Ouchy Heads

In the movie Kindergarten Cop, Arnold Schwarzenegger plays a detective who goes undercover as a school teacher. In one scene, as he’s reading a children’s book to his class, he rubs his head and moans. The kids ask what’s wrong, he says he has a headache, and one of the kindergartners helpfully pipes up, “maybe it’s a brain tumor.” Arnold snaps back in his goofy Austrian accent, “it’s not a tumor!”

Children and teens get headaches just like adults. The majority are tension headaches, resulting from stressors like going to bed too late, anxiety from school or family troubles, and not drinking enough fluids. Poor diet habits like skipping meals, not eating enough fruits and vegetables and fiber, contribute as well. Too much screen time with phones and video games certainly doesn’t help. Many kids also get headaches with infections. Strep throat, walking pneumonia, Influenza, colds and sinus infections, stomach viruses all can cause head pain along with their other symptoms. And kids get migraines too. More on that below.

When children complain about headaches, parents of course think the worst. Is this a brain tumor? Meningitis? A bleeding aneurysm? Fortunately, these bad things are rare in kids, and there’s usually clear signs that the headache’s not from more benign causes.

If children have bad pain, moaning and wanting the lights off because it makes the headache worse, or crying with pain, bring them in. Acting tired, sleeping more than usual, is concerning too. Headaches that continue day after day, or are worsening, deserve a doctor visit. Finally, headaches that wake kids at night, are worse in the early morning, or cause vomiting, could be trouble. All these symptoms go with migraine headaches, but if kids don’t already have a migraine diagnosis, they need checking. Probably however, as Arnold said, “it’s not a tumor!”

Like adults, teenagers get migraines. They come in two flavors: kids who are sitting up and smiling; or the obviously miserable ones, lying down, wanting the lights off, mumbling their answers. Another “test” of a teen’s misery: telling them the best way to relieve their pain is with IV medication. Those who say, “A shot? Ooh, no thank you, can I have a pill instead?” aren’t so bad. Those who moan, “Give me anything to stop this pain!” are the real deal.

Migraines are recurrent headaches, more painful than tension headaches, and often have other symptoms like nausea and vomiting. Occasionally they have weird alterations of sound and color perception or stroke-like signs like numbness, difficulty speaking, and paralysis.

Like we mentioned above, parents worry about brain tumors or strokes when kids get migraines. If their child has vomiting or weirder signs, this fear is understandable. If it’s the first time for those symptoms, get them seen. Migraines are usually diagnosed with just a history and thorough neurologic exam, but sometimes CT or MRI scans reassure everyone that it’s not something worse.

As migraine sufferers discover, lying down and napping in a dark room often makes them go away. Ibuprofen or Tylenol also help, especially if taken right away. Waiting to take medication may give the headache time to “lock in” and be more difficult to alleviate. If the migraine is terrible like with our miserable teen above, we use IV medications. For chronic migraines, we prescribe medication like triptans if OTC meds don’t work.

Finally, neurologists talk about “migraine hygiene,” using lifestyle changes to prevent migraines. These include eating three healthy meals daily, getting enough sleep, avoiding caffeine, and learning to manage stress. Good luck with teens on those things, except with kids who’ll do “anything” to stop the pain!

 

Down The Hatch

This week’s guest columnist is Dr. Tasia Bradley, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Remember “Show and Tell” from grade school? In fourth grade, I had a classmate bring in his pet soft-shell turtle, named Eric. He took Eric out of his aquarium to crawl on the table. Then he flipped Eric on his back. That seemed mean, but then we learned that soft-shell turtles can stretch their neck out far enough to push on the ground and flip themselves over. Flip!- back went Eric onto his feet. Another thing we learned about turtles, Eric’s owner in particular, is that they carry a bacteria called Salmonella.

Salmonella contaminates many foods, like eggs and raw chicken; besides pets like turtles and snakes. Salmonella causes gastroenteritis, a.k.a. “stomach bug,” with vomiting and diarrhea. Usually the symptoms only last a few days, but diarrhea from salmonella can sometimes go for 10 days. Though it’s a bacteria, antibiotics are seldom necessary- it’s usually gone before you can get a prescription filled, much less by the time tests on your kid’s poop come back to show it’s salmonella.

