Sinusitis:
"There are several sinuses in our head that can become infected. The maxillary sinuses, the ethomoid sinuses and the frontal sinuses. Symptoms of sinusitis include thick green nasal discharge, tenderness over the above mentioned sinuses to palpation, fever, green drainage without fever for longer than a week, headache, eye pain, earache and sore throat. As you can see these symptoms range from very specific to very vague. I personally use four criteria to determine whether someone has a sinus infection. They are symptoms longer than a week, thick green nasal drainage, fever, and tenderness to palpation. If a patient has two of those four or more I am willing to make the diagnosis of sinusitis. Some sinusitis is bacterial and some is viral but I always treat with antibiotics if the patient has two of these four symptoms. One exception, remember children under one year of age do not have developed sinuses sufficient enough to cause actual infection. They may have upper respiratory infections in the nasal passages but not in the sinuses." TDM
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Strep Throat:
"Approximately 20% of all cases of tonsillitis are caused by Group A streptococcus bacteria. About 80% of tonsillitis is caused by viruses and therefore does not need antibiotics. The usual findings for a bacterial strep throat include fever, bright red tonsils the color of wild cherry lifesavers, thin, white pus dripping off of them, red spots on the soft palate, sore throat, headache and abdominal pain. We of course have a quick test in the office to determine whether your child has strep throat or not. But don't be surprised if it is negative because remember 80% of the time tonsillitis is viral and only 20% of the time is it bacterial. Only the bacterial infections need antibiotics. Viruses are not cured with antibiotics." TDM
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Vomiting & Diarrhea:
"Patients with gastroenteritis, meaning intestinal viruses, will have vomiting first then followed by diarrhea. About 50% of these children will also have fever which will last about 3 days. The vomiting usually lasts less than 48 hours, followed by the diarrhea which can last as long as seven to ten days. Occasionally the bowel can be so irritated that there is blood in the stool. Children who get dehydrated from gastroenteritis usually do so in the first two days because of the vomiting. This will cause dehydration much faster than diarrhea. There are medicines to treat the vomiting if your child is old enough, specifically Phenergan or Zofran, but we usually do not treat the diarrhea because the medicines only work 10% of the time at best. Therefore, diet changes are the better treatment. During the vomiting phase the child should have clear liquids only until they have not vomiting for twelve hours then you can advance to the BRAT diet, which is B for bananas, R for rice, A for applesauce, T for toast or crackers and chicken noodle soup is included. After twenty-four hours of the BRAT diet then you can return to a regular diet. Some studies done have shown that the diarrhea will last just as long whether you change the diet or not. Anecdotally, I think that it does help to simplify the diet, however. These viral illnesses of the intestine are rarely serious and rarely lead to hospitalization except in the very young children, usually under two years old. Please feel free to talk to us about this subject in more detail at any time." TDM
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Cough, Colds, & Congestion:
"I would like to take this opportunity to talk to you about upper respiratory infections, allergies and related secondary infections for the fall and winter. Young children going through the fall and winter will be congested approximately 50% of the time. This is especially true in children under two years of age. If they are in day care this will increase their chances to 75%. If they are kept at home the chances will be approximately 25%. This means that half the days between September and May your child will be congested and have some cough as a result of that. Also, the average number of infections in children under two years of age during the fall and winter is one illness with fever every 4 to 8 weeks. Once again those in day care will have more frequent infections.
With this congestion will come secondary infections. How does this work? Either from allergies or from viral illnesses the body begins to produce mucus in the nasal passages, the sinuses, the ears and the lungs. This mucus is thick and sticky. A child breathes in a virus or bacteria through the mouth. They stick to the thick mucus and they grow there, thus a child who has had congestion for days or weeks may develop a secondary infection that requires antibiotics. This is especially true of younger children under two years of age.
This is why a child may come in for a common cold or an allergy one day and two or three days later they suddenly have a fever and now have an ear infection, sinus infection or a bronchitis. It is not because it has been there the entire three days. It is a result of the constant mucus and therefore a secondary infection.
There is no cough, cold or allergy medicine that permanently stops mucus production. Once your body begins to produce mucus for whatever reason, allergies or infection, it will continue to produce mucus for 30 to 40 days. Even if you develop a secondary infection and this is treated successfully the mucus production will continue for 30 to 40 days. Cold medicines and allergy medicines are simply antihistamines which temporarily dry up the mucus and prevent the body from forming mucus. The longest preparations last 12 hours. After that the mucus will return. The is no medicine that will totally stop mucus production. It will only decrease the mucus production. Therefore, do not look for total cessation of mucus production. Also, remember it will be 30 to 40 days before the mucus stops completely.
