Itchy And Scratchy

This week’s guest columnists are Drs. James Hyatt and Amir Farizani, Family Practice residents at the University Hospital and Clinics here in Lafayette.

Friday night in the Pediatric Emergency Department, a 16 year-old checks in with mom.  While mom looks concerned the boy, wearing headphones, is obviously annoyed to be here.  Not his first choice for a Friday night destination!  They tell me he was on the porch swing last night with his girlfriend when itchy bumps appeared on the back of his neck and arms.  He wasn’t concerned, but when his mom noticed them tonight she hustled him into the car to come in.

After examining him, I realized that though the boy only had mosquito bites, mom had worse worries.  Was this a severe allergic reaction?  Would he start wheezing, his throat close up, and could he die?  After reassuring her this wasn’t anaphylaxis (“I told you it was just mosquitoes!” huffs the boy), they head home.

Child and adolescent rashes make up 12 million office visits per year.  The vast majority are annoying but benign: insect bites, eczema flares, poison ivy, viruses, or hives.  So when do you worry?  First, it’s rare for something to be bad without other signs and symptoms.  If your child has a rash without fever, fatigue, shortness of breath, or vomiting, these rashes aren’t emergencies.  If your child does have a fever accompanying the rash, that’s a little more concerning, but even most of these are okay.

What many parents worry about is anaphylaxis.  This is a life-threatening allergic reaction caused by whole-body sensitivity to an allergen.  Allergens are small molecules in the environment- pollen, ant venom, poison ivy- that trigger our immune system.  Usually the reaction is localized to one organ, like the skin (making hives) or the nose (making it itchy and runny).  When an allergen irritates more vital organs- airways, lungs, or the cardiovascular system, that’s anapylaxis.

Fortunately (as far as diagnosis), anaphylaxis is easy to spot.  There’s immediate lip and eyelid swelling, watering eyes, shortness of breath, wheezing, drooling, and fatigue. Time to call 911.

Like our boy above, it seems most benign rashes come in at the most unlikely time- weekend nights.  This next girl, 8 years-old, came in Sunday night after a weekend at the beach.  When she was in the bath, mom saw a strangely shaped rash on her arm.  It looked so freaky that mom snatched her out of the tub, threw on some clothes and came in.

The rash sure was odd, with paisley shapes and curly-cue streaks, like someone had  splashed liquid sunburn on her.  One question solved the mystery: were there limes at the beach?  “Why yes,” replied mom, “we were having margaritas, and she had a non-alcoholic one.”  In fact, she squeezed her own limes.

DIagnosis: Phytophotodermatitis.  Cuter names for this are Margarita Burn, or Lime Disease (instead of tick-borne Lyme Disease, get it?).  When certain plant substances drop on your skin, like lime juice, and are then in sunlight, they cause irritation.  Skin turns red, burns, and can even blister.  After the initial inflammation, the rash becomes hyperpigmented, like a tan, and can last for weeks.  Besides lime, many other plants can cause this reaction, merely by brushing their leaves.  Wild parslies, mulberry bushes, and hogweeds are some of the culprits, and the sun-activated streaks they leave on skin are often mistaken for poison ivy.

Like we mentioned above, many parents lose nights of sleep thinking about worst-case scenarios.  It’s only natural to worry about kids, but late-night internet searches don’t help.  Most helpful for parents is knowledge about common rashes, and what are the “red flag” symptoms.

Most pediatric rashes are caused by benign infections like viruses, and minor allergic reactions like hives, eczema, and heat rash.  While these rashes can cover the whole body and look freaky, if your child is otherwise acting well, he is well.  For example, two  common viral rashes are Roseola and Hand-Foot-Mouth disease.  While covered with spots, most of these kids are smiling, drinking, and calm.  They might have fever initially, but they’re not showing bad signs.

Bad signs are shortness of breath, worsening fatigue, pain, headache, and vomiting.  Rashes accompanied by these need to be seen.  But if your child is otherwise well, don’t panic over funky rashes!  Instead ask, Where were the limes?    

Camp Mt. Allamuchy

One of my favorite summer camps as a kid was violin camp.  My teacher had a bunch of us work on Corelli concertos every day for two weeks, with a concert for our parents at the end.  Corelli’s music is complex and entertaining, yet reasonably easy to play for school kids. I enjoyed it, but my best friend from that camp, Jonathan Dinklage, had such a ball that he wanted to jam even during breaks, grinning away with his violin tucked under his chin.  Something apparently clicked, and Jonathan went on to play professionally in hit Broadway plays, with rock bands, and his own groups. Jonathan’s even more famous brother Peter, (star of Game of Thrones), was probably doing theater camp in another part of the building.