Though salmonella is a risk when chicken or eggs are under-cooked, children can get it from mud puddles, petting zoos, and show-and-tells like above. Kids touch contaminated raw egg, unwashed cutting boards, mud puddles, or turtles; a little while later put their fingers in their mouths, and bingo!  8 to 72 hours later, they’re running for the toilet.

We haven’t seen salmonella for the past year or so, given our COVID precautions. Kids have had cleaner hands and mask-covered mouths to prevent picking up and transmitting salmonella. However, now that we’re all relaxing some, we’re bound to start seeing it again. Make sure your kids are still practicing good hand hygiene, especially if they encounter Eric the Turtle!

Did this 8 year-old have leprosy?  The school sure acted like it! Mom thought her 6 year-old boy just had a runny, crusty nose from a cold virus.  But when the crust involved his upper lip, chin, and cheeks, mom got a stern call about sending her son to school like that. To hear them tell it, he should have acted like a biblical leper, wearing torn clothes and shouting “unclean” to other passersby on the road to Jerusalem.

But the boy did have more than just a runny nose. The lesions on his face were red, with a honey-colored crust on them. Diagnosis: Impetigo, a.k.a  Indian Fire. Impetigo is a bacterial skin infection. If a child’s face gets the bacteria on it and the skin has a break in it, like with a scratch or mosquito bite, the bacteria invades the defect and spreads.

Like with salmonella above, kids catch impetigo by putting contaminated hands on their faces and in their mouths and noses. While they pick up salmonella from turtles and raw eggs and chicken, they pick up impetigo bacteria from other kids. The school therefore wasn’t entirely wrong to suggest mom get the kid seen- impetigo just isn’t a community-threatening scourge like ancient leprosy.

Treatment is easy: we prescribe an antibiotic cream which kills the bacteria and keeps children from spreading it to other parts of their bodies, or to other kids. Prevention is even easier- make sure kids wash their hands or use hand sanitizer frequently, and not touch each other (good luck on that one!). As you might guess, we’ve seen about zero impetigo during COVID, but as everyone is now relaxing their hand hygiene, we’re seeing it again. Unclean!

 

My Heart Hurts!

Last week I saw yet another teenager with chest pain. He’d been lifting weights, and now his chest hurt, particularly when he moved his arms. Diagnosis: costochondritis, a common condition in kids where the ligaments of their ribcages get sore with strains like breathing hard, coughing, or weight-lifting. The only “red flag” with this teen was he also had pain while playing basketball; chest pain during exercise could mean trouble. Again, it was probably because he was breathing hard while playing, but I called the pediatric cardiologist to be safe. Fortunately, he had an opening that afternoon; talk about service!

The cardiologist called me later that evening: “Scott, that boy certainly has costochondritis, but my echocardiogram also showed an anomalous right coronary artery.” Holy cats!  For once a kid actually had chest pain from a heart problem! This rare condition, if not treated, can cause heart pain and even heart attacks.

We see kids in the Pediatric ER several times per week with chest pain. The majority of these kids have costochondritis. It’s easy to diagnose- press where their chest is sore, and they wince and go “ow” as you squeeze on the inflamed ribcage. While some children get costochondritis with chest wall exertion, others can get it out of the blue. The kid could be sitting watching TV, and suddenly get a sharp pain around her breast bone.

While this condition is benign, when parents hear “chest pain,” they sometimes freak out. After all, adults have been told that if they have chest pain, get seen right away- it could be a heart attack. Sometimes children will even say “my heart hurts,” because they know their heart’s in there and that’s the word they have. Saying that really gets parents’ attention!  Fortunately, less than 1% of kids with chest pain have an actual heart problem like my teenage patient.

In 1999 I had another patient with chest pain that was actually heart trouble. This 9 year-old girl had been born with a heart defect, had had one corrective surgery, and needed another. Before that second operation, however, the family inexplicably stopped going to the cardiologist. Years later, she showed up in my ER with chest pain. The pain was gone by the time I saw her and she looked fine, but cardiology decided to admit her to the hospital to check out her partially-fixed heart.

Time passed while the girl waited for her bed upstairs. Then her mom poked her head out of the room and said, “something’s wrong.” I went in to find the girl unconscious and grey, in full cardiac arrest! We started CPR, slapped on the monitor leads, and saw a lethal cardiac rhythm on the screen called ventricular fibrillation. The fix: shock with the defibrillator paddles, like on TV. One zap and her heart rhythm normalized. Later the cardiologists found that her heart was beyond surgical repair, too scarred from years of neglect and abnormal function. Instead, she went home with an implanted defibrillator.

