Adenovirus

 

I usually include a ‘what’s going around section’ in my weekly newsletter/email. Parents have told me that it is very useful to know what to look out for. There is also some comfort in running with the pack. Misery loves company. For several months now, adenovirus has been on that list. Interestingly, although I have been working in pediatrics for more than 40 years (yikes), unlike RSV, hand-foot-mouth, and slap cheek, adenovirus was not an illness that I frequently discussed. Is it new? Nope! What’s new is the ability to easily do a respiratory panel to identify the actual virus. What I used to refer to as a ‘viral package’ or the ‘creeping crud’ now has a specific diagnosis. So, what is adenovirus? Adenovirus is a family of viruses that has more than 60 types. It is quite common. You've probably been exposed to it at some point in your life. In fact, by the age of 10-years, most children have had at least one adenovirus infection. It can happen year round but tends to be more common in the Winter and Spring. It is very contagious. Symptoms are variable and range from a mild cold to severe illness. Most people don’t bother to test a little sniffle, so it is hard to have accurate data on how common it actually is. The more annoying and serious presentations include: Runny nose and congestion Pinkeye fever Cough Headache Sore throat Muscle aches Pneumonia Ear aches Vomiting Diarrhea This is indeed the ‘viral package’ with a little bit of everything. The most recent wave, as reported by Dr. Ted, was a “pharyngoconjunctival fever,” aka sore throat, pink eye, and fever. Most cases last from 3 to 7 days, but the more severe cases can last for weeks. Like other nasty viruses, there can be secondary infections.  People with weakened immune systems, or existing respiratory or cardiac disease, are at higher risk of developing severe illness from an adenovirus infection. Exposure and spread The onset of respiratory symptoms is usually between two and fourteen days after exposure. When it is gut related (vomiting and diarrhea) it moves a little more quickly and you will see signs within 3-10 days. People are most contagious right before they get sick or within the first couple of days of the illness. Even people with very mild cases can spread it.  The most common ways that it spreads are Close contact (shaking hands) fecal/oral transmission  contaminated surfaces airborne transmission from one infected person to another.  Occasionally it can be spread through water and public pools Testing More often than not the diagnosis is the ‘best guess’ based on the symptoms. Those red eyes are often a big clue. If the patient is pretty sick or has a persistent illness, then your doctor may opt to do a respiratory panel to get a more definitive answer. A stool sample might also give a diagnosis. Blood work is not usually done, unless your provider wants to rule out something else, but it might show an elevated white blood cell count if done. Treatment Most of the time treatment is based on the symptoms and there are no special medications (or magic wands) This includes, fluids, rest, fever medications as needed and a humidifier at night. Soothing eye drops are helpful for the pinkeye and Manuka honey feels great for the throats (only for folks older than a year.) People who are immunocompromised and get a severe version may need to be hospitalized for supportive care. Those folks may have access to antiviral medications. Prevention Good hand washing and wiping down surfaces are important ways to protect yourself from this. Try hard not to touch your face with unwashed hands. Boost your immune system Try to get enough sleep. Vitamin D and ZInc are associated with a healthy immune system. I also like sambuccol/elderberry at the first sign of illness. Thanks as always to the amazing Dr Ted for his valuable input!!

Slap Cheek 2022

 