While I still languish at the back of the ULL symphony viola section (my career aspirations lay elsewhere), summer camps and activities are important for child development and health.  Not every kid will find his life’s passion like Jonathan, but they can still have fun and make summer time fly by.

Leave kids alone and bored long enough, and of course they’ll gravitate to video games.  A summer of sitting at consoles, with no school schedule or work to distract them, does these kids a world of hurt.  They don’t get up and move around, causing soreness, poor muscle tone, and constipation and ensuing abdominal pain.  They don’t interact with their peers face-to-face, leading to isolation, loneliness, and depression.  They can develop addictive behavior, wherein they’ll scream, get aggressive, and lie to avoid being torn away from their electronic cocaine.

Get to work on that summer schedule now!  A great place to find opportunities is the 2019 Ultimate Guide to Summer Camps In and Around Lafayette.  This website has listings for regular day camps, and camps for music, cooking, swimming, theater, science, karate, dancing, cheering, painting, sewing, and soccer.  The University of Louisiana at Lafayette Programs for Children and Families has academic options in science and engineering.  The ULL sports programs have camps for kids too. Individual businesses, like sewing schools and swimming pools, also have their own summer programs.

As a teenager my wife worked at a summer camp in North Carolina. It was frequented by kids of wealthy New Yorkers, and many moms decked out in high heels and designer sun glasses whined about about how they couldn’t take their little darlings anymore after the long school year. Then they breathed perfumed sighs of relief, depositing their kids for the whole summer and heading to Europe.

While most of us can’t afford that kind of summer, there’s plenty of local sleep-away camps that fit most budgets.  While parents like a week away from their children, it’s the kids who really benefit. They get to try out a slice of life away from home, have some freedom, get outdoor exercise, and make new friends. 

As we mentioned above, spending summers home playing video games isn’t a healthy option.  Those kids get weak, develop back aches, and have abdominal pain from slouching around and getting constipated.  They complain of headaches from staring at screens all day (and night).  They can develop addictive symptoms, screaming and lying when parents try to limit their gaming. These are preventable ailments, easily avoided by real-world physical and intellectual activity.

My favorite summer camp was Boy Scout camp (Mt. Allamuchy).  During my first year at camp, at age 11, I was wracked with homesickness, but every year after I had a blast.  I learned to cook, canoe, lifeguard, sail, build a tower out of tree limbs, and hung out with my friends around campfires.  Overcoming homesickness was a growth experience, and I only half-joke that my leadership skills were learned with the mistakes made as a patrol leader.

Another good option is Camp Hardtner, near Pineville.  It’s a church-based camp, and provides scholarships for kids whose families have financial need.  Hardtner boasts 4 lakes, along with the traditional cabins, craft shacks, pool, and dining hall.  Another great thing about Hardtner is that there’s no phones or other electronics allowed.

So parents and grandparents, make those summer camp plans for your kids now.  Ask them what they’d like to do, either at sleep-away or day camps.  It’s good for them, and fun, and while you may not get to Europe while they’re gone, maybe Grand Isle instead?

It’s Always Sunny in Acadiana

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

One spring day, a teenager decided to get a head start on his summer tan.  Like any teen, he didn’t heed his parents’ advice to wear sunscreen. It was a pretty cloudy day at the beach, so to increase his chances of tanning, he applied tanning oil. It had an SPF of 4, so you’d think he was okay between the SPF and the clouds, right?  Wrong!

When he got home and looked in the mirror, he was shocked to see he was red as a lobster!  It really hurt to get a shirt on to go out that night with friends.  Then when he got into the car, he scraped the top of his head on the door sill- YOW!  While his friends killed themselves laughing, he realized he had burned his scalp too.

Sunburns seem to be a rite of passage for kids and teens at the beginning of the summer.  We sometimes see kids in the Pediatric Emergency Department for these burns- they whine and hurt and can’t sleep.  Though teenagers often laugh at their discomfort and cherry red skin, our Dermatologist colleagues shake their heads- they’re contemplating their future skin cancer patients.

How did our teenager burn on a cloudy day?  Sunlight is composed of several wavelengths of radiation, including infrared heat, visible light, and ultraviolet rays.  While clouds stop some sunlight, they don’t stop it completely.  After all, you still have plenty of visible light to see on an overcast day.  Likewise for ultraviolet wavelengths, the ones that burn and lead to cancer. There’s two types of ultraviolet, UVA and UVB.  UVB is the spectrum that causes sunburns. UVA rays are the sun’s “silent killer,” because though you don’t feel them, they penetrate skin and damage skin cells’ DNA, a potential cancer trigger. Like visible light, they get through clouds just fine- burning and injury may take longer, but it happens. This is especially true here in the South, where we’re closer to the sun than the northern parts of the globe.