Like we said above, most pediatric chest pain is benign. Usually in kids it’s ribcage soreness, called costochondritis. Occasionally it can be a lung problem, like asthma or pneumonia. Sometimes it’s esophagus irritation, a.k.a. “heart burn.” Only about 1% of pediatric chest pain is cardiac. Kids’ hearts are one of their healthiest organs, young and ready for a lifetime of work. Only when hearts get really old, like in the elderly, do they begin to exceed their warranty and break down.

Red flags in pediatric chest pain: pain during exercise, like with our teen boy from above, can occasionally mean heart trouble. Those kids need to see cardiology. But if chest walls hurt when you press on them, rest assured: it’s not a heart attack!

Hogwarts?

This week’s guest columnist is Dr. Shalini Choudhary, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Growing up I attended an English-style boarding school in India, like Hogwarts in Harry Potter, but without the magic. Except for a rumor that the eerie, abandoned church on the grounds was haunted. Then one day I came upon our dorm’s Head Girl lying on the floor, eyes closed, rolling side-to-side, screaming, “I’m back!” As the school nurse held her tight, my friends and I were petrified: was she possessed? Those episodes became more frequent and longer lasting, and students whispered among themselves that feeding the invasive spirit would keep it happy. We all began dropping our ration of cookies, cakes, and candies in the Head Girl’s locker to be safe.

Now in 2021, a 14 year-old girl came to the Pediatric Emergency Department with apparent seizures. She had recently been diagnosed with Multiple Sclerosis, a neurological disease with recurrent stroke-like and seizure-like symptoms. Soon after she arrived she began convulsing again, closing her eyes and throwing her head back and forth, much like my Head Girl from years ago. But now to my trained eye these didn’t look like seizures, they looked like “pseudo-seizures.”

Psychogenic Non-Epileptic Seizures (PNES) are seizure-like episodes that aren’t actually seizures. In real seizures, the brain’s normal electrical activity goes haywire, neurons mis-fire at random and the patient falls unconscious and twitches. After a few minutes the seizures stop, and the patient is sleepy for a half-hour or so while the brain recovers. PNES episodes have shaking that is “manufactured” by conscious brain activity, and the patient acts normally immediately after. Sometimes the child is purposefully acting out for some gain, like extra attention or extra goodies from her terrified dormitory underclass!. Other times the child subconsciously believes they’re seizing, and it’s a psychiatric issue.

Back to the Head Girl from my youth in India, where I attended a Hogwarts-style boarding school. She was a bully, taking out whatever frustrations she had on us underclass girls that she was supposed to care for. When she began having seizure-like episodes, we believed she was possessed by the soul of one of her friends who had died in an accident. While she already occasionally stole our cookies and candies, when she began having apparent seizures, we voluntarily put offerings of sweets in her locker to appease her friend’s spirit. As the episodes increased, the Head Girl’s cake and candy yield increased as well.

As we discussed above, PNES, or “pseudo-seizures,” describes episodes where a child appears to be seizing, but is actually making seizure-like movements for non-neurological reasons. In other words, they seem to be “faking” seizures. Sometimes it’s for obvious secondary gain, like getting attention and sympathy from parents, teachers, and school mates, or getting more sweets!  Sometimes though, PNES is a sign of psychiatric trouble. These kids often have depression, anxiety, and Post-Traumatic Stress Disorder. They don’t need anti-seizure medication, they need therapy and sometimes anti-depressants.

The 14 year-old girl with newly diagnosed Multiple Sclerosis certainly had reason to be depressed. MS is a life-long, debilitating disease with stroke-like symptoms that come and go. She was having pseudo-seizures apparently as a stress-reaction to this new terrible diagnosis. After her pseudo-seizure we witnessed, she opened up to me about how miserable she was. We discontinued her anti-seizure medication that had been started, and she was discharged with advice to start counseling and see a psychiatrist.

Many PNES cases have happy endings. The Head Girl from my youth got over the trauma of losing her friend, stopped her convulsions, and after a social media search I discovered is now a psychiatrist herself!

Lassie, Get Help!

