Friday, August 30, 2013

Dealing with those pesky colds and congestion


With school back in session there is usually an increase in the colds that we see, so I am brushing off an earlier post with some updates.

Colds and coughs are a common issue for all of us with or without kids.
Studies say that most children will have an average of EIGHT colds within the first 18 months of life.

Most of the time the congestion is caused by a viral syndrome. Allergies and teething can also be culprits making you congested.
All that mucous is the perfect breeding ground for bacteria, which is why something that starts as a virus can turn into an ear infection, sinus infection, or lower respiratory infection fairly quickly.
Be warned,  
We can see a patient one day with clear lungs and no ear issues, and the very next day they can seem a lot worse and have a raging infection.

When to come in:  
If you are dealing with a congested family member, here are the questions to consider. 
*Do they seem to be having any labored breathing?  
Babies with labored breathing will look like their little tummies are going in and out more than usual.
(I am more focused on the lungs than a stuffy nose). Some very noisy breathing is upper airway stuff that we aren't too worried about, so the noise isn't always much of a factor.

*How is their mood?

*Do they have a fever?

*How is the appetite? If your baby is nursing well, that is very reassuring

*Are they sleeping well at night?

* What color is the mucous?

*How long has this been going on?

Many colds and coughs can last between 7-10 days. Some coughs can linger for a few weeks.  

If we have  
a reasonable consolable child
clear mucous
eating and sleeping  are okay
breathing isn't alarming
no significant fever 
 I am okay playing the "wait and see" game.
Of course if the symptoms show no signs of improvement, please check in with your doctors office.

IF you have any labored breathing,  
a child who is much grumpier or fussier than usual 
a fever that is hard to control or has lasted more than 3 days 
 mucous that is getting thicker and greener

that person needs to be seen.

Any baby less then 2 months old is probably worth a look at with their first cold, unless they are eating really well and seem happy. It is certainly at least worth a call to the nurse. 

Management tips:

The best way to manage congestion at home is to make sure your little patient is getting plenty of fluids (this will help to keep the mucous thinner) Breast milk is perfect if you are lucky enough to have it.

With some older kids, cows milk may not be the best choice because it can increase the amount of mucous. (it doesn't impact everyone the same way)

Steam is great. Hang out in the bathroom when anyone takes a shower.
Running a humidifier or vaporizer at night is a good idea. Turn it off during the day and give the room a chance to dry out so that you don't grow mold. Make sure you change the water daily. As long as you follow those rules, I don't have a preference between warm or cool mist. 

Keeping the head elevated makes a huge difference. Some of the younger babies will do best sleeping in their car seats, bouncy seat or swing (make sure it is safe)
Otherwise try a crib wedge or placing a towel underneath the mattress to raise it up a bit.

You can put saline drops or breast milk into the nose (and then suck it out with a Nose Frida or snot sucker). This is the most natural way to clear the nose. Your baby will no doubt hate this, but if you can manage to do it about ten minutes before a feeding, it may clear the nose up enough to make eating much easier.

For patients over 6 months of age, ask your doctor about Windbreaker (a Chinese herb that we use to dry up congestion) Many of our families swear by it. It is sold at the Chinese medicine works on 25th and Noe. For convenience our office tries to also keep it in stock.

For older kids don't minimize the value of chicken soup!

For night coughs try a bit of Vick's Vapo-rub on the feet!


For parents and big kids I really like Sambuccol and Zinc lozenges.
This may be placebo, but in my case I say " bring it on" because they seem to work.
Remember that I work in the germ factory and (knock wood) I manage to avoid many of the things I tend to be exposed to.
The second I feel that little tickle in my throat or any tell tale signs of an illness I take a Zinc cold therapy lozenge (Walgreen's generic taste better and are cheaper) and a Sambuccol lozenge twice a day.

Another very good thing to do for folks who are old enough is to use a Neti Pot or sinus irrigation

Good Hand washing is of course essential.

Wishing you a back to school season that is kind and gentle.