Dr. Hamilton once took his new 6 week-old daughter to the beach.  His wife loves the beach, and couldn’t wait to get out of the house after recovering from delivery.  They used all the precautions- floppy hat, big baby skirts, even a beach tent with an SPF rating. But that first day when they got home, baby’ face and arms were sunburned.  They learned that sunlight reflected off sand and water, up under tents and hats, can burn just the same!

Babies under 6 months old should be kept out of direct sunlight, in shade.  As Dr. Hamilton discovered, avoid reflected sunlight!  Infants that age are too young for sunscreen, but over 6 months, slather it on liberally.  Babies of any age shouldn’t be in the sun between 10 am and 2 pm, the brightest part of the day, where anyone is most likely to burn.

All kids, when wearing sunscreen, should have it applied 15 minutes before going outdoors, since it takes time to absorb into the skin.  Use SPF 30 or higher-less isn’t enough.  Cover all surfaces- ears and tops of feet and hands.  If your kid isn’t wearing a hat, get that scalp.  You don’t want your kid to be that teenager from above, who burned his scalp sunbathing.  If your children are at the beach or pool all day, re-apply every 2 hours, and after kids get out of the water.  Don’t forget lips- use at least SPF 15 lip balm if you don’t like the taste of regular screen.

This past Mardi Gras, the Scott parade was on a sunny day.  Since it was February, many families didn’t think to use sunscreen.  That night we saw so many sunburned kids in the Pediatric ER that our nurse dubbed it “The Scott Mardi Gras Glow.”  If your kid gets sunburned, you don’t have to bring them in.  Do what we recommended: keep skin moisturized, particularly with an aloe-containing lotion.  Burned skin dries out, and then itches and burns more.  Use ibuprofen or tylenol for pain at bedtime.  Cool baths with moisturizing soap help, but don’t use washcloths, which scrape sensitive skin.  When they get out of the bath, pat dry with towels, don’t scrub dry.  Then slap on that moisturizer!


Miniature Monster Movies

I loved japanese monster movies as a kid, watching titanic lizards and insects stomp scale models of Tokyo.  Doctors are biology nerds at heart, and find depictions of biology-gone-haywire entertaining.  So you’ll understand my thrill at an American Academy of Pediatrics conference where we learned why there’s few Lyme disease cases in Louisiana.

Lyme disease is transmitted by deer ticks.  Lyme bacteria is carried in deer and mice,  tick feeds on those, and then when biting humans, regurgitate the bacteria into the human.  Infection starts with a target-shaped rash at the bite site: a central red spot surrounded by a red ring.  If untreated Lyme can infect joints and even the brain.  So why don’t we see Lyme in the South?  It turns out that while ticks in the North feed on mice and deer, ticks in the South feed on…..LIZARDS!  COOL!  Talk about monster movies in miniature! 

While lizards have proteins in their blood that kill Lyme, humans have to worry about Lyme and other tick-borne infections.  Rocky Mountain Spotted Fever, Erlichiosis, and Tularemia are just a few of the tick-borne infections.  Now that it’s a warm and lovely spring and we want to be outdoors with blooming flowers and trees, ticks are blooming too.   

Ticks live in bushes, dead leaves, and tall grass, so hiking, hunting, camping, and gardening are perfect activities for ticks to hitch a ride as we brush past. To prevent this, wear clothing treated with 0.5% permethrin, or spray clothes yourself.  Ticks climb upwards, under pant cuffs, so tuck those cuffs into socks or boots to keep them off your skin.  You can put certain sprays on your skin, but some you can’t put on kids under 3 years-old, and none on babies under 2 months.

Soon after being outside, shower to not only wash off sweat and dirt, but wash off ticks. While doing so, inspect for ticks that have already started to burrow into skin.  Ticks love to hide- in hair, behind knees and ears, in armpits and belly buttons, under waist bands, and way up between legs.  Check those places carefully.

Let’s continue our theme of minature monster movies, starring ticks and lizards.  When we discussed ticks feeding on lizards and humans, what exactly does that mean?  Well, horror-movie fans, it means they suck your blood!  How they do that has been unknown, until 5 years ago when german scientists caught the act on film.  Go to to watch that mini-monster movie.

Ticks have two specialized harpoons on their heads called chelicerae (pronounced Kale-y-Siri).  These harpoons are covered with barbs like fish hooks, so as they plunge into your skin, the barbs lock in.  After about 30 thrusts of these weapons, the tick’s deep enough to deploy another barbed spear called the hypostome. This thrusts down between the chelicerae to open a big enough path for blood to flow up to it’s mouth.