Slap Cheek

Slap cheek is one of those illnesses that seems to come around a couple of times a year. Dr. Ted mentioned that he has been seeing a lot of it this week, so it is worth knowing about it. This virus is also known as Fifth disease. It got that name back in the 1880s. At the time, childhood diseases that caused rashes were assigned a number. This was number 5 out of 6. Others on that list included measles and scarlet fever. It is also known as Erythema Infectiosum or Parvovirus B19. I just call it Slap Cheek. Just like Hand Foot Mouth (another of those viruses that make parents question why they signed up for this), Slap Cheek is a contagious rite of passage. Most people get it while they are still children and thus have immunity as adults. The majority of cases happen in kids between 4-14 years of age. It spreads through respiratory secretions, but can also be carried through infected blood. Unless you had a memorable case of it, most people don't actually know whether they have had it or not. You can check with the grandma or grandpa, but I bet they don’t remember either. The symptoms may have been mild enough that no one paid much attention. This illness can be quite variable. Some kids don't seem too impaired while others are miserable. The mild cases can present with a child who has a red chapped cheek for a day or so, and that's it!  The common denominator (hence the name) is one or both cheeks usually appear very red and irritated. Red cheeks aren't definitive. Some kids look flushed when they have a fever no matter what. This diagnosis often has some guessing involved. For most patients, the red cheeks are followed by a lacy, mottled rash that works its way up and down the body. This rash tends to cover the arms and legs more than the trunk. Of course there are exceptions; some kids don't read the textbooks and present in their own unique way. People with more moderate cases often have high fevers. Kids tend to be pretty fussy. These fevers can come and go over a period of several weeks.  In more severe cases it can cause painful or swollen joints (polyarhropathy syndrome). This is much more common in older kids or adults. In rare cases, it can also cause the body to temporarily stop making new red blood cells. This can lead to anemia. People with sickle cell disease, other types of long lasting anemia, or weakened immune systems are more at risk for these complications There is no real treatment for Slap Cheek. Western medicine doesn't have any magic wand for this. What you will likely get out of a visit to the doctor is assurance that there is nothing more serious going on. Four out of five of my patients with high fevers might have slap cheek, but that fifth might be the one with strep throat. In general, if you have a miserable kid with a fever that doesn’t respond to medication, it is usually worth having them checked out.  Frankly, the issue about slap cheek that is of the most concern, is that it can be dangerous to a fetus.  If a woman is infected in the early stages of pregnancy there is an increased chance of miscarriage. If you have a toddler with Slap Cheek, try to minimize exposure to anyone who is expecting. If you are pregnant and may have been exposed, take a deep breath and remember that most women had this as a child and are therefore not at risk. Just to be on the safe side, talk to your OB about getting a blood test to check your immunity. It is not reasonable to try to isolate yourself from your own child. The fact is, they were likely contagious before you had a diagnosis. The incubation period is thought to be about 4-21 days after the exposure. In other words, if you come into your doctor’s office and walk out with a red cheek, you didn't get it there; that would be way too soon. The kids are most contagious at the very beginning of the illness when the main symptom is probably simple fussiness. The cheeks might be red, but you reasonably figure that this could simply be caused by being a little warm. By the time the rash is in full throttle they are probably not very contagious anymore. Often patients have some congestion as part of the package. Treatment is symptomatic. Treat the fevers as needed with Tylenol/Ibuprofen and tepid baths. Make sure your child gets plenty of fluids and rest as needed. My best daycare, camp, and school guidelines are to keep a child home if they are fussy or have a fever. If you have a happy child with a red cheek, it seems unreasonable to expect you to stay home from work. Chances are, once one of the kids in daycare shows up with it, everyone has already been exposed.

