Archive for the ‘Children’s Health’ Category



There appears to be an outbreak in our community of a benign (non serious) viral infection caused by a virus called Coxsackie. This infection can manifest itself in two ways.

First it may be seen as hand, foot, and mouth disease. The most common manifestation of this disease in children causes symptoms of fever, runny nose, sore throat, and poor appetite, all beginning about 4-5 days after exposure. Several days after these symptoms occur, a blister-like rash forms in the mouth, on the palms of the hands, and on the bottom of the feet. It takes about a week for the rash to clear up.

The other manifestation of this disease is called herpangina, where along with the fever and fussiness, the mouth has painful blisters, but no involvement of the hands or the feet.

This virus usually occurs in children under 10 years of age, but as it is doing now, it can occasionally occur in middle and high school students as well as young adults. It is spread by direct contact with nose and throat secretions, blisters, and feces of infected people.

Contagiousness begins with the onset of the first symptoms and continues for about 5-7 days. The virus may remain in the stool for several weeks.

There is no known cure for this infection. Because it is caused by a virus it just has to run its course. Treatment of the symptoms includes over the counter pain medications such as Tylenol (acetaminophen) or Advil (ibuprofen). Lifetime immunity may occur, but not always. Pregnant women who have been exposed to this illness should consult with their doctor.

Most of us who treat children with this disease feel that they can return to day care or school when the fever is gone and the child feels well. This usually takes about one week from onset of the first symptoms. Thorough hand washing in general, particularly after changing diapers, is important in limiting the spread of this disease.

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I’d like to talk about several common activities involving our children, how to ensure safety and to avoid unnecessary injury.

Playground injuries, mostly from falls, account for over 200,000 emergency room visits per year. The highest risk group is five to nine years of age. Young children need close adult supervision.

Make sure that underneath the equipment there is an adequate shock-absorbing material, such as chipped wood or any type of rubber product. Also, one needs to inspect the equipment to ensure that it is in good repair.

Bicycling (300,000 emergency visits a year) and skateboarding (30,000 visits) are the leading cause of head injury accidents in children. Proper safety for these activities includes adult supervision of younger children, routine bicycle maintenance, and mandatory use of head-protective helmets. These helmets must be proper to the activity and they must fit appropriately, but most importantly they must be worn!

Swimming accidents leading to drowning, and are the second leading cause of injury death among children 14 years and younger. All pools must be adequately fenced in and have properly functioning gates. Injury can be avoided by not running around the pool, not jumping onto floating objects, and proper use of a diving board. Again, adult supervision is paramount in preventing swim-related activities.

In 1971, trampoline injuries led to the NCAA eliminating the trampoline from sports competitions. I’m sure it’s also why we don’t see this event in the Olympics.

Trampoline injuries cause 80,000 emergency visits per year, for children age five and younger. If you own a trampoline, do not allow a smaller child to be on a trampoline with a larger child, as the smaller one is 14 times more likely to be injured.

In fact, one should follow the manufacturer’s recommendations and not allow more than one person on a trampoline at a time. Safety netting around the trampoline is essential to protect a child but is not foolproof to prevent injuries.

As with all the above activities, adult supervision is mandatory.

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With the holidays upon us, I wanted to take this opportunity to talk about holiday safety — especially for our children. I will discuss just a few of the many recommended safety precautions.

Poisoning: Contrary to popular thought, the poinsettia plant is not poisonous, but could make a little one quite sick if ingested. Mistletoe and holly are considered poisonous. Be careful with these plants.

Choking: Children have a natural tendency to put things in their mouths. The following are items to keep away from little children: small toys or larger toys that can be broken down into smaller pieces, small batteries, small decorations and ornaments, coins, and food such as peanuts, popcorn, and small hard candy.

Clean up carefully after opening presents as little ones can choke on scrap pieces of tape, wrapping paper, and ribbons. Look carefully around your living environment and be aware of children’s exposure to anything that will fit in their mouths.

Burns: Place candles in a safe location far from the reach of a young child as well as away from flammable objects such as curtains, decorations, and the good old Christmas tree.

Keep matches and cigarette lighters out of a child’s sight and reach. Do not leave burning candles unattended and especially remember to extinguish them before going to bed. Have a fireguard in front of the fireplace.

Do not burn wrapping paper in fireplaces and be sure that the area around the fireplace is free of combustible material. Look around closely for potential fire hazards. Keep hot drinks and food out of a child’s reach.