In January 2019, 911 dispatcher Antonia Bundy answered a call from a 9 year-old boy.  He said “Hi, um, I had a really bad day….,” told her he had a “ton” of homework, and was stumped by a math problem involving fractions. Instead of giving him a grumpy lecture on proper use of 911, she helped him solve the problem. The boy thanked her, and when the news story came out, Ms. Bundy’s police chief lauded her for her kindly service helping the boy with his homework. Of course, the chief recommended against this use of 911 by anyone in the future.

Last month the journal Pediatrics published a study titled “Children’s Ability to Call 911 in an Emergency: A Simulation Study.” Emergency dispatch has come a long way from the days when Timmy would send his dog Lassie for help when trapped in the old abandoned mine. As emergency calls have increased over the past 50 years, the 911 system was developed to enhance efficiency and ease getting assistance in a crisis. The question in this study: can kids Timmy’s age use it properly?

The researchers started by enumerating the necessary steps. First, can children recognize an emergency is happening? Then can they find a cellphone, bypass the password, dial 9-1-1, and answer the dispatcher in a meaningful way? They videoed simulations where an actor pretended to choke and collapse unconscious on the floor. With the video running, the scientists checked off each step the study child got right.

As you might expect, younger children had more difficulty. Kindergartners and first-graders were pretty bad at it; second and third graders a little better. The main problem for littler kids was recognizing that an emergency was happening; even though before the simulation began, the child was told there would be a pretend emergency for them to respond to, and s/he agreeing to participate.

This study raises many questions about how kids might learn emergency response. For example, many schools teach kids how to use 911, but demonstrate with land-lines, which fewer households have now. And how do you use a cellphone if you don’t know the password?

When I was 7 years-old, I had my first emergency. I came home from school to find smoke coming from our windows. I went inside into the kitchen, coughing and calling for mom. I found chicken burning in a pan, shut the stove off, and went back out. Mom arrived soon after, having gone on an errand and forgotten about the chicken. I was a hero for saving the house. Any wonder I’d grow up to be an emergency guy for a living?

Of course, I shouldn’t have gone into a house with smoke pouring out- I could have been overcome by fumes and suffocated. Maybe I should have called 911, but the service wasn’t invented yet. With no cellphones either, I’d need to go a neighbor’s to call the fire department. In the study discussed above, “Children’s Ability to Call 911,”  pretend emergencies were used to see if kids could use a cellphone to call 911 and report it successfully to a dispatcher.

In the study, kids were videotaped in simulations where actors pretended to choke and collapse. They had to find the cellphone, bypass the password prompt, dial 9-1-1, and answer the dispatcher in a helpful way. Less than half the 7-and-under kids even recognized an emergency was happening. As for finding the cellphone, the researchers cheated: they had the actor first pretend to be on a call, then put the cellphone down in view of the child. A more realistic test would have had the phone somewhere else. After all, how many times per day do you misplace your phone? Try finding it when someone’s choking to death!

While schools often teach kids how to call for help, it’s usually lecturing and demonstrations with land-line phones. When’s the last time kids used one of those? Thus schools and parents need to better drill kids how to respond to an emergency, particularly if they stay with grandparents, who might actually keel over sometime with only the child to help. They should see demonstrations of what ailing adults look like, be taught how to find the tiny “Emergency Call” button on the password screen, practice dialing 9-1-1, and rehearse what to say to the dispatcher. Just in case it’s their turn to be a hero.

Poisoned by Grandma?

This week’s guest columnists are Drs. Chris Johnson and Traci Bourgeois, Family Practice residents at the University Hospital and Clinics here in Lafayette.

When I was three, a fun trip to my grandma’s became a trip to the Emergency Department. I found insecticide spray in her kitchen, tasted it, and brought it to mom saying it was yuck. The active ingredient was probably allethrin, a compound synthesized from crysanthemums.  Sounds all-natural, right? Except when it causes vomiting, muscle spasms, coma, and even death. In the ER they “pumped my stomach,” which means putting a tube down my throat and flushing saline solution in and out. I remember screaming for my mom (back then parents were kicked out of the room for such unpleasant procedures). To this day I get panicky when laying down for medical stuff. Worse, we always got gumbo at grandma’s, and I missed lunch!

While most parents are strict about home safety, this doesn’t always go for other places  a child might visit, like grandparents’, babysitters’, or in-home daycares. Even our own homes that we think are safe may not be with exploring, clever toddlers. Kids have been home more during the Pandemic, and if parents are working at home, they’re often concentrating on work, not the children. Poison Control Center calls jumped up 18% in March 2020.