About this time we discover the tick on our kid, head buried, body sticking out.  After experiencing a profound case of the creeps, it’s time to act. If the tick can’t be brushed off, it means those barbed spears are stuck in.  Your grandparents’ methods of removing ticks won’t work.  Smearing them with butter to suffocate them so they’ll run away- myth. Touching them with a hot match-head- kills them, but they don’t release.  Painting them with toxins like nail polish or gasoline- same result.  They die, but die before they can extricate themselves.

Tweezers are the best way to remove ticks.  Grasp the tick by its head, up against the skin, and pull gently but firmly.  If the tick breaks and the head’s still embedded, you can pick it out with a sewing needle and tweezers, like a splinter. The good news is that you don’t have to turn your kid into hamburger to extract every last fleck of tick parts. The chelicerae and hypostome don’t carry disease, and the skin will extrude those with time.

More good news. If you catch the tick before it’s engorged, it won’t have transmitted disease. Ticks only regurgitate infections after a blood meal.  They need to get full of blood before refluxing blood and infection from the rear of their bodies down into you. So if the tick isn’t swollen, it’s cool as far as worrying about Lyme disease or Rocky Mountain Spotted Fever.  The monster loses!

The GERD, The Bad, and The Ugly

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

My dad enjoys telling about the time he ate my vomit. Stay with me!  When I was a few months old I loved being tossed up in the air.  One unlucky day while playing our favorite game, I was mid-air over dad when my latest feed flowed out and into his laughing mouth.  He still caught me, or so he claims.

While perhaps not suffering this same fate, many parents have spitty babies.  When they spit up a lot, it’s called Gastro-Esophageal Reflux, or GER.  When tots have complications of GER, like problems gaining weight or throat irritation, that’s called Gastro-Esophageal Reflux Disease, or GERD.

GER is no big deal, medically.  It’s normal behavior in babies because, first, newborns’ stomachs are tiny.  At 2 days old, it’s the size of a cherry; at one month, that of an egg.  Not until one year of age is it as big as a small grapefruit.  Second, the muscle that seals the top of the stomach, the Lower Esophageal Sphincter (LES), is still weak.  Like it takes months for babies to be able to sit unsupported, the LES needs time to develop too.  Thirdly, well-meaning parents fill their newborn’s tummy with 3 to 4 ounces of milk at a time, so it’s no wonder that what doesn’t fit comes back up.

When is GER a problem, or GERD?  Fortunately, the vast majority of reflux babies are just spitty kids who still gain weight, mature normally, and soak lots of bibs.  It’s GERD when babies don’t hold down enough milk to grow.  These babies need to be on high calorie formulas or other regimens to put on weight.  Some get irritation in their throat, nose, or airways from stomach-acid irritation.  Those tots can have chronic congestion, coughing, fussiness, and sometimes wheeze like asthmatics.

It’s great that babies who spit up do fine, but are parents expected to just suck it up while their child’s LES gets into shape?  And what about vomiting?  When is spitting up not just spitting up, but true vomiting?

James Herriot, the best-selling British veterinarian, writes of mis-diagnosing a vomiting puppy.  It first grew normally, but then began spitting up and losing weight.  He tried everything- antacids, de-worming, small frequent meals, and still puppy wasted away.  Then one day while examining the dog yet again, it vomited clear across the room.  “Does he always do it like that?” Herriot asked.  “Aye, he mostly does, sends it flying out, like.” replied the owner.  Herriot realized his mistake, not asking the details which supplied the diagnosis: Pyloric Stenosis.

The occasional baby gets Pyloric Stenosis too, and this story illustrates the difference between vomiting and simple spitting up, or Gastro Esophageal Reflux (GER) that we discussed above.  The American Academy of Pediatrics defines reflux as “the effortless passage of gastric contents,” while vomiting is “the forceful expulsion of gastric contents.”

As mentioned above, rarely does GER affect growth (called GER Disease (GERD) when it does).  But vomiting in babies is more serious.  Babies can get dehydrated, or have surgical emergencies, with vomiting.  Most babies who vomit have a simple stomach virus and get better.  The occasional baby has Pyloric Stenosis, wherein the muscle at the bottom of the stomach (the Pyloric Sphincter) grows much faster than the rest of baby, gradually cutting off the stomach outlet.  These babies begin to vomit more, and more forcefully, until they vomit like the dog in the story, called “projectile vomiting.”  These babies (and puppies) need a simple surgery to fix the sphincter.

There’s other surgical problems heralded by vomiting.  If baby vomits dark green, or vomits with a swollen abdomen, those are signs of a potential intestinal blockage needing emergency surgery.  Also, babies who vomit and have bloody poops need to be seen immediately.