Rashes/ When to worry 2020

Rashes/when to worry

Rashes are a fact of life. Over the course of my career as an advice nurse, you can't imagine the scope of the emails I have gotten from people asking for me to help them figure out what is going on. Some came along with photos of random body parts, not all of them easily identifiable. Rashes can be spotty, blotchy, hivey, oozy. They can be caused by allergies, bug bites, scabies, bed bugs, poison oak, contact dermatitis, virus, bacteria or fungus. They can be on only one body part or cover most of the patient. They can be part of a chronic condition that comes and goes, or something acute. Once in a while I can look at a photo of a rash and have a good guess of what I am looking at, but more often things aren't completely clear cut. The most important thing really comes down to one very important and basic question: "Do we need to be worried about this rash or not?" This has never been more important. Data is continuing to emerge about a multi system inflammatory disorder in children that is apparently connected to COVID-19. It is very rare, but important to be aware of.  Rashes that I am curious about If your child is acting fine but has a random rash, ask yourself the following questions: -Are there any new medications (especially antibiotics; even if it is the end of a course, this is important information) ? -Was there a recent illness/fever? If you had a mystery fever and then a rash comes out once the fever is gone, I am NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash Do they have a history of eczema or atopic dermatitis (tends to be a common culprit)? Have they had a MMR or chicken pox vaccination within the past 2 weeks? Are there any new foods? Have they been enjoying lots of citrus or berries lately? Are there any new soaps, detergents, bubble baths? Have you used a new sunscreen or lotion of any sort? Do you have pets? (Think fleas!) Has there been an exposure to a new animal? (think allergies) Has your child been in a hot tub? Is the weather very warm? (my San Francisco babies don’t like the heat) Has your child been laying in the grass or sand? Has there been any recent travel? Any recent hiking? (think poison oak) Has your child done a recent art project with a new substance? Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around? (shudder) If your detective work has given a promising clue, make the common sense adjustments and see if you see any improvement. Regardless of what is causing a rash, there are several basic staples that are worth keeping on hand. The first several on the list are used for basic skin care and can be somewhat preventive. Cetaphil cleanser (no water needed, apply and wipe off) Aquaphor or Cerave ointment A good moisturizer You all know that I love adding a splash of apple cider vinegar to the tub for all sorts of rashes Over the counter hydrocortisone cream/ointment for itchy areas Over the counter Neosporin or prescription Mupiricin for any open areas Over the counter anti fungal cream/ointment for any possible yeast rashes. oatmeal bath (don't clog your drain with real oatmeal, there are special products used for this) Zyrtec or Benadryl Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections. Of course feel free to call your advice nurse or doctors office to help you troubleshoot. If a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn't helping, You may be sent to the dermatologist. Rashes that I am worried about Any purple rash needs to be evaluated. These rashes don't lighten up when you press on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make me even more concerned. These kids look SICK! Any rash that comes along with a fever at the same time is probably worth being seen. Strep throat can do this. Fortunately measles is not common at the moment, but that also would present with a rash and fever at the same time. The patient will look sick. Other viral syndromes that may have the rash and fever at the same time are Slap Cheek and Hand Foot Mouth. We don't have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out. If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common. If your child has a history of impetigo and you already have Mupirocin, you can try to treat a small area. If it isn't clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated. If a rash seems to have clear fluid filled centers, it could be chicken pox! If the rash seems very painful or itchy certainly try Zyrtec or Benadryl, but if your child is uncomfortable let's get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids. Hives are scary because most people associate them with a severe allergic reaction. What most people don't realize is that most of the time hives are not always a big deal. They are a signal that the body is reacting to something, but often it can be viral. I have had patients with mystery hives that have cycled on and off for several weeks before finally fading. If your child has hives along with any facial swelling or difficulty breathing, they need immediate attention. If they have a history of severe allergy to something, you should have an epi-pen or AuviQ on hand and follow that up with an emergency room visit for some close monitoring. Any painful rash that is only on one side of the body and doesn't cross the midline could be shingles. It is rare for children to get this, but it can happen. Here is an important update to this post. Data is continuing to emerge about a multi system inflammatory disorder in children that is apparently connected to COVID-19. It has some similarity to a rare illness called Kawasaki Disease that causes blood vessels to become swollen or inflamed throughout the body. This new Pediatric Multisystem Inflammatory Syndrome (PMIS) has many similarities, but where Kawasaki is much more common in patients under 5 years of age, this new illness doesn’t care so much about the age. The kids look sick! As Dr. Ted from Oath Pediatrics says, most parents can easily recognize that these kids need to get right to the hospital, not wait to get a call back from the doctors office. This is a very serious condition. Most kids will recover, but medical treatment and hospitalization are essential. Red flags include: swelling and redness in the hands and feet redness or cracking in the lips or tongue swollen lymph nodes in the neck high fever red eyes belly pain trouble breathing confusion A child who has a rash, but is happily playing and doesn’t have other symptoms mostly likely does NOT have PMIS. Scroll up to the rashes we are curious about. So to recap, if you are WORRIED, make sure that you are seen sooner rather than later. If you are simply curious, it is time to play detective!

