who care for infants also should also get the vaccine. For more specific up-to-date recommendations: www.vaccineinformation.org/pertuss/.

As we enter the season for catching snowflakes and coughs, we hope none of your children catch whooping cough.

Julie Kardos, MD with Naline Lai, MD
©2011 Two Peds in a Pod®

revised Nov 16, 2011 to reflect the indications for antibiotic prophylaxis

Not cute as a button: Babes and button batteries

In a couple of weeks my 16 month old nephew will visit my non-baby proofed house. Chances are, he will find things in my house to chew on besides turkey. The first items I am hiding are the devices which contain the tiny round batteries called button batteries. Below, Kristen Casavale of The Battery Controlled reminds us about the hidden hazards of button batteries.

Electronic devices are a part of daily life. And they’re getting smaller, slimmer and sleeker. But inside the battery compartment of mini remote controls, small calculators, watches, key fobs, flameless candles, singing greeting cards, and other electronics, is a very powerful coin-sized button battery. When swallowed, these batteries can get stuck in the throat and food pipe, causing severe burns in as few as two hours.

“Our trauma surgeon told us that they see 10 ingestions a month. Unfortunately, I didn’t really think twice about Emmett playing with the remote control,” said Karla Rausch, mom of son Emmett, age two.

Small children often have easy access to these devices; parents often don’t know about the risk, and little ones can’t always communicate with adults. Grown-ups may be unaware of an ingestion until the battery starts to erode through a child’s food pipe. The Battery Controlled is a partnership to raise awareness about the severity of the issue and share information with parents, caregivers and the medical community. Launched by Energizer and Safe Kids USA, this effort is committed to helping parents prevent children from swallowing coin-sized button batteries.

Teaching points for parents:

1. Keep out of reach. Devices with coin lithium “button” batteries have no place in unsupervised hands or toy boxes.
2. Get help fast. Life-threatening damage can happen in as few as 2 hours.
3. Tell others.

We, and my nephew, thank Kristen for her safety alert.

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

Those stinky kitchen sponges: how germy are they?

Dr. Lai and her husband had a running debate about when to replace kitchen sponges. Today we thank guest blogger Dr. Karina Martino, Food Safety Engineer, for exposing the germs in our kitchens. We certainly learned a lot, and Dr. Lai’s husband lost a bet.
Naline Lai, MD and Julie Kardos, MD

WHO’S THE WORST OFFENDER IN THE KITCHEN???

The winner is…….the kitchen sponge (and dishcloth)! The next worst offender is your kitchen sink. This is where vegetarians have a definite advantage since they don’t bring raw meat into their homes. There’s less chance of E. coli and Salmonella spreading, but vegetarians still have to be on the lookout for viruses and parasites.

What are the kitchen’s hot germ zones?

In descending order by highest bacterial count, these are:

1. Sponges and dishcloths

2. Sink drain area

3. Faucet handles

4. Cutting boards

5. Refrigerator handles

Here are simple steps that you can follow to create a healthier kitchen environment:

Dip sponges after every use in dilute sanitizer water (1 teaspoon bleach per quart of water); boil them for 3 minutes on a weekly basis.

• Change dish cloths daily, especially after wiping up raw meat juices.

• Wash sinks with hot soapy water prior to food preparation and before washing dishes.

• Wipe down refrigerator handles daily with dilute sanitizer water.

• Choose non-porous cutting boards that are easy to clean.

• Avoid rinsing raw meats. It contaminates the sink. If you cook meat at the correct temperature for enough time, bacteria on raw meat will be killed.

When we are handling food products everything in the kitchen must be clean, especially ourselves. It is vital to wash our hands with soap and hot water for at least 20 seconds before handling any food product. Each time you re-enter the kitchen from outdoors or any other place in the house where you might have contaminated your hands, you should wash your hands again.

Clean clothing, including aprons, is also an important part of personal hygiene. Dirty clothes and dish towels are a good place for bacteria to hide and grow. Sneezing and coughing spreads germs from our lungs, throats, and noses. When handling food, we must control the spread of germs from these natural occurrences by covering our mouths with disposable tissues and then rewashing our hands.

While the Centers for Disease Control (CDC) provides information about illness from food in homes, it does not yet offer statistics about how many people become ill from their kitchen sponges. However, here are some facts for you to keep in mind:

• The kitchen environment can be more heavily contaminated with fecal bacteria (those bacterial species associated with feces) than the bathroom, suggesting that the risk of spreading infection in the home may be highest in the kitchen-the area in the home where food is prepared.

• Microbiological surveys of domestic kitchens have found significant contamination from a variety of bacterial contaminants, including E. coli, Campylobacter, and Salmonella.