But if your baby’s simply urping milk, smiling away, then relax.  There’s things to make that better.  Breastfeeding results in less reflux than bottle feeding, giving baby the right amount of milk to grow, be healthy, and spit up less.  Feeding baby less formula but more often, thickening formula with rice cereal, and holding baby upright for 30 minutes after feeding may help too.  But no worries!  If your baby is fat and happy, leaky’s okay! 

Industrial Nightmare

It’s the stuff of nightmares: your child is wandering around a busy factory floor.  She walks past red hot surfaces and open flames that threaten to burn her, or catch the place on fire.  There’s cauldrons of boiling liquid, machines full of whirring blades.  Crowds of workers bustle about, threatening to bump her into anyone of these dangers.  Some of these people do sinister things- encourage your child to play with the knives lying about, or pick up broken glass.  Is that candy down there too?  No!  It’s poison in disguise, don’t eat it!

Wake up, and welcome to your kitchen.  The red hot surfaces and open flames are your stove, topped by pots of boiling liquids. Teaching kids food prep explains the knife handling, and who do we expect to clean up after they break a glass?  Whirring blades: blenders and sno-cone makers.  It’s a high-traffic area too, with parents cooking and kids going in and out to get something to eat.  Someone’s bound to bump somebody into something bad.  Poison disguised as candy?  Look under your sink at those dish washing detergent pods.  Why do they have to make them look so tasty?

It’s surprising there’s not more kids in the Emergency Department with kitchen injuries.  The most common injury we do see is scald burns from liquids in the microwave.  It happens like this: the child heats up some noodles, goes to take out the bowl, and gets bumped by that big clumsy microwave door.  They often get burned on some of the most sensitive places- faces and hands- as well as on chests and bellies. The second most common kitchen injury is knife cuts.  Kids are often supervised when this happens, but aren’t quite respecting the sharpness of the knife. The third most common injury is toddlers eating rat poisons and detergents from under the sink.   

Why don’t we see more injuries?  First, parents are generally pretty good about watching their children in this potentially dangerous environment.  The second reason is that these days kids and parents are spending less time in the kitchen. While this may be better for injury prevention, it’s not so good for overall family health.

Though my kids are ages 25, 23, and 21 years, they still get dragged into our traditional  Christmas cookie making.  While I prefer traditional decorating, like icing the Christmas trees green and the stockings red, the kids think it’s hilarious to make gIngerbread men with five eyes and bullet holes, sheep with missing limbs, trees iced to look tie-dyed, whole trays of cookies decorated like some LSD-fueled acid trip. My wife and I have apparently raised some sick puppies.

But we did something right getting our kids into the kitchen: they all can cook for themselves, and know healthy eating.  There’s many dangers in the kitchen enumerated above: hot stoves and liquids, sharp knives, lots of traffic, broken glass, poisons under the sink.  Though these come with the territory, the kitchen’s also a great place to learn important life skills.

People aren’t feeding themselves enough anymore, relying on packaged, pre-prepared food, or fast food, rather than on home-cooked meals from natural ingredients. For the world to feed itself in a healthy and sustainable way, the next generation must learn how to cook. Kids should how to use knives without cutting themselves.  They need to learn to make meals with fruits, vegetables, good starches and proteins.  They should know how to handle raw meat using non-wooden cutting boards, washing their hands and tools afterward, and disposing of the wrappings and skins safely.  They need to learn how to use the stove, oven, and microwave without setting themselves or the rest of the house on fire.

Besides knowing how to make good food, the kitchen is also a place for healthy interactions. It’s where the family cooks together, learns together, eats together.  Cooking is a creative art, and exercising creativity grows healthy kid brains.  Children develop pride in their new-found abilities, and of course, everyone likes to eat.  Families talk better while eating a meal together, rather than separately in front of TVs, games, or computers.

So make your next meal at home and get those kids into the kitchen with you, to learn what you know.  And I guess it’s okay to let them screw around with the Christmas cookies.

Assembly-Line Medicine

This week’s guest columnists are Drs. Ashanti Smith and Ravi Alagugurusamy, Family Practice residents at the University Hospital and Clinics here in Lafayette.

It’s a common scenario now in Lafayette, and nationwide: The child wakes up feeling awful- tired, whining, feverish.  Her throat hurts, and she shivers from chills.  She’s also been coughing.  Mom gives her some ibuprofen, a glass of juice and…she goes back to sleep?  That’s really weird in this normally rambunctious kid, so mom brings her to the doctor.