Nurse Judy' Blog

Welcome to my blog.

When I was the pediatric advice nurse at Noe Valley Pediatrics in San Francisco,  I answered questions about a huge variety of topics. I also soon recognized that I got the same questions over and over again.

I started writing these posts in order to save myself from repeating the same answers constantly.

I combine 40 years of being a pediatric nurse with my experience of raising children (and now grandchildren) of my own. My approach combines the desire to treat things as naturally as possible, staying on top of the current data and a large dollop of common sense.

I understand that there are SO many opinions out there about just about every topic.

 It can be confusing and overwhelming!

My suggestion is that you  gather all of the various suggestions, sift through them and then figure out what instinctively feels right to you. If you try something and it doesn't work, learn the lesson, go back to the well and try one of the other choices.

I am just one more opinion to add to the list (but my batting average is pretty high)

If you are looking for advice about a  particular topic, You can put the title in the search bar and see if I have covered that.

You can also skim through the list at the bottom. Once you know when the post was written, it is fairly easy to scroll down on the right and click on the month and year

I send out an email to folks on my list  when I do a new post. If you would like to be added,just send me an email to nursejudysf@gmail.com or find me on substack.

Over time I have covered a wide and odd assortment of subjects, but  I am happy to get comments or requests on topics that you would like me to address.

I hope you find these posts helpful.

~Nurse Judy

March 2013
Creative things to do with your child

June 2013

Blocked tear ducts
How much sugar is too much ( Nurse Jen)

August 2013
Tylenol before vaccines?

October 2013
Nurse Charity on biting

December 2013
Vick vaporub on your feet?

February 2014
Impetigo

March 2014
Charity on warm weather nursing

April 2014
Roseola

May 2014
Your baby's weight/growth chart
spitting up
Nurse Jen blogs on how words matter

June 2014
Is it a Urinary Tract infection?

July 2014
Travel tips
Thrush (Nurse Charity)

August 2014
infant acne
Hep B/your first vaccination opportunity

September 2014
Pacifiers: Friend or foe
Tech time: how much is too much
Keeping play dates safe (Nurse Jen)

October 2014
Enterovirus D68

November 2014
Temper Tantrums

problem solving skills


January  2015
Febrile seizures

February 2015
Charity blogs about nipple wounds

May 2015
Sleep tidbits part 1 infant
Sleep tidbits toddler/ shifting naps
Sleep tidbits  leaving the crib behind

June 2015
Head aches
travel tips (updated)

July 2015
Cord care

November 2015
parapertussis


January 2016

cradle cap

February 2016
Vicks vaporub on the feet (update)

May 2016
Night Terrors (update)
Bed wetting

June 2016
Fathers Day post ( Mr Nurse Judy)
Talking to your kids about horrible headlines

July 2016
Travel tips (update)
Eye health/vision

September 2016
Achieving a healthy weight (update)


November 2016
Antibiotic considerations
taking your baby out into this germy world ( update)
story telling ( update)

February 2017
Zika (update)

March 2017
Flat heads/PT options

May 2017
Mothers Day musings

June 2017
Father's Day
Water safety/ Dry Drowning

July 2017
Swimming ( update)


August 2017
Food Heroes and Villians
Problem solving skills (update)
First aid kit


September 2017
Organizing your stuff ( update)

October 2017
Smoke and air quality

November 2017
The Impact of a single sentence

December 2017

Inhaler tips/Reactive airway
The best Present is your presence 2017
Will the real Santa please stand up 2017

January 2018
Building and protecting your immune system
Old letters and pictures

February 2018
The Misadventure of Nurse Judy/Managing stress 2018
We could all use a little bit more Mr Rogers

March 2018
The Back to work transition 2018
Dealing with Altitude 2018
Travel 2018
Attitude
Vision Health 2018

April 2018
Urgent care options 2018
Constipation 2018
TemperTantrums 2018
Warts and Molluscum

May 2018
Diaper changing tips
Lessons from my Mom

June 2018
Talking to your kids about homelessness
The Partners Job
My Fathers Influence