While most parents keep cleaners locked up, some haven’t thought that hand sanitizer was a hazard, and we’ve all been using tons of that. Cleaner poisonings rose 35% from March to May 2020, and ingestions of surface disinfectants and hand-sanitizers rose 108%!  Toddlers eating sanitizer may sound like an innocent taste test, but they often contain 70% alcohol or more. That’s equal to the strongest liquors, like grain alcohol, that occasionally kill unfortunate fraternity pledges.

The lessons are clear: lock away all toxins, including medications, hand cleansers, and other chemicals so that even the smartest toddler can’t pry in. Crawl around your house on hands and knees, pulling on every door and cabinet, pushing every chair and step-stool to a counter or bathroom cabinet. If you can get at these hazards with reasonable ease, so can they!

Some toddlers just aren’t good about taking medicine. Unlike Dr. Bourgeois’s story above where she drank Grandma’s insecticide, some kids spits out medicines, hosing down mom with ibuprofen or amoxicillin. Sometimes to entice the child to take it, parents will say the medicine’s candy or juice.  After all, these are sweet things all kids like to eat, so why not try to fool them?  Which makes us wonder- what toddler gets candy? What kind of lousy diet are these kids on, that they know what candy is?

Besides being unnecessary for kids, invoking candy as an incentive can lead to anything colorful being regarded as candy or juice.  Including that poison under Grandma’s kitchen sink. Furthermore, toddlers usually can taste the difference between juice, candy, and medication.  Parents still end up wearing the Tylenol.

How do we get resistant children to take medicine? Drug companies and pharmacies make pediatric stuff taste as good as possible, but that’s a two-edged sword. The better it tastes, the more likely children will want to drink it when they’re not supposed to, leading to overdoses or kids taking other’s medication. Some medicines come as suppositories to put in the butt. They’re absorbed by the intestines, just like swallowed medicines, and they’re harder to spit out! Ultimately, medication can be injected, though you need to go to the pharmacy, doctor’s office, or hospital for those.

If your child takes something they shouldn’t, don’t panic.  First, call Poison Control at 1-800-222-1222. They’re easier to get on the phone than your doctor, and can tell you if what the kid took is dangerous. They’ll tell you if you should call the ambulance, drive to the hospital yourself, or stay at home and not worry. Things like baby shampoo or most antibiotics, no sweat. Grandma’s insecticide- come in!

Prevention is the best medicine. Like we advised above, toddler-proof your house. This goes for parents, grandparents, babysitters, in-home daycares, anywhere that’ll host mobile children. They’ll slip out of sight and into stuff quicker than you think, even if it’s just an afternoon visit. Get on your hands and knees and explore the potential hazards before they do.

He Who Hesitates…

With the Pandemic, no one’s wanted to be in tight spaces with others who might be shedding deadly Coronavirus. California’s Disneyland has been closed because of that concern. Being squeezed into lines and rooms at Disney is unavoidable, to get as many people through the rides as possible- after, all everyone wants their turn to be immersed in the magic. But in 2015, some Disneyland visitors were unlucky enough to also be immersed in measles.

That year an unvaccinated 11 year-old visited the park. The child was infected with measles, not symptomatic yet, but already shedding virus. 110 people caught the virus, most of whom were unvaccinated. 20% had to be hospitalized; luckily, no one died. Like COVID, measles is highly contagious. When an infected child coughs, virus-laden droplets can hang in the air for 2 hours, waiting to be inhaled by others. That makes for lots of exposed people if that cough is in the elevator in the Haunted Mansion- how many people shuffle through that ride in two hours!?

Vaccine hesitancy has been growing in the past twenty years, and is now an issue again with the COVID vaccine roll-out. Parents want their kids to be as safe as possible, and some are confused by competing voices in the media and online about vaccine safety. Medical experts know vaccines are safe and important to prevent deadly infections. However, their voices are sometimes drowned out by anti-vaccine folks who frankly don’t know what they’re talking about.

Vaccines have been around for centuries. Smallpox inoculation began in the 1700s, and has saved millions of lives since. Most vaccines kids get these days have been around for 50 years or more. We have lifetimes of experience with these medicines to know they’re safe.  They’re also the most administered medicines- the vast majority of kids get them. Thus we have plentiful opportunities to detect side-effects.  Finally, vaccines are some of the most studied medicines. Anti-vaccine hysteria has driven some of this research, and any serious worries about safety have been thoroughly investigated. Mission accomplished: vaccines are some of the safest medicines available.  Oh, did I mention they save children’s lives too?