Let us suppose for instance that your child is in day care and exposed to an upper respiratory infection, gets that infection and begins to produce mucus. This mucus will continue for 30 to 40 days. During that time your child in day care will probably be exposed again to another virus, thereby prolonging the mucus production another 30 to 40 days. This could literally go on all winter. That is why young children especially under two who are in day care seem to be sick all winter long. They are bouncing from one infection to the other. These are not serious infections but are certainly frustrating.
Most of these infections will be viral and you do not treat viral infections with antibiotics. For every 10 infections your child gets, only two(2) out of 10 will need antibiotics, eight(8) will not.
One last thought - green drainage does not always mean bacterial infection that needs antibiotics. Green drainage with fever greater than 101 degrees F mostly needs antibiotics but just green drainage alone may be from an allergic reaction or a virus infection, neither of which needs antibiotics. Please remember 80% of infections in children are viral and do not need antibiotics." TDM
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Ear Infections:
How can i tell if my baby has an ear infection?
The easiest way to tell if your baby has an ear infection (also known as acute otitis media) - or any other illness, for that matter - is a change in his mood. If he/she turns fussy, or starts crying more than usual, you should be on the lookout for a problem. If he develops a fever (whether slight or high) you have another big clue. Ear infections tend to strike after a common cold or sinus infection, so keep that in mind too. You may also notice the following symptoms:
- Your baby pulls, grabs, or tugs at his/her ears: This may be a sign they are in pain. However, babies do pull their ears for all kinds of reasons or for no reason at all, so if your baby seems fine otherwise, they probably don't have an ear infection.
- Diarrhea: the virus that causes ear infections can also affect the gastrointestinal tract.
- Reduced appetite: ear infections can cause gastrointestinal upset, they can also make it painful for your baby to swallow and chew. You may notice your baby pull away from the breast or bottle after they take the first few sips.
- A yellow or whitish fluid draining from the ear: this doesn't happen to most babies, but it's a sure sign of infection. It also signals that a small hole has developed in the eardrum. Don't worry - this will heal on its own once the infection is treated.
- A foul odor emanating from the ear.
What causes ear infections?
An ear infection results when fluid and bacteria build up in the area around your baby's eardrum. Normally, any fluid that enters this area leaves pretty quickly through the Eustachian tube (which connects the middle ear to the back of the nose and throat) when your baby yawns or swallows. But, if the Eustachian tube is blocked - common during colds, sinus infections, even allergy season - it traps the fluid in the middle ear. Bacteria like to grow in dark, warm, wet places, so a fluid-filled ear becomes the perfect breeding ground. As the infection worsens, so does the swelling in and around the eardrum, and, as a result, the pain. Fever develops as your baby's body attempts to fight the infection.
Babies are particularly susceptible to ear infections because their Eustachian tubes are short (about 1/2 inch) and horizontal. As they grow to adulthood, the tube triples in length to 1 1/2 inches and becomes more vertical, so fluid can drain more easily. Ear infections are one of the most common childhood illnesses. Although, there are no statistics on how many babies get them, the American Academy of Pediatrics expects that most children will have gotten at least one ear infection by the time they turn 3.
When should i call the doctor?
Call the doctor at the first sign of an ear infection. They will ask you to come in so they can take a look in your baby's ear with an instrument called an otoscope. An eardrum that's red, bulging, and possibly draining is likely infected. The doctor may also look to see whether the eardrum moves in response to a device called a pneumatic otoscope, which releases a brief puff of air into the ear. If it's not moving, you have one more clue that fluid is collecting in the middle ear and it may be infected.
How will the doctor treat my baby's ear infection?
Though recent research shows that many ear infections eventually clear up on their own without any treatment, when it comes to babies, doctors will almost always reach for an antibiotic. "With young infants it's usually better to err on the side of caution and prescribe something," says Robert Ruben, an otolaryngologist (ear, nose, and throat doctor) at Montefiore Medical Center in New York. In addition, your doctor may recommend that you give your baby children's acetaminophen or ibuprofen to help relieve any pain caused by the infection.
Make sure you give your baby his entire prescription of antibiotics and follow up with an ear re-check a few weeks later so the doctor can gauge whether the medicine did its job. Don't hesitate to call your doctor if your baby seems to be getting worse or hasn't improved significantly after a few days on the antibiotic. He may want to switch the antibiotic or examine your child again.
What can I do to prevent ear infections in the future?
Babies who attend daycare or playgroups with other children are more prone to getting ear infections because they're exposed to more germs. That doesn't mean you should keep your baby home all the time. That's not fun or practical and even if you managed to do it, your baby would still catch an illness here or there. Instead, wash your hands (and your baby's hands) often, and try these prevention ideas.
- Keep your baby up to date on his vaccines. They help prevent certain illnesses that can lead to an ear infection. For example, the Hib vaccine has helped tremendously in reducing the number of ear infections in babies, and the new pneumococcal vaccine can help prevent them as well. If your baby has suffered repreated ear infections, especially after bouts with the flu, you may want to consider an annual flu vaccine, but talk to your doctor first. Only children over 6 months old can get a flu shot.