July 2018
July 4th safety tips (2018)
Speech milestones ( 2018)
Drowning/appoint a water guardian

August 2018
Motion sickness ( 2018)
Epipen/anaphylaxis ( 2018)

September 2018
Mental illness
Attention
Time outs

October 2018
Acute Flaccid Myelitis

November 2018
Pie Theory/Finding balance 2018
Air Quality
Impact of the recent smoke/radical acceptance 2018

December 2018
Keep a journal 2018

January 2019
Vaporizers/humidifiers 2019
Pertussis 2019
Four month sleep regression

February 2019
Head injury 2019
Hepatitis A 2019
Talking to your kids about sex 2019
Tech time/how much is too much 2019

March 2019
Urgent care options 2019
Cleaning up made simple 2019
Chicken Pox/Shingles exposure guide 2019

April 2019
There is no such thing as a silly question
Poisonous plants 2019

May 2019
The amazing Nanya/Mother in Law
Nurse Judy the mom
Bath time 2019

June 2019
Measles by the numbers
Fathers day Post
Travel safety

July 2019
Allergy alternative 2019
Lead exposure 2019


August 2019
When kids play favorites
Sleep tips/ insomnia

October 2019
Branching out from English only

November 2019
The Power of story telling 2019
Election time

December 2019
The Best Present is your presence 2019
Holiday safety 2019
The World can use more Mr Rogers 2019

January 2020
Habits update 2020
Flat head/ tummy time update 2020
Building and protecting your immune system

February 2020
Novel Corona Virus
Selling the family home/the end of an era
Covid-19 update
Adverse Childhood experiences

March 2020
social networking
Quarantine tips
Assessing Priorities

April 2020
Too much togetherness
It is okay not to be right all of the time
Poison Oak ( update)
Finding Humor in the time of Quarantine

May 2020

The science of hair loss

The impact of a single sentence ( update)

Vitamin D (update)

Rashes/when to worry ( Update)

Talking to your child about sex ( update)

June 2020

In Memory of Uncle Landshark
Stop feeling guilty for finding moments of joy 

 Decisions about the quarantine

 Drowning

 July 2020 

 Dealing and managing emotion

 Blink my baby is turning 30 

Dietary guidelines 2020 

August 2020 

Ergonomics 

Happy Birthday Lauren 

How trivial choices can make a huge impact

 September 2020 

 Mosquito bites 

 A story of the mysterious socks 

 Talking to your child about Loss

October 2020

 Family tree info

Happy birthday to Frida the lamp

Dealing with the time change

November 2020

Teach your child how to be a good winner or loser

Thanksgiving/food safety ( update)

Holiday safety checklist 2020 (update)

December 2020

Talking Barbie takes a bath

Santa and Covid (update)

The christmas Cactus

January 2021

Give your kids the gift of music

I am a Grandma!

Car Seat Guide 2021 ( update)

Having a baby is HARD

Basic Butt Care (update)

February 2021

Covid one year later

Heavy metal in Baby Food

Do you know your love language?

Carbon Monoxide (update)

March 2021

Passover musings

Cleaning up made simple (update)

Eczema management (update)

April 2021

Lessons from my mom(update)

Poisonous plants (Update)

Astrological shenanigans

May 2021

Talking to your children about Homelessness ( update)
 

June 2021

Making sense of the changing Covid Guidelines

Air safety in your classrooms and homes

Ghosts and Radios

July 2021

July 4th safety guide (update)

Things we take for granted

The Magic and importance of play

Motion sickness ( update)

September 2021 

A story about strange coincidences

Forgiveness and atonement

October 2021

Fever (update)

Earthquake preparedness

Halloween safety tips (update)

Dealing with Time shift (update)

November 2021

Lead poisoning/prevention (update)

Adverse childhood experience (update)

Covid vaccine children 5-11

December 2021

The best Present is your presence (update)

Travel safety tips ( update)

Travel tips part two (update)

Holliday angst and Joy

January 2022

Keep a journal (update)

Croup ( update)

Pain and Fever reducers with dosage charts ( update)

