Pink eye. Yuck. More appropriately, pink eye, or bacterial conjunctivitis, should have been named “gooey eye.” Caused by bacteria, the thin layer over the eyeball becomes infected.  Only after the gooey pus produced by the infection irritates the eye will the white of the eye turn red.

 I call pink eye the goo that will not go away.  When your child has a cold he may wake up with crusty eyes. But after you clean them up, the gooey discharge goes away until the next nap. If your child has pink eye, be on the lookout for other bacterial infections. When there is infection in the eyes, there may be infection in nearby parts of the body such as the ears or sinuses.

Antibiotic eye drops are the treatment for pink eye. After starting treatment, your child is contagious for 24 hours. Call your child’s school for their specific school/daycare exclusion recommendations. In general it is one day after starting treatment. Even if the infection is in one eye, to prevent spread into the other eye, place drops in both.

To prevent pink eye from spreading through your home, wash your hands before and after treating your child with drops, give your child his own towel to use, and in general try to prevent touching your own eyes after touching things your child has touched, such as toys.

If your child has pink eye, the infection may spread into the skin surrounding the eye as well as back into the eye socket. If there is swelling, redness, or tenderness of the upper or lower eyelids, the infection may be spreading. New high fever in a child with these symptoms can also herald a more severe infection.

A cold can predispose your child to pink eye.  Bacteria love to brew in the nose during a cold and you don’t want to inadvertently place nasal discharge from the nose into the eyes. Teach your child to wash his face from top to bottom.Wash eyes, then nose, then mouth. Pictured above is one of my patients who had pink eye.

The next you see boogies coming from the eye, even if the white of the eyes are clear… think pink.

Naline Lai, MD
© 2010 TwoPeds in a Pod

Dr. Dave, a friend of Dr. Kardos, is a physician in a Student Health Center at a respectable college in a large city. Here is an alarming, yet typical, scenario involving binge drinking that Dr. Dave encounters on a too-frequent basis.

A 19 year old young man comes in to the Student Health Center very concerned because he had woken up that morning in an apartment in bed with a woman he did not know. He had been out with friends drinking at a bar (a frequent occurrence), vaguely recalls meeting a woman, but had so much to drink that he cannot even recall leaving the bar, let alone what happened afterward. His greatest concern is that he has no idea if he used a condom (he left before she woke up), and thus could have been exposed to HIV and other sexually transmitted infections.

Ironically, this student is worried about exposure to sexually transmitted diseases but not about the root of his problem: binge drinking. In other words, he is worried about sexually transmitted diseases but not about his drinking which caused his potential exposure to dangerous diseases.

Here is what Dr. Dave, a career student health doctor, wants parents of college students to know about binge drinking in college students:

Although alcohol use is often considered a rite of passage for college students, it is also one of the major health risks for this age group.  Alcohol-related health problems can present in a variety of ways and do not have to involve any signs of dependency.  Among college-aged students, the most common manifestation of alcohol abuse comes from the consequences of binge drinking.  

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports the following sobering statistics regarding annual health risks directly attributed to alcohol use among college students between the ages of 18 and 24.  These statistics also serve as an important reminder that a person does not have to be drinking to be adversely affected by alcohol abuse.

·         1,400 student deaths from alcohol-related unintentional injuries (including motor vehicle accidents)

·         500,000 unintentional student injuries 

·         More than 600,000 cases of student-on-student assault 

·         More than 70,000 cases of sexual assault or date rape

·         400,000 students having unprotected sex and more than 100,000 students too intoxicated to remember if sex was consensual.

The first 6 weeks of the first semester of college is an important predictor of first year academic performance and is an important window period to monitor for any significant changes in a new student’s behavior and lifestyle habits.  Parents can help by being aware of these issues and by being open to speaking with their children about the potential risks of alcohol use both before and during the college experience.  A simple rule of thumb for parents is to stay involved, while still allowing their children the space necessary for learning, exploring, and maturing into adulthood. 

If your child begins to exhibit unusual behavior, such as lower grades, mood changes, or a new unwillingness to talk to you, this behavior should prompt you to find out more. 

Additional information is available at http://www.collegedrinkingprevention.gov/.

Dr. Dave, MD is a physician who has been working in college health since 2000.

© 2010 Two Peds in a Pod

Three little kittens, they lost their mittens, and they began to cry. 

Oh, mother dear,  we sadly fear That we have lost our mittens. 

What! Lost your mittens, you naughty kittens! 