- Breastfeed your baby for a minimum of six months. A recent study from the Centers for Disease Control and Prevention and the Food and Drug Administration, which appeared in the journal Pediatrics, showed that children who are breastfed for the first six months of life are less likely to develop ear infections. In fact, the risk of ear infections was 70 percent greater in formula-fed babies. Practitioners such as Ruben believe that mothers transfer certain immune-building antibodies to their babies through breast milk. However, those antibodies seem to decrease after the six-month mark.
- Limit your baby's exposure to tabacco smoke. Even a weekend spent in a house with a smoker can significantly harm a baby and increase his chances of getting an ear infection. Tobacco smoke seems to suppress the immune system, making it more difficult for your baby to fight off infection. Actually, a single breath of tobacco smoke can kill the cilia inside your and your baby’s throat. These cilia are important in removing bacteria and viruses from you throat, they further transport mucus and other inhalant from your system. If they are destroyed for several weeks then you can see how it would set up an environment for infection to establish itself. Not to mention the FACT that tobacco smoke in high enough quantities will cause your child to develop asthma.
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My baby gets repeated ear infections. Can ear tubes help?
Babies with multiple ear infections - which, for many children, is actually one ear infection that lingers on for months despite antibiotic treatment - may be good candidates for ear tubes. This procedure, known as tympanostomy, is the most common surgery performed in North America on children under 4, according to a study in the Canadian Medical Association Journal. In the United States alone, ENT specialists, not pediatricians like some believe, perform roughly one million ear-tube insertions each year.
During the procedure, which is done under general anesthesia, an otolaryngologist makes a tiny incision in the child's eardrum and inserts a millimeter-long tube into the slit. These tubes act as a vent, letting air in and fluid out so bacteria can't flourish. "It helps the Eustachian tube work better," says Ruben. Your pediatrician may suggest this surgical solution because a baby with persistent fluid in his ears (or otitis media with effusion) is not only a prime candidate for repeated ear infections but also for hearing loss. Babies who have trouble hearing may suffer delays in language development.
Still, the procedure is considered controversial and there's little consensus among doctors on whether it's really necessary. Studies have shown that some babies who've hand recurrent ear infections are a little behind when it comes to school readiness. But somewhere between ages 2 and 5 the connection between chronic ear infections and decreased school readiness disappears, says Joanne E. Roberts, a senior scientist at the Frank Porter Graham Child Development Center at the University of North Carolina in Chapel Hill. Children with chronic ear infections eventually perform on par with their peers who didn't battle ear troubles in the first few years.
What should you do? Talk to your doctor and weigh the pros and cons for you and your baby. Unfortunately, there's no definitive answer to the ear tube question yet.
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Are ear infections ever serious?
They can be. A severe or untreated infection can rupture your child's eardrum. Ruptures don't happen very often and they generally heal quickly, but it's important to see your child's doctor for a follow-up to make sure that the infection has cleared and that the eardrum is healing well. Repeated ear infections can sometimes lead to hearing loss and scarring. In very rare cases, untreated ear infections can lead to an infection and the skull behind the ear (mastoiditis), or meningits.
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Respiratory Syncytial Virus - RSV:
Is your baby at risk for RSV?
Respiratory syncytial virus (RSV) is a common, easily spread virus that almost all children catch at least once by the time they turn two. It usually causes moderate to severe cold-like symptoms. But for babies born at 35 weeks or less, or born with heart or lung problems, RSV can lead to serious lung infection, hospitalization, breathing problems and, in some cases, death. RSV has also been linked to asthma-like wheezing episodes during childhood.
Watch for these RSV symptoms: If you see any of these common RSV warning signs, call your baby's doctor right away:
-A fever above 100.4°F
-Bluish lips or fingertips
-Coughing
-Wheezing
-Trouble breathing
-Rapid breathing
-Gasping for breath
Learn when RSV season starts in your area
RSV season usually starts in the fall and runs into the spring, but can be different in certain parts of the country. Ask your baby's doctor about RSV season in your area
Talk to your baby's doctor:
Talk to your child's healthcare provider to find out if your child is at risk for severe RSV infection. And if the doctor says your child is at high risk, ask about ways you can help protect your baby from RSV.
Tips to help keep your baby safe: Everyone wants to see your baby. But RSV spreads just like a regular cold, so you have to take extra precautions around family and friends. Here are some ways to give your baby added protection during RSV season. For more information, call 1-866-441-9863 or visit www.aboutRSV.com.
Wash your hands before touching your child, and make sure others wash their hands, too.
Clean your baby's toys, crib tails and any other surfaces he or she might touch.
Avoid exposing your baby to crowds, like at daycare, family gatherings, or public places. Keep your baby away from anyone with a cold or fever.
Don't let anyone smoke near your baby. Tobacco smoke can increase the risk of severe RSV.
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