Friday, August 23, 2013

Basic Butt Care/ diaper rash

Diaper rash can occur from multiple reasons.
Most diaper irritations are simply your baby's delicate skin being in contact with irritating stool and urine.
Prevent Prevent Prevent........when you can.
The key is to keep your baby as dry as possible.
Use gentle wipes that don't have perfume or alcohol.
Some folks use plain water if even the gentlest wipes seem irritating.
After you have done the wiping, it is time for one of my favorite tricks.
Take a plain tissue and tap it around your babies recently cleaned skin. Most of the time the skin is still a bit damp and tacky feeling. The tissue will actually stick to the skin.
Your job is to tap tap tap, (get into all those little creases) until the Kleenex no longer sticks to the skin at all. NOW you have a perfectly dry baby.
If you don't actually need to get that diaper right back on, a few sessions of "diaper off" time throughout the day is the best thing you can do for your baby's little tush.
Air time is helpful at preventing rashes and it is essential when it comes to clearing them up.
The next time your baby is in the office getting weighed, ask to take the protective blue pad with you. Those are great to put your baby on during air time (They don't protect from spraying, alas...put a little wash cloth over your little fellows and avoid white carpet.)
Pee pee pads from a pet store are also a good place to lay your baby for some "air time".

Another thing I do as a preventive measure is to add a splash of apple cider vinegar to the bath water (I don't have an exact amount because tubs vary greatly)

Keep your baby well hydrated, concentrated urine is more irritating.

If your baby is rash free, you don't actually need to put any diaper creams on during the day.
Once your baby is giving you a longer stretch at night I would apply a barrier cream. For preventive care I don't have a favorite, there are lots of wonderful brands.

Desitin is a fine cream, but I find it hard to clean off. I often find that it is easier to work with if you mix it with some A and D ointment or Aquaphor.

If your baby has a rash, I like a cream called Calmoseptine. The Noe Valley and Diamond Heights Walgreen's try to keep it in stock for me.

It seems to me that some kids are more susceptible to rashes when they are teething.
I also will see rashes flare up when babies start solids.

Once in a while a rash can be caused by yeast which thrive is warm, moist dark places.
(As you can imagine, two places where yeast love to hang out are a wet diaper and the inside of a nursing bra)
Yeasty rashes can look very spotty or very red with distinct borders.
I am never afraid to add an anti fungal cream if we are suspicious of yeast..
For a yeast diaper rash:
*As much air as you can manage
*Apple cider vinegar to the bath
* a thin layer of Lotrimin (over the counter...yes it is the same cream that is used for Athletes foot) three times/ day
*Calmoseptine or another barrier cream on top of the Lotrimin

Some rashes get so raw that the poor little bottoms bleed.
I would put a thin layer of Neosporin on any open, sore areas...also three times a day (Sometimes it feels like a little paint by numbers kit...a little of this here, and a little of that there)

An old baby nurse that I worked with many years ago used to create her own concoction.
She would get an empty plastic container and mix in equal parts of the 3 following ingredients:
*A&D oitment
*Maalox or Mylanta
 This stuff worked wonders. I speculate that the antacid  component helped combat especially acidic poop irritation.

You will often know within a day or so that you are on the right track. Some rashes look remarkably better after the first session of fresh air. 
If there is absolutely no improvement after a couple of days, it is worth having an evaluation in the office.

We will most likely always want to see any diaper rash that is pimply or oozy.

Okay, get that tush out for some air ( sorry about your carpet)

Friday, August 16, 2013

Flu Vaccine 2013/2014 information

All about this season's flu vaccine

It is recommended that all children over the age of 6 months get the flu protection.
If you have an infant under 6 months of age, please consider getting the flu shot for yourselves and any of the baby's close contacts.
All children under the age of nine, need to have one season where they have received two doses of the flu vaccine in order to be considered fully protected. The two doses need to be separated by at least four weeks.
Children under the age of three get a half dose. All of the vaccine in our office is preservative free.  
Children over the age of two have the option of getting the shot or the nasal flu mist.
(most two year olds do NOT like having something squirted in their nose, sometimes you are better off with the shot)
Until we are well into the season, I won't know if one method is more effective than the other. Every year is different.

Most years have some differences in the vaccine, although a couple of years ago the shot stayed the same for two seasons in a row.
The disease trackers do the best they can to predict which strains of the virus will circulate. Some years have better matches than others.

Last season the flu wasn't much of an issue. Plenty of people got the flu and had a miserable week, but most of the folks who got the shot ended up with decent protection (there was one strain B that they didn't get right)  


 We had ample supply of the vaccine last season, although other offices did run out. In the recent past there have been years when a nasty flu made the rounds, the media banged the panic drums and there was a run on the vaccine. One never knows when that will happen. I will never forget the year that H1N1  wrecked havoc. I don't anticipate any issues this season, but it is a good idea to get the shot early in the season. The protection should last the year. 