The waiting room is packed with snotting, sneezing, hacking tots and their bleary-eyed parents. To add variety, one kid throws up.  After hours of waiting, they get a room, the doctor zips in, and proclaims the Influenza swab was positive.  He rattles off an obviously oft-repeated lecture on Influenza, what it is, how to treat it, and how long she’ll be sick.  A long time.  He dashes off to the next goopy patient.  Mom’s handed a prescription, a school excuse, and a paper describing Influenza.

Welcome to assembly-line medicine during flu season!  Doctors and nurses have to crank patients through as efficiently as possible- there’s so many to see!  Let’s unpack what happened above.  First, what is “Influenza?”  It’s the “flu” that you get a flu shot for, and have been hearing a lot about from friends, schools, and the news.  It’s a highly contagious virus that ravages the country every year between October and April- and this year’s been particularly active.

Highly contagious means that you catch it easily, and it’s easily spread to others.  One awful fact: if a kid with the flu coughs in a room, the tiny virus-laden droplets he expels will land on surfaces and remain infectious for 2 hours.  Thus if you touch a table or arm of a chair with the virus within that time, then lick your finger to turn a page, you’ll get it.

This is why the CDC recommends everyone get the flu vaccine every year.  You could inadvertently get it anywhere- school, work, the grocery store.  Okay, so it’s super-contagious.  So what? Isn’t it just some cough and congestion, maybe some fever, and lasts just a few days?

If you’ve ever had Influenza (the “flu”), you now get the vaccine every year, realizing it’s not just a bad cold.  Besides a hacking cough and pouring nose, you have the worst fever of your life- shivering under blankets and quilts despite ibuprofen.  Your head really hurts.  Your throat feels like you’ve swallowed glass shards.  Everything aches.  You have cramps and diarrhea, maybe vomit too.  You wonder- am I dying?

Even worse, it’s been three days with this misery.  At the doctor, more bad news- it can last 7 days before abating!  This is when you make deals with yourself and God.  I’ll never take feeling good for granted again!  I’ll get the flu shot next year!  Make it stop, I promise I’ll be good!

Our hurried doctor from above, running from room to room, stamps out prescriptions and school excuses left and right.  Got to keep the assembly line going- there’s so many miserables to see.  What’s he giving out?  Tamiflu.  Influenza is one of the few viruses for which there’s a medicine that makes it better.

However, it’s not a miracle drug.  Your kid’s not going to pop out of bed next day turning handsprings.  It shortens the course a little- a day or two.  It makes you a little less sick, and also importantly, a little less contagious to those around you.  But you’ve got to start Tamiflu within 48 hours of symptom onset, or it won’t help.

You wonder when you have the flu, am I dying?  Unfortunately, sometimes the flu does kill.  It’s particularly worrisome for the elderly, the pregnant, and the sickly.  Children who are already medically vulnerable- asthmatics, ex-preemies, special-needs kids, kids with heart conditions, are at high risk.  This is a big reason doctors, the CDC, and state health departments insist people get vaccinated.  With the vaccine and hand-hygiene, deaths are preventable!

So get your kid their flu vaccine now- it’s not too late.  Make sure they wash their hands.  And for goodness’s sake, if they have a fever, keep them out of school and get them seen at their doctor’s.  For their sake, and yours!  

The Mundane Epidemic

The big medical news recenlty is either about Influenza (the “flu” you get a flu shot for), or measles, which has had recent national outbreaks in undervaccinated communities.  However, we’re also having a local outbreak of “stomach virus”.  Though it’s certainly a more pedestrian illness than measles or influenza, try telling that to the parents of kids who re-enact the pie-eating-contest-vomit-fest from the movie Stand By Me.

Vomiting is distressing.  It’s just plain disgusting, and many parents get nauseated themselves at the sight.  And they have to clean it up!  Nausea and vomiting are miserable for kids too- it feels lousy.  Parents often have a more profound worry- what if he won’t stop vomiting and gets dehydrated?  That’s when they come to the Emergency Department.

Most vomiting lasts only a half day or so.  However, parents often panic at the first vomit: it seems like so much!  In their disgust, they overestimate the actual volume, seeing the kid from that movie spewing gallons of blueberry smush.  Then after a few more vomits, parents worry about intake, and push too much liquid, or worse, food.  This taxes the stomach, and more yakking ensues.

However, kids do have some reserve; there’s time to work this out.  After vomiting, wait an hour for the stomach to settle.  Then start small amounts of fluids like pedialyte, sports drinks, or dilute juices.  This means just an ounce or two.  Wait a half hour, then give another few ounces.  Then another.  When those little bits are staying down, then gradually increase the volume.  Your child may start begging for more as she starts to feel better, but be strong and be patient- better to hold down a little than throw up a lot.