Then you shall have no Nintendo   DS 

    -the modern version of a traditional poem

It’s only January and pictured here is a photo of my three kittens’ mittens (gloves) which are already missing mates.

Prolonged exposure to cold can lead to injury in body parts with relatively less blood flow such as the ears, fingers and toes. In frostbite, injury occurs secondary to ice crystals which form within or between the cells in your body. Injury can be so severe that the tissue dies and infection sets in.

Early signs of frostbite include tingling or achiness. Without treatment, the area will become pale and lose all sensation.

If you suspect your child’s hands are starting to become frostbitten, first remove all wet clothing. Rewarm the area by placing immediately in warm water.  Think opposite of a burn- where you use cold water. Do not massage the hand as this may cause further injury, but do encourage your child to move his hands. As very cold hands warm up, they will become blotchy and painful or itchy. Ibuprofen (brand names Motrin and Advil)or acetaminophen (Tylenol) will be helpful.  Warm for at least half an hour even if it is painful.

Signs of actual frostbite are blistering, numbness, or color changes. As my sister, an emergency room doctor says, red is good. Black and white are not.

Head over to the emergency room if you think your child has frostbite. To avoid the risk of over-heating and to manage the pain of treating frost bite, thawing for frost bite should be medically supervised. Just as you would seek care for a burn, seek medical care for a cold induced injury. To rewarm properly, the frostbitten part of the body should be submerged in warm 37-to-40 C (98 -to-104 F) water.  No higher because then it's like trying to defrost a chicken. You will end up cooking rather than thawing the tissue, says my sister. Also a big no-no: starting to thaw but then not completing the thaw. Thaw-refreeze-thaw will injure tissue, same as it ruins a defrosting chicken. So again, seek medical attention for your child if you suspect frost bite has set in.

For a recent interesting, but somewhat technical article with photographs on a case of frostbite, check out the New England Journal of Medicine, N Engl J Med 2009;361:2654-62

Naline Lai, MD

Two Peds in a Pod © 2010.

Haiti, one of the poorest countries in theWestern Hemisphere, was struck by a devastating earthquake last week.

If you are looking for a way to help the children, consider donating to the American Academy of Pediatrics Friends of Children Disaster Relief Fund. The American Academy of Pediatrics has used this fund in the past to respond to disasters that affect children in the US, such as hurricanes Katrina and Ike, and worldwide, such as recent earthquakes in China.

 The fund provides emergency relief to pediatricians and the children they treat by:

• Addressing primary health care needs ofchildren;

• Supporting medical services (example: power generators for medical facilities, replacement of medical equipment damaged by the disaster);

• Supporting future disaster preparedness and response programs with a special focus on children.

 http://www.aap.org/donate/fcfdonate.htm

 Naline Lai, MD and Julie Kardos, MD
© 2010 Two Peds In a Pod 

Here is how to tell if your child is VERY ill with fever vs not very ill:

Any temperature in an infant younger than 8 week old that is 100.4 (rectal temp) degrees or higher is a fever that needs immediate attention by a health care provider, even if the infant appears relatively well.

Any fever that is accompanied by moderate or severe pain, change in mental state (thinking), dehydration (not drinking enough, not urinating because of not drinking enough),  increased work of breathing/shortness of breath, or new rash is a fever that NEEDS TO BE EVALUATED by your child’s health care provider. In addition, a fever that lasts more than three to five days in a row, even if your child appears well, should prompt you to call your child’s health care provider, who most likely will want to examine your child. Reoccurring fevers should also be evaluated.

Should you treat fever? Given the information from above and from Part 1 of this fever blog post, you may have concluded that fever is an important part of fighting germs, and in fact I do NOT advocate treating fever UNLESS the side effects of the fever are causing harm. Reduce fever if it is preventing your child from drinking or sleeping. If your child is drinking well, resting comfortably or playing, or sleeping soundly, then he is handling his fever just fine and does not need a fever reducing agent just for the sake of lowering the fever.

A note about febrile seizures (seizures with fever): Some unlucky children are prone to seizures with sudden temperature fluctuations. These are called febrile seizures. This tendency often runs in families and usually occurs between the ages of 6 months to 6 years.  Febrile seizures last fewer than two minutes. They usually occur with the first temperature spike of an illness (before parents even realize a fever is present) and while scary to witness, do not cause brain damage. No study has shown that giving preventative fever reducer medicine decreases the risk of having a febrile seizure. As with any first time seizure, your child should be examined by a health care provider, even if you think your child had a simple febrile seizure.

I refer you to our “How sick is sick?” blog post for further information about how to tell when to call your child’s health care provider.