My friend Brent has a sheep farm in Georgia. The farmers around him are mostly older, taciturn types.  Brent got his first COVID vaccination, and tried to talk his colleagues into doing likewise, but they’ve decided to wait and see. To goad one farmer into getting his shot, Brent offered, “How about, if I feel fine after my second shot, you get yours?  Deal?” The farmer replied, “Well, let us know how it goes.”  Note the non-committal response- talk about giving nothing away!

As we mentioned above, small pox inoculation is centuries-old, and we’ve had modern vaccinations for over 50 years. Vaccine hesitancy is that old too. In the 1800s, governments mandating smallpox inoculation met with popular resistance. After all, inoculation meant taking fluid from a cow’s pox blister and scraping it into the skin of a child- doesn’t sound very clean or safe, does it?  The Leicester (England) Demonstration March of 1885 had over 80,000 participants, opposing forced vaccination.

Fast forward to 1998, Dr. Andrew Wakefield published a study that supposedly linked the Measles/Mumps/Rubella (MMR) vaccine to autism in children. Despite the revelation that Wakefield falsified his data and lost is medical license for other ethics violations, the anti-vaccination movement was off and running. Besides bad data interpretation, vaccine hesitancy is also fueled by complacency. In the 1950s when polio was epidemic, killing and crippling thousands of children yearly, people clamored for a vaccine. Now vaccines have been victims of their own success: few parents experience the horror of children dying from vaccine-preventable diseases, and wonder why all these shots matter.

Conspiracy theories have also eroded confidence in experts and vaccination.  Conspiracies are inherently attractive to human thinking (they’re so exciting to contemplate, like UFOs!), and have been grafted onto vaccines. From microchips and DNA manipulation in Coronavirus shots, to good-old-fashioned drug company corruption, conspiracy theories make saving kids from vaccine preventable disease harder.

Rest assured, vaccine makers aren’t dastardly villains poisoning kids for fun and profit. They’re nerds and careerists who live for good data and publishing well-researched papers. They’re nice folks doing good science to save kid’s lives. What more could a parent want for their child?

COVID and Kids

This week’s guest columnist is Dr. Mai Vu, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

A 16 year-old boy came in with three days of fever, vomiting, and diarrhea. He didn’t have anything left to throw up- he could only dry heave; but he still managed six bouts of diarrhea that morning. His blood pressure was down and he looked beat. You’d think he had dehydration with a bad bout of stomach virus, except his eyeballs were red? Could this be COVID?

After his first liter of IV fluid, he perked up.  He sat up, smiled, and even his lips were less cracked. An hour later he was back down, pale, tired, with borderline blood pressure. Despite receiving two more liters, he quit rallying. While his COVID PCR came back negative, his antibody test was positive. This means he wasn’t shedding Coronavirus now, but had antibodies to previous infection. Mom confirmed that after Christmas he was with cousins who tested positive. He hadn’t had symptoms like fever back then, but many kids don’t with their initial infection. He was our first case of Multisystem Inflammatory Syndrome in Children (MIS-C).

MIS-C is a rare complication of Coronavirus. Many elderly and sickly adults get rampant inflammation from their infections- in their lungs, hearts, kidneys, and just about any other organ. They have respiratory failure, heart attacks, and spend weeks in ICU. Kids don’t have these problems, except a rare few like our boy. Something about COVID irritates the immune system after the main infection, and while you’ve recovered from the initial bout, your immunity goes haywire against your own body.

Besides his eyeballs, our patient had heart inflammation, called myocarditis, which  affected it’s ability to pump blood.  Hence his low blood pressure. It also attacked his GI system, causing all that vomiting and diarrhea. MIS-C is diagnosed when the child has fever, looks really sick, and inflammation in two or more organ systems; our patient’s inflammation blood tests were sky high. He spent 3 days in the ICU for blood pressure support, immunoglobin therapy, steroids, and more fluids, and eventually got better.

A 14 year-old female came in last week after feeling tired for 2 days. She had fever, headache, and cough. Though she denied sick contacts, she had been in school and out shopping. She had also attended a family reunion. Given all those exposures, we weren’t surprised when her COVID test came back positive. Dad wasn’t happy she caught Coronavirus, but since he had also attended the reunion, he had no moral high ground to stand on!