February 2022

Healthy fish as part of your diet

Head injuries (update)

Talking to your child about differences

March 2022

Horrible headlines (update)

Tick bites (update)

Febrile seizures (update)

April 2022

April Tuesday

Tips for giving medicine (update)

No such thing as a silly question (update)

Slap cheek (update)

June 2022

Hepatitis A (update)

Stories about my dad

Covid Shots for the little ones

July 2022

Sids/crib safety (update)

Melatonin (update)

Swimming guide (update)

Intentional communication (read this if you are bickering with your partner!)

colds and Congestion (update)

August 2022

spotlight on Polio

insect and Mosquito bites (update)

When your child is holding the keys and you are locked out

September 2022

Dealing with stress (semi update)

Flu vaccine 2022/23

hitting/biting/kicking

Grandparents and boundaries

baby poop

October 2022

conjunctivitis (update)

Skinfold irritations (update)

November 2022

sippy cups (update)

RSV (update)

pinworms (update)

Thanksgiving/food safety tips (update)

December 2022

Nothing as fun as a big box

Ear infections (update)

Holiday Safety tips (update)

talking to your child about Santa (update)

Managing tylenol shortage

January 2023

Homage to Uncle Bert

Gun safety (update)

February 2023

Potty training (update)

Those wacky parental moments

Milestones/shmilestones

How loud is too loud? (update)

March 2023

The milk transition/calcium (update)

Good Dental habits (update)

Poisoning

Organizing your stuff (update)

Adenovirus

April 2023

Travel stories

May 2023

sunscreen (Update)

speech and language milestones (update)

Mothers Day 2023

Managing seasonal allergies

June 2023

Identify and mange your emotions

Chinese medicine and the summer season

Father's Day 2023

Head Lice (Update)

July 2023

Probiotics

Parent GPT

Measles 2023/global travel info

August 2023

Poop and solid foods (update)

The Pie Theory of life (update)

The enormous impact of seemingly trivial decisions (update)

September 2023

What would you do if?/problem solving pearl ( update)

Understanding medical terminology/How is your Greek and Latin?

Making the most of your doctor's appointment

Flu shot info for the 23/24 season

Forgiveness and Atonement (update)

October 2023

RSV (update)

Earthquakes and natural disasters ( update)

Dealing with Bullies (update)

My favorite piece of advice

November 2023

Strep Throat (update)

Creating healthy Sleep routine

When is your child contagious? (update)

December 2023

Gratitude

They put What in their mouth? (update)

Dealing with the long dark days of winter

Personal musings/end of a start up

What is in your medicine cabinet? (update)

January 2024

Happy Birthday Elliot

Colic and fussiness (update)

Chaos versus  quiet

kids stick things into all sorts of plaes

February 2024

Iron

Introducing allergens to your baby

election/get out to vote

March 2024

introducing a new sibling

hello from the rocking chair at 1 pm

Red hair/story about my grandmother

May 2024

Hotel bathrooms

kids and pets

June 2024

Nursing strikes

Breastfeeding resource

honesty

July 2024

dealing with excessive heat

my covid tale

August 2024

Back to school adjustment

Talking to your child about germs

September 2024

Picky eating

family dinners

October 2024

A Rosh Hashana message from beyond

Solid Foods document

Halloween safety tips 2024

Can you love your siblings more than you love their politics

November 2024

The Ghost in the Mirror

The world can you a little more Mister Rogers

Intensive Parenting

December 2024

Gift giving season

Pertussis and Walking pnuemonia

Holiday Angst and Joy

The gasoline Balloons

January 2025

The Christmas Cactus

Tummy Bug Basics

Colds and Coughs

Fevers

February 2025

Head injuries

Do you know your love language?

Measles

March 2025

Urgent Care vs ER

April 2025

How is your micro world?

Lessons from my mom

Crib safety/ Sids prevention

May 2025

Do you know how your grandparents met?

Mothers Day Musings

Once Upon a time I made up a Fairy Tale

June 2025

Say Yes when it is an option/  a pillow and a new suitcase