Julie Kardos, MD
©2010 Two Peds in a Pod                                                                                                                                                 

So now that your children have been back in school, there has been plenty of opportunity for germs to circulate. In addition to washing hands, your child’s body has many ways to fight germs. I receive many worried questions about fever, so here is what every parent needs to know:

Fever is a sign of illness. Your body makes a fever in effort to heat up and kill germs without harming your body.

Here is what fever is NOT:

·         Fever is NOT an illness.

·         Fever does NOT cause brain damage.

·         Fever does NOT cause your blood to boil.

·         Unlike in the movies and popular media, fever is NOT a cause for hysteria or ice baths.

·         Fever over 100 degrees F is NOT a sign of teething.

Here is what fever IS:

·         Fever is a body temperature that is equal to or higher than 100.4 degrees F rectally in a newborn until the age of 8 weeks old.

·         Fever is a body temperature of 101 degrees F or higher in anyone older than 8 weeks old.

·         Fever is a very effective defense against disease.

 To understand fever, you need to understand how the immune system works.

Your body encounters a virus or bacteria (germ) that it perceives to be harmful. Your brain sends messages to your body to HEAT UP and kill the germs. Your body will never let the fever get high enough to harm itself or to cause brain damage. Only if your child is experiencing Heat Stroke (locked in a hot car in July, for example) can your child get hot enough to cause death. This is because the heat source is EXTERNAL (a hot car) and not generated by your child’s body.

When your body has succeeded in fighting the germ, the fever goes away.  If you “treat” the fever with a fever reducing agent (Tylenol, Motrin, etc) the fever goes away temporarily but WILL COME BACK if your body still needs to kill off more germs.

Symptoms of fever include: feeling very cold, feeling very hot, muscle aches, headache, and/or shaking/shivering.

Fever may be a sign of any illness. Your child may develop fever with cold viruses, the flu, stomach viruses, pneumonia, sinusitis, meningitis, appendicitis, measles, and countless other illnesses. The trick is knowing how to tell if your child is VERY ill or just having a simple illness with fever.

Stay tuned for how to tell.

Julie Kardos, MD
©2010 Two Peds in a Pod

How can I tell if my child has strep throat?

The definitive way to diagnose strep throat is for a health care provider to get a sample of the sore throat germs from your child by using a long cotton swab to gently swipe the sore throat and send the germs to a laboratory for culture. The laboratory lets the germs grow to determine if the Strep Throat bacteria grows from your child’s throat.

Thus, strep throat cannot be diagnosed over the telephone. Nor can health care providers rely solely on physical exam findings, because while there is a “classic” look to strep throat, some kids have normal appearing throats yet the test reveals strep, while others have yucky looking throats but in fact have some other viral infection causing their sore throat and thus do not need antibiotic treatment since antibiotics do not cure viruses. Health care providers ask questions about your child’s symptoms and perform a thorough physical exam and then do a “strep test” if they are suspicious that your child may have strep throat.

Many pediatric offices use rapid strep tests to help make a quick decision about treatment because the strep culture takes from 24 to 48 hours to finalize. These tests are fairly reliable, but sometimes the quick test is negative (shows NO strep) even if strep is present, so most offices will send a culture back-up if the rapid test is negative (no strep germs found). The other problem with the quick test is that once your child has strep, the quick test stays positive for about a month, even if your child no longer has strep disease. So if a child is treated for strep throat and then develops another sore throat within a month of treatment, that child needs a strep culture back up if the office quick test is positive.

To further complicate matters, some kids “carry” the strep germ in their throats but never develop the disease (no sore throat or illness symptoms). These kids will test positive but do not require treatment. This is why we do not routinely check kids for strep throat unless they have symptoms of strep throat.

My child was treated for strep throat. We used all of the antibiotic. Three days later his sore throat is back. Why did this happen?

The most common reason for getting two episodes of strep throat close together is that your child contracted the germ again, usually from a classmate in school. If your child gets strep throat again, it is usually not because the antibiotic didn’t work but rather it is from bad luck. Most doctors treat a second episode of strep with the same medicine used the first time around.

Luckily, strep throat has not shown much, if any, resistance to standard antibiotic therapy. The reason that children (and adults) are treated for a full course of antibiotic is that this duration is known to prevent some of the complications of strep throat. You should give your child the complete course of antibiotic her health care provider prescribes, even if she “feels better” part way through the treatment. In addition to treating with antibiotic, be sure to provide pain medicine such as acetaminophen (brand name Tylenol) or ibuprofen (Motrin or Advil) to treat sore throat pain as needed.