Though few kids get severe disease like our 16 year-old boy from above, they can still get sick and pass the virus to others, including older loved ones. As of February, the CDC reported only 204 deaths in ages 0-17 years. Those above 50 years-old make up 95% of deaths. COVID is now the leading cause of death in the US; heart disease second, cancer third.

Other bad things about Coronavirus: our 16 year-old from above had myocarditis. A competitive athlete, his weakened heart put him out of sports for at least 6 months. Though he was likely to regain his strength, that wasn’t guaranteed. Also, kids with “regular” COVID like our 14 year-old are out of school and sports for two weeks. Those restrictions were terribly disheartening for our two patients.

A second problem is delayed procedures for positive patients. This affects adults who need diagnostic and therapeutic interventions for heart disease and cancer. It also impacted a teenager with lymphoma- he had swollen lymph glands, night sweats, and terrible pain. He needed chemotherapy to shrink his cancer and relieve the pain.  However, he couldn’t start chemo without a biopsy to identify the cancer and choose the best regimen. And he couldn’t have the biopsy because he was COVID positive, and anesthesia would expose the OR team to his virus. He was finally admitted to the hospital when his pain couldn’t be controlled at home, and eventually got his biopsy.

Though states, parishes, and towns are easing restrictions, don’t you and your family!  Continue mask-wearing and distancing, particularly with the advent of more highly contagious variants. No teens going on spring break! The end of the Pandemic is near, if we can all hang in there a little longer.

Who’s Medication?

This 16 year-old boy hurt his knee playing basketball, banging it into another player’s knee. He was brought in limping by his mom. “Did you give him anything for pain?” I asked. “I gave him one of my prescription ibuprofens,” mom replied. I gave a little jerk inside: you did WHAT?  But I checked myself from berating her, because mom actually did right- ibuprofen is safe, good for her son’s injury pain, and he was big enough to tolerate that dose. She chose right, but I had instinctual alarm because some parents don’t.

Parents give their kids all kinds of medications- old prescriptions, over-the-counter (OTC) meds, herbal supplements. Using someone else’s prescription is fraught with danger. Those medications are available only by prescription for a reason; their misuse can harm. OTC medicines are typically safer; thus the FDA allows people to buy them without a doctor’s okay. But sometimes they can be dangerous if used improperly.

Among the safest, most effective, and most under-used medications are OTC fever and pain relievers. It’s hard to hurt kids with Ibuprofen and acetaminophen (Tylenol), and they work great. However, some parents are afraid to use them, or give enough. I’ll ask “how much Tylenol did you give?” Mom will indicate a tiny portion of the dropper, and I’ll say “no wonder her fever didn’t break, she didn’t get near enough!” Mom’ll look sheepish and say she was afraid to overdose her child. We laugh, and then have a conversation about effective dosing.

Sometimes parents worry these’ll make their child too sleepy, as if they’re narcotics. However, no one’s ever seen drug dealers pushing ibuprofen or Tylenol: “Psst, over here! This’ll get you high!”  Some kids do sleep after these medications, but not because of narcosis. It’s because their pain or fever’s relieved, and they can finally rest!

Other safe OTC medications include Peptobismol and Imodium for diarrhea, and laxatives for constipation. Except when parents give laxatives when they think their kid’s cramps are from constipation. If they’re actually from a stomach virus, the ensuing diarrhea from the virus plus the laxative is really bad!

Even doctors make mistakes with medications and their kids. During my residency, one of the pediatric oncologists rushed his toddler into the Emergency Department. He’d  been brushing his teeth at the bathroom sink, and looked down to see his boy sucking on a bottle of Visine eye drops. The doctor’s eyes bugged out, and he scooped up the toddler and zipped in. After several days in the Pediatric Intensive Care Unit, the boy’s heart rhythm quit hiccuping in scary ways, and he went home. I remember thinking: why did he buy Visine in the first place?  It’s not even good for eyes, much less exploring children.

Above we discussed safe and helpful over-the-counter (OTC) medications. Conversely, most OTC cold medicines are bad for children: they don’t work, and they’re not safe. They’re not deathly harmful, or the FDA wouldn’t allow their sale. They also get a pass from the FDA because they’ve been around for decades. But they’re not good: they can  make kids jittery and irritable. One time I gave a kid a prescription version of a cold medicine, the mom was so desperate for relief. The next time I saw her in the Emergency Department, she had dagger-eyes for me. I asked, what’s wrong?  She told me after giving her child that medicine, he screamed all night. That’s why we don’t  prescribe cold medicines. And they don’t relieve coughs and runny noses either.