This method, called Oral Rehydration Therapy, is one of the greatest medical inventions.  It seems simple, but before ORT, the pediatric death rate from third world cholera and dysentery epidemics was astounding.  These are much more violent infections than their benign American counterparts, and doctors were amazed how many kids could “feed through” these illnesses without needing expensive and scarce IV treatment.

My family is fortunate that we haven’t had many stomach viruses.  One time we did we were vacationing in New Mexico, and my wife and I had gotten a babysitter to go out to dinner.  When we got back, the babysitter looked like hell, having cleaned up vomit from our two daughters. Only our son seemed unaffected.  I went to tuck him in, and there he was with the covers pulled up to his chin.  “Dad, I hate to tell you this,” he piped in his 8 year-old voice, smiling sheepishly, “but I just had diarrhea.”  In the bed.

Parents are grossed out by diarrhea, just like with the vomiting we discussed above.  It can also be accompanied by painful cramps.  And like with vomiting, parents start to worry about dehydration, particularly when they feed the kid some fluids or food, and it seems to pour right out the back end.

Kids typically absorb enough fluids to get by though, even if it seems to run right through.  In fact, the quickest way to get your child better is get them on their regular diet as soon as possible.  They won’t feel like eating much at first, so like with vomiting, start with fluids like pedialyte for babies, sports drinks or dilute juices for older kids.  No full strength fruit juice- that sugar load can act like a laxative, and make diarrhea worse.

When your child can eat, back to their regular diet.  A generation ago we were told not to give milk with diarrhea, but now the thinking is when you’re eating your regular food, including milk and yogurt, your guts get “back in balance.”  No heavy, greasy foods like fast foods though, whose fat loads can also worsen diarrhea.

The best treatment for stomach viruses is prevention. Kids contract these bugs by putting contaminated fingers in their mouths (don’t go “ew,” you do too!).  Thus they should wash their hands before eating and after using the bathroom. If your child vomits more than 12 hours, or has diarrhea for more than 4 days, call your doctor for medicine that can stop vomiting.  Unfortunately, there’s not great medicine for diarrhea.  Pepto-bismol or Imodium may slow it down some, or help with the cramps, but they’re not miracle cures.  Typically you just need to….let it pass.

Unsociable Media

This week’s guest columnists are Drs. Meghan Gaddis and Mark Carreras, Family Practice residents at the University Hospital and Clinics here in Lafayette.

I’ve been thinking on how things have changed for kids in recent decades.  It seems  the days of riding bikes to friends’ houses, playing outside until the street lights come on, and having water balloon fights on hot summer days, are gone.  Parks and playgrounds in my hometown that were once packed are now empty wastelands.  Kids no longer rely on their imaginations for play, some even repulsed by the thought of going outside and getting dirty.

As adults, we’re witnesses to a generation growing up not doing the same things we did. One of the culprits that’s robbed our kids of such adventure is the advancement of technology.  Kids don’t have to deal with the disappointment of riding bikes to a friend’s house only to find him not home- they just text to communicate.  No waiting for Christmas or birthdays for a toy they’ve been yearning for- just a few clicks and Amazon brings it to the doorstep.

Of couse there’s good and bad sides to technology.  While computers have taken over a large part of children’s play, they’ve also enhanced parts of our lives.  Modern medicine relies heavily on technology and its advancements.  It was an old joke about doctors’ bad handwriting in their notes and prescriptions, which was sometimes a medical risk if a pharmacist mis-read instructions.  Now it’s all printed and legible.

A hidden risk for kids is the accessibility of a potentially dangerous side of modern tech- social media. In the United States, 77% of the population has a social media profile, on Facebook, Instagram, Twitter, etc.  Social media is taking over a large part of our lives.  We’ve all enjoyed social media’s benefits.  I’ve connected with many old friends and family I haven’t seen in years.  I’ve also been able to network with other professionals with similar interests.  But just as we’re able to access a world of others, so can our kids.

Imagine letting your child wander through the worst neighborhoods in a big city, all alone.  She might be threatened by strangers, certainly would be scared, and bad things might actually happen.  Modern technology has made this nightmare more possible for kids, in social media.  Kids can be bullied by scores of schoolmates, and strangers too.  Predators may lure them into unspeakable situations.

We see lots of victims of social media in the Pediatric Emergency Department.  Besides injuries and illness, we take care of psychiatric emergencies- depression, aggression, suicide. Often the bullying that finally drove the child to the despair of contemplating killing herself started online.  Consider these statistics:

-88% of teens have seen someone be mean or cruel to another person on a social networking site.

-15% of teens say they were a target of online cruelty.

-8% of teens got into a physical fight over something posted on social media.