• Pathogenic organisms (germs that cause disease) have been shown to be introduced in the home by people, food, water, pets and insects.

• The domestic kitchen is not used only for food preparation, but may serve as a laundry, a workroom, and a living area for family pets. Each of these functions can serve to introduce bacterial contamination into the kitchen environment.

Moreover, research focusing specifically on the kitchen environment has found:

• 67% of kitchen sponges may be contaminated with fecal bacteria

• Contaminated cloth towels serve to transfer bacteria to dishes during drying

• 82% of sink faucet handles are contaminated during food preparation

• 60% of people do not wash the cutting board after cutting raw meat or poultry and before cutting fresh vegetables for salads

• 9% do not wash the work surface at all after cutting raw chicken

So, please don’t duplicate these mistakes! The next time that you get ready to do your dishes with your six-month-old sponge… think again!… either toss it or get your Clorox immediately!

Karina G. Martino, PhD

Dr. Martino received her Masters degree and her PhD in Food Safety Engineering from Michigan State University. A former professor at University of Georgia, she now has her own consulting business (www.kgminnovations.com) and is the mom of two children.

Who would have thought? Walking in a prewinter wonderland

If you live on the East Coast of the United States, you were bombarded today by a surprise pre-Halloween snowstorm. Now that we have our power back, we thought we’d share with you a few posts we were reminded of today:

As Dr. Lai struggled with chimney flues, she was reminded about hidden sources of carbon monoxide.

Scrambling around for a halloween costume reminded Dr. Kardos of ways to keep the candy intake down to a reasonable amount.

Squeezing children’s toes into snow boots from last year reminded us of how to dress your child appropriately for cold weather.

Looking for matching mittens reminded us of home remedies to prevent dried chapped hands.

Surely the cold, harsh weather is the fault of the retail industry- the big box stores lined their shelves with winter-holiday knick-knacks halfway through October. Mother Nature, like other mothers, was not pleased.

Naline Lai, MD and Julie Kardos, MD

Should I vaccinate my child?

Yes, yes, yes.

However, in the face of overwhelming evidence of safety and benefits of vaccines, we pediatricians despair when we see parents playing Russian roulette with their babies by not vaccinating or by delaying vaccinations. We hope fervently that these unprotected children do not contract a preventable debilitating or fatal disease that we all could have prevented through immunizations.

Should you vaccinate your child?

YES!

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®

Visit these posts for more information about vaccines: Evaluating Vaccine Sites on the Internet, and Closure: there is no link between the MMR vaccine and autism

Hear ye, hear ye: how can I tell if my child hears?

I just watched “The Miracle Worker” with my oldest son. This classic 1962 movie depicts Helen Keller, who was deaf and blind, struggling to understand language, with the help and supreme patience of her determined teacher Annie Sullivan.

As I watched the movie, I was reminded about how children depend on their senses to learn about the world. Starting today, Two Peds in a Pod will bring you periodic posts about the early development of senses. We start with hearing.

Unlike eyesight, which is limited at birth, babies are usually born with normal hearing. Before leaving the hospital after birth, or by two weeks of age, your newborn should receive a hearing test. Then, at every well child check, your child’s health care provider will ask you questions to confirm your child’s hearing remains the same.

Even though they are unable to localize where sound is coming from, newborns will startle to new or sudden sounds and their eyes will open wider in response to the sound of your voice. All babies babble, even deaf ones, but language progression will stop in children who cannot hear. By six months, kids usually babble one syllable at a time. By nine months, children will produce syllables that sound like whichever language they hear the most. At this point they should also respond to their name. Babies who fail to meet these milestones may do so because they cannot hear.

For older kids, hearing screening may be conducted in schools or the pediatrician’s office. The American Academy of Pediatrics recommends formal hearing screens starting at four years old. These screening tests can detect subtle hearing loss that parents did not notice. Kids who fail the screen should have a more comprehensive hearing evaluation by an audiologist. Many kinds of hearing loss are either reversible or manageable. The earlier the diagnosis the better.

Sometimes speech, behavior, or attention problems are secondary to hearing difficulties. School aged children may mispronounce words because they cannot hear sounds clearly. These children commonly do not distinguish well between the “s,” “ch,” and “sh” sounds (please click here to review language development). Symptoms attributed to Attention Deficit Hyperactivity Disorder such as difficulty focusing or inattentiveness may actually result from hearing loss. Some kids who “just don’t listen” to adults simply can’t hear well enough to follow directions.

As your child’s hearing loss progresses, you may notice your child’s language regresses, or that your child turns the volume up on the TV. Your child may accuse you of mumbling or ask you to often repeat questions. Although a common myth, a child who talks loudly is not necessarily deaf. After all, a child does not need to raise his own voice in order to understand himself.