Reasons to contact your child’s health care provider during treatment would be increasing pain, inability to swallow, or looking worse instead of better during the course of treatment.

You just got the call from the school nurse, who tells you: “I have your child here with me and she has a sore throat. I think you need to take her to the doctor to see if it’s strep throat.”

What exactly IS Strep Throat?

Strep throat is a throat infection caused by Group A streptococcus bacteria. Symptoms can include sore throat, fever, pain with swallowing, enlarged lymph nodes (glands) in the neck, headache, belly pain, vomiting, and rash. Not all symptoms are present in all kids with strep throat.

Symptoms do NOT include cough, profuse runny nose, or diarrhea. Only about 15 percent of all kids coming to our offices with a main concern of “sore throat” are going to actually have strep throat. That means that MOST kids with sore throats will turn out to have something other than strep throat, usually some form of virus causing pain or post-nasal drip.

Who gets Strep Throat?

The most common age for kids to get strep throat is between ages 5 to 12 years old. For some reason, kids younger than 3 years are not as prone to strep throat. Also strep throat is seen less often in adults than school aged kids.  Some children appear really ill with strep throat and other kids just have a bad sore throat, but with pain medicine can look quite well.

So why do we care about strep throat?

Most children’s immune systems are really good at fighting the strep germ off and in fact most kids will get better from strep throat even if they are not treated. However, some kids’ immune systems get a little haywire when fighting the strep germ, and in addition to making antibodies (germ-fighting cells) to fight the strep, they make antibodies against their own heart valves (immune system gets confused) which causes rheumatic fever. It has been shown that treating strep throat with antibiotics shortens the duration of strep throat only by about one day, but more importantly prevents the body from making the wrong kind of immune cells, or antibodies, against the heart valves thus lowering the risk of rheumatic heart disease.

Strep throat can also lead to other complications such as scarlet fever (strep throat plus sandpaper-feeling rash on the skin), peritonsilar abscesses (pus pocket in the tonsils) and kidney inflammation (first symptom can be cola-colored urine).

Stay tuned for Part 2 about Strep Throat: how it is diagnosed and treated.

Julie Kardos, MD
© 2010 Two Peds in a Pod      

Ode to the Binkie

Bed time when toddlers starts to shout,

It is you, dear binkie, who knocks them out.

Those thumb suckers look so snide,

But haven’t been without you on a long car ride.

None in the diaper bag, none in the crib?

Take one from our infant sib.

If you touch the ground, I’ll give you a quick blow,

Back into the mouth you’ll just go.

But now my child can run and jump with both feet off the ground,

Two to three word sentences she can sound.

If old enough to politely ask for you,

Then old enough to make permanent teeth go askew,

Oh dear binkie, you once had your place,

Now let’s take the cork from the face

Once you were our beloved binkie,

But right now….. you are just stinky.

Whether you love or hate the pacifier, at some point, to avoid the possibility of dental and speech articulation impairment, your child needs to wean.  Besides, it’s nice to see your child’s entire face.  The easiest time to wean is usually around two to three years old. At that point, your child’s dependence on sucking for self-comfort begins to lessen and he begins to want to dissociate himself from being a “baby.”

Now that it’s the New Year, here are some ways to say bye-bye to the binkie, if this is on your child’s (or your) resolution list.

·         Practice throwing the pacifier across the room and saying “yucky, binkies are for babies.”

Naline Lai, MD

© 2010 Two Peds in a Pod

Special note: all of Dr. Lai’s and Dr. Kardos’s children are former binkie users. You could call us “binkie specialists.”  Leave a comment about how your child weaned.

 We are thrilled to release our first podcast recorded from a podcast party!

We recorded with GNO, a  group of dynamic moms with young school aged children (pictured above).  GNO stands for Girls Night Out. That evening, Two Peds in a Pod was "the night out." The recording you hear below is a distillation (with a few later additions) of the conversation we had on three topics: tantrums, anxiety and tics.  We found the discussion reflected the concerns of parents of kindergarteners and first and second graders whom we see in the office.

In photo: Dr. Kardos on left and Dr. Lai on right.

Live in the greater Philadelphia area? Give a Two Peds in a Pod podcast party as a gift or host one yourself.  Email us at twopedsinapod@gmail.com

(If you subscribe via Atom feed or do not see a podcast player displayed, please go to our website www.twopedsinapod.com)

 Happy New Year

Naline Lai, MD and Julie Kardos, MD

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