–29% of sex crime relationships were initiated on social media.

These are the victims.  But any kid on social media is at risk if they have unregulated access.  More stats: 

-67% of teens know how to hide their online activity from parents.

-22% of teens log on to social media site more than 10 times per day.

-85% of parents with teens report that their child has a social networking profile

-29% have been stalked or contacted by a stranger

The best way to avoid this is to closely monitor your child’s online activity.  Frequently talk to them about what they’re seeing, and with whom they’re communicating.  Ask them if they’re being bullied, or recieving messages from stangers.  Get them used to talking openly about it, and see for yourself what they’re reading and writing.

Some teens argue that this is an invasion of their privacy, and fight monitoring tooth-and-nail.  And as we just stated, most teens know how to hide their activity.  The best way to avoid this is to early in their lives, before they’re teens, let them know that there’s no such thing as online privacy.  Explain to them this contract: from the first day they get access to a screen, if you’re paying for the access, you get to see it all.  And just like you wouldn’t let them wander through the city lost and alone, you wouldn’t leave them all alone in the online jungle either.


Live More Amish?

In her book “Animal Vegetable Miracle,” author Barbara Kingsolver describes a year where she feeds her family only locally grown food.  When she vacations at an Amish farm to see how they do it, her hosts are fascinated by her Prius.  In reality, the Amish aren’t against all technology. They just choose what won’t “change their lives for the worse.”  For instance, when milking machines could replace the need for repeated lifting of 80 lb. milk cans, difficult for children and small women, the community voted to allow them, so that the whole family could work together milking the herd.

When parenting, we should make similar decisions about what technologies to adopt for our children’s health.  Some fruits of technology are certainly harmful, like packaged snack foods and sodas, and polluted air, water, and soil.  Some technologies are undeniably good, like municipal clean water.  But with most, there’s a tension in doing more good than harm.

One such tension is the use of antibiotics.  In some cases, where a child has pneumonia or other life-threatening infection, antibiotics are a god-send.  However, antibiotics are overused, like when a child has a virus.  Antibiotics don’t kill viruses, but many parents and doctors want to use them anyway, “just in case.”  When too many antibiotics suffuse the environment, the bacteria they’re meant to kill develop resistance to them.  Then one day when a kid gets that pneumonia, the antibiotics won’t work.

Besides not insisting on antibiotics for that green runny nose, there’s lots more good choices you can make for your kids to keep them on the good side of technology.  Certainly the more home grown or locally sourced foods you buy, the better for them.  Supermarket foods’ packaging and advertising scream about their healthfulness, but  they don’t come close to the bread and produce from the farmer’s market at the Horse Farm.  Likewise, a pedal bike is certainly safer, and healthier, for your child than a powered one.

Finally, as we discussed last month, playing a game of tag or reading a real book at bedtime are better than video games and phones.  I’m not against these technologies- I’m writing at a computer right now.  But later I’m going to the library to check out a book.

Many in the world are forced to live like the Amish we discussed above- little technology, lots of hard farm work.  They must live this more “natural” lifestyle, rather than choose it as the Amish have, because of poverty. I just returned from my annual medical mission trip to Honduras, where I’m immersed in their world of cooking on open fires, sleeping in huts that let in weather and insects, and having to walk everywhere.  

While we enumerated the advantages of natural living above- home-cooked food, fresh air, and exercise, there’s reasons those in the third world have shorter lifespans.  Cooking fires fill the home with smoke, leading to asthma and burning eyes.  Insects brings itchy bites, disease, and sleepless nights.  Unending, back-breaking work wears out bodies.  And there’s no modern medicine nearby to bring relief for these problems.

And yet, the kids seem pretty happy.  WIthout smartphones, video games, cable, or even toys, they have smiles on their faces.  They play and carry each other around.  They innovate.  And they are resilient, putting up with dental extractions without a cry or tear.  When we bring paper and crayons, it’s a popular draw, almost more so than the dental, medical, or eyeglass clinics.

In fact, with their resilience and innovation, these kids often seem smarter and more capable than their American counterparts. If the natural life is so good for people and their brains, how did Europe and North America come to rule the world?  In his book “Guns, Germs, and Steel,” anthropologist Jared Diamond recounts being asked the same question by a New Guinea tribesman when Diamond pointed out how smart his people were. The book’s short answer: dumb luck. Europeans weren’t superior; they just happened to settle lands with richer soil and better livestock, which is the basis of a society’s wealth.

So be thankful you can choose your technology; but do as the Amish, being careful to use only that which makes you and your kid’s lives better, not worse.  Have them play freely, finding their own resources instead of having them provided by a computer.  They’ll get some exercise too.