Finally, I should mention signs of “selective hearing loss.” Many parents describe this form of “hearing loss” to me in the office. In these cases, a child does not hear her mom say “Clean your room,” yet hears her mom whisper “Let’s go out for ice cream.”

We address the topic of listening, as opposed to hearing, in our next post.

It’s a gas! your young infant’s burps and farts

Gas is another topic most people don’t think much about until they have a newborn. Then suddenly gas becomes a huge source of parental distress, even though parents are not the ones with the gas. It’s the poor newborn baby who suffers, and as all parents know, our children’s suffering becomes OUR suffering.

So what to do?

First, I reassure you that ALL young babies are gassy. Yes, all. But some newborns are not merely fussy because of their gas. Some become fussy, ball up, grunt, turn red, wake up from a sound sleep, and scream because of their gas. In other words, some babies really CARE about their gas.

Remember, newborns spend nine months as a fetus developing in fluid, and have no experience with air until they take their first breath. Then they cry and swallow some air. Then they feed and swallow some air. Then they cry and swallow some more air. Eventually, some of the air comes up as a burp. To summarize: Living in Air=Gas Production.

Gas expelled from below comes from a different source. As babies drink formula or breast milk, some liquid in the intestines remains undigested, and the normal gut bacteria “eat” the food. The bacteria produce gas as a byproduct of their eating. Thus: a fart is produced.

The gas wants to escape, but young babies are not very good at getting out the gas. Newborns produce thunderous burps and expulsions out the other end. I still remember my bleary-eyed husband and I sitting on the couch with our firstborn. On hearing a loud eruption, we looked at each other and asked simultaneously, “Was that YOU?” Then looked at our son and asked “Was that HIM?”

Gas is a part of life. If your infant is feeding well, gaining weight adequately, passing soft mushy stools that are green, yellow, or brown but NOT bloody, white, or black (for more about poop, see our post The Scoop on Poop), then the grunting, straining, turning red, and crying with gas is harmless and does not imply that your baby has a belly problem or a formula intolerance. However, it’s hard to see your infant uncomfortable.

Here’s what to do if your young baby is bothered by gas:

Start feedings before your infant cries a long time from hunger. When infants cry from hunger, they swallow air. When a frantically hungry baby starts to feed, they will gulp quickly and swallow more air than usual. If your infant is wide awake crying and it’s been at least one or two hours from the last feeding, try to quickly start another feeding.
Burp frequently. If you are breastfeeding, watch the clock, breastfeed for five minutes, change to the other breast. As you change positions, hold her upright in attempt to elicit a burp, then feed for five more minutes on the second breast. Then hold your baby upright and try for a slightly longer burping session, and go return her to the first breast for at least five minutes, then back to the second breast if she still appears hungry. Now if she falls asleep nursing, she has had more milk from both breasts and some opportunities to burp before falling asleep.
If you are bottle feeding, experiment with different nipples and bottle shapes (different ones work better for different babies) to see which one allows your infant to feed without gulping too quickly and without sputtering. Try to feed your baby as upright as possible.
Hold your infant upright for a few minutes after feedings to allow for extra burps. If a burp seems stuck, lay her back down on her back for a minute and then bring her upright and try again.
To help expel gas from below, lay her on her back and pedal her legs with your hands. Give her tummy time when awake. Unlike you, a baby can not change position easily and may need a little help moving the gas out of their system.
If your infant is AWAKE after a feeding, place her prone (on her belly) after a feeding. Babies can burp AND pass gas easier in this position. PUT HER ONTO HER BACK if she starts to fall asleep or if you are walking away from her because she might fall asleep before you return to her. Remember, all infants should SLEEP ON THEIR BACKS unless your infant has a specific medical condition that causes your pediatrician to advise a different sleep position.
Parents often ask if changing the breast feeding mother’s diet or trying formula changes will help decrease the baby’s discomfort from gas. There is not absolute correlation between a certain food in the maternal diet and the production of gas in a baby. However, a nursing mom may find a particular food “gas inducing.” Remember that a nursing mom needs nutrients from a variety of foods to make healthy breast milk so be careful how much you restrict. Try any formula change for a week at a time and if there is no effect on gas, just go back to the original formula.
Do gas drops help? For flatulence, if you find that the standard, FDA approved simethecone drops (e.g. Mylicon Drops) help, then you can use them as the label specifies. If they do not help, then stop using them.

The good news? The discomfort from gas will pass. Gas discomfort typically peaks at six weeks and improves immensely by three months. At that point, even the fussiest babies tend to mellow. The next time your child’s gas will cause you distress won’t be until he becomes a preschooler and tells “fart jokes” at the dinner table in front of Grandma. Now THAT is a gas.

Julie Kardos, MD with Naline Lai, MD