Asprin is another OTC medicine kids shouldn’t get. In the 1970s they found that children who got Influenza or Chicken Pox viruses, and aspirin for their fevers, had liver damage. Thus for your child’s fever and pain, Tylenol and ibuprofen only. Beware, aspirin comes in forms you may not recognize as aspirin, like BC Powder or Goody”s.

Above we also mentioned not using old prescriptions. They’re available only by prescription for a reason- their potential harm. Certainly don’t give your kids old narcotics. If you get the dose wrong, they could stop breathing. Never give children old antibiotics either, since each antibiotic has a specific use and probably won’t work for this new illness.  Also, they have side effects like allergic reactions or yeast infections. Leave the prescribing to us!

Teen Depression in the Pandemic

This week’s guest columnist is Dr. Stephanie Barrow, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

A 16 year-old girl saw me in clinic after she’d told mom she was feeling down. Prior to the Pandemic, she’d been a spirited teenager, involved in student council, the Welcoming Committee, and intramural sports. After school closed last spring, she went from being busy every day to having nothing to do for months. She started isolating in her room, sleeping more, eating less, and becoming irritable with family.

Since the beginning of COVID, we’ve seen an uptick of patients with depression. Some  are having symptoms for the first time in their lives. Scariest of all, in the past month we’ve had an epidemic of adolescent overdoses. Every day at least one teen’s come to the Emergency Department having taken whole bottles of their medication, or someone else’s. One girl took fistfuls of several of her grandmother’s medications, any one of which could have been lethal.

My 16 year-old patient had a more common presentation of depression. Her world was turned upside down, like everyone’s this past year. Stuck at home with only social media and family, she felt trapped in four walls, and trapped in her own mind. She went from wanting to be with everyone and involved in everything, to closing herself in her room and even minimizing social media interactions with friends.

When we see kids like this in clinic or the ER, one first thing we do is check for metabolic causes for depression, like thyroid disease or drug use. We also ask questions to assess the symptoms and severity. His he feeling like a failure?  Has he lost interest in favorite activities? Trouble concentrating or sleeping? Appetite changes?  Moving more slowly? Even more worrisome: has he had suicidal thoughts or worse, attempted suicide in the past and not told anyone?

We set my patient up with a counselor and started an anti-depressant. She slowly improved with video counseling and the medicine, and mom saw a positive change. She began to feel like she had her daughter back.

Once my 16 year-old patient was doing better, mom brought in her 13 year-old brother. He was always an introvert, keeping to himself and never having many friends. However, recently he began sleeping poorly and barely eating. In clinic, he stated that he felt like nothing he could do was good enough. During my interview, he was slow to answer questions, mumbled, and wouldn’t make eye contact.

We knew his sister had depression, and counseling and medication had worked for her, so we tried that with him. Just one month later when he returned for a check-up, I could tell he was a new boy the moment he walked in. He looked all around and asked a million questions, and when he sat down he didn’t slump like a sack of potatoes; he sat straight up, looked me in the eye, and smiled! His sister was excited too, because earlier that week he spontaneously hugged her, which he hadn’t done for over a year.

Both my patients are so far having happy endings to their depression. Unfortunately, not all kids have that. As we mentioned above, we’ve seen a spate of suicide attempts by overdose recently. While some of those teens have had life-long depression and even admissions to psychiatric facilities, we’re seeing more and more with no previous histories.

It’s sometimes difficult to know what’s on a child’s mind. Knowing was less of an issue when they were going to school five days per week, interacting with teachers and schoolmates, and busy with school work and extracurriculars. And early in the Pandemic children could coast along with electronic interactions. As things linger though, they’re getting just as fed up with it as adults are. Many are also dealing with illness and death in loved ones and friends.

If you’re suspecting a child’s depressed, seek help immediately. Your kid’s doctor, your priest or pastor, the school, or counseling centers have resources to help. At home, restrict access to medications, lock away guns or keep them out of the house, monitor your kid’s on-line activities, and just talk to them about depression. Depression, and the Pandemic, aren’t quite going away just yet.