The vaccine this season covers the H1N1 as well as up to three new strains. For the first time ever a  quadrivalent (covering 4 strains) vaccine that  will be available.
All of the nasal flu vaccine will cover all 4 strains, The injectable vaccine that will be available this season will be either trivalent (covering 3 strains) or quadrivalent.  It might be worth asking before you get a shot.
. Our office will only have the quadrivalent. It remains to be seen whether or not the extra strain that will be covered will ultimately matter, but we were given an early opportunity to go with the newer vaccination so we jumped on board. (my understanding is that only 20% of the vaccine this year will protect against that extra strain)
We have already received the first shipment of the flu mist.

Every year the vaccine reaction differs.
I will have a better sense of that once we start giving the vaccine.

I will be blogging the reactions and the vaccine availability on the weekly Noe Valley Pediatrics update blog

Click below for the 2013 Flu information statement from the CDC

flu information

Friday, August 2, 2013

Should you give tylenol before the shots? / vaccine reaction discussion

With the exception of the Hepatitis B, the first round of vaccinations is usually given at the two month visit. I get plenty of calls from parents wondering if they should dose their baby with Tylenol or Ibuprofen before actually getting the shots.
This is one of those situations where you will likely get a different answer from anyone you talk to.

In my experience children respond to the shots in different ways.
About one third of my patients have almost no discernible reaction at all except for a moment or two of crying after the injections. Some of these babies are sleepier than usual for the first night (Which most parents enjoy once reassured that this is normal).

The second group is fussy and has a mild to moderate fever. This typically starts about an hour or two after the shots.

The third group (my daughters were in this crowd) seem fine until about twelve hours or so after the shots and then the reaction kicks in.

Knowing this, giving medication ahead of time doesn't make sense to me. Although I have no hesitation using Tylenol or Ibuprofen as needed, instinctively I don't like to give any medication unnecessarily.
There is a two thirds chance that giving the meds ahead of time is not needed, either they are the group that won't react, or they are the group that won't react until hours later.
The medication ahead of time does NOT make the shots hurt less.

But of course nothing is ever quite so simple. There are many folks that opt to give the medication ahead of time and they have valid reasoning. 

The fact is that the Tylenol/ Ibuprofen do seem to work better if you catch the reaction before it has reached it's peak. If your choice is giving it too soon, or waiting until your baby is miserable  I would say give it early to be on the safe side.
Somewhere there must be a happy medium. 

My advice is to watch your baby very carefully. Certainly have the medication on hand and make sure you know the proper dose. (I do not have a strong preference between the medications)
After the vaccines (let them calm down for a bit, that first bit of crying from the shot doesn't count), at the first sign of fussier than usual behavior go ahead and give them some medication.  
We can use the first set of shots as a learning experience.
If your baby is really miserable after the first vaccinations, I would plan on giving that dose ahead of time for the next shots. 

To calm your baby immediately after the shots I have found that dancing with them is the best solution. Big bouncing and shoooshing often does the trick pretty quickly.
Some moms choose to nurse during the injection. I personally prefer not to do it that way. In my mind, breast feeding should be considered a safe and pain free situation. I don't like the idea of messing with the 'sanctity of the boob'. 

Most of the time babies who are having a vaccine reaction will have mild to moderate fevers for a day or so. They appear like they just don't feel well.
They may have some redness and a little lump at the injection site.
(I like to put Arnica or little black tea bag compresses at the site for some relief)
Some of these lumps feel like the size of a pea and  may last for several weeks.
Redness at the site might be a reaction to a band aid. 

If your baby is having a rough time, make sure you give Tylenol/ Ibuprofen as needed those first couple of days.
An inconsolable child who has had the full dose of pain reliever is one who you should check in about.
We rarely see super high fevers ( >102) from the shots these days. As with any fever, please notify someone if it doesn't respond to tepid bath or medication within an hour.

I often have folks calling me a few days after the shots, The babies did okay for the days immediately after the vaccinations, but now they are worried that their child now seems ill.

My speculation is that the vaccinations do tweak the immune system as they work on getting the body protected from big bad diseases. When this happens, the door is open for other mild illnesses to take the opportunity to come along. Unfortunately it is not that unusual.  

It is hard to watch your child get miserable after shots. Keep in mind that the diseases that you are protecting them from are very real.