Injuries: Check new and existing furniture, TVs, and equipment, to be sure they cannot be tipped over easily. Ensure that outdoor play equipment is assembled properly and has a soft surface underneath.

I can’t stress enough the importance of children wearing a helmet when riding bikes, scooters, etc. Too many children are seriously injured or killed from a head injury which could have easily been prevented by wearing a helmet.

Tree safety: Make sure at time of purchase that an artificial tree is labeled “fire resistant.”

When purchasing a live tree, be sure it is as fresh as possible. This can be done by shaking the tree to see if an over abundant number of needles fall off.

Place the tree in a secure stand with water as soon as possible to keep it from further drying. Do not position it close to heat sources such as fireplaces, heating vents, and radiators.

Use only flame resistant or non-flammable decorations to adorn the tree.

And now, a word to adults.

Christmas is a fun and social season, when a fair amount of alcohol and salty food can be consumed.

A bit of overindulgence can cause “holiday heart” syndrome which is due to an abnormal heart rhythm manifested by a fast and irregular heart beat.

People with a history of atrial fibrillation are more susceptible to this condition, which although serious, is usually not life-threatening. If it lasts more than a few hours, or if you feel short of breath, have chest pain, or feel faint, go to the emergency room.

And please, if you decide to enjoy alcoholic beverages, do not drive. Have a designated driver. Being in an accident or arrested for drunk driving is just not worth it.

Have a very happy and healthy holiday season.

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The winter “respiratory, cold, and flu” season is upon us. I have seen quite a spike in visits to urgent care with people suffering from coughs, nasal and sinus congestion, sore throats, and generalized achiness.

I believe that people, now, more than ever realize that there is no cure for the common upper respiratory infection also commonly known as “URI” or head and chest cold.

I am sympathetic to anyone who feels ill and I understand one’s desire to feel well as soon as possible, but there just is no quick fix to the common URI including bronchitis and sinusitis.

Unless one’s symptoms last longer than expected, as I will describe below, antibiotics will do no good and may even cause unwanted side effects and help to create germs that are resistant to antibiotics.

Here are some reasons why someone with URI symptoms should be seen by a doctor:

– You have a fever of 103 F or higher.

– You have any fever lasting more than three days.

– Your cough is associated with wheezing, chest pain, or shortness of breath.

– You are elderly or have a compromised immune system due to chronic disease or chemotherapy.

– You are basically well except that you have a cough for two to three weeks.

– Your sinus congestion with green nasal mucous doesn’t improve after 7-10 days.

Most all coughs, even with yellow or green mucus, are considered bronchitis and are caused by viruses which cannot be cured with antibiotics.

A recent large study concluded that bronchitis can last up to two or three weeks. If your cough lasts longer than this, you should see your doctor.

Another reason to see your doctor is if you have a cough associated with fever, shortness of breath, and feeling as if you’ve been “run over by a Mack truck” — then you could have either pneumonia or influenza for which treatment is available.

Regarding sinusitis, almost all sinus infections, even with green mucus production, begin as a common virus infection and will improve without antibiotics. If these symptoms last more than 7-10 days, then an antibiotic may be indicated.

When you do see your doctor, let them evaluate you by listening to what you have to say, examining you, and then determining what type of treatment is necessary to make you feel better.

P.S. It’s not too late for the flu shot. Influenza cases are just beginning in our area, and as is happening in other parts of the country, this disease may spread among us quickly. Better safe than sorry.

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According to a recent public health alert, California is experiencing an epidemic of pertussis, with over 5,000 cases reported this year.

Santa Cruz County has had at least 60 known cases (twice the number as last year) and probably many more cases, which have not been reported or have yet to be diagnosed.

Pertussis, also called whooping cough, is a highly contagious infection of the lower respiratory tract, involving the lungs. It usually manifests as a mild persistent cough, but can advance to a severe cough. Often in children, this cough is followed by a high-pitched intake of breath that sounds like “whoop” – thus the name “whooping cough.”

Pertussis is caused by a germ which is a bacteria and not a virus. It is passed from an infected person who sneezes or coughs and therefore spreads infected tiny droplets into the lungs of anyone who may be nearby.

Once in the lungs, the germs can cause an infection, thereby creating inflammation and narrowing of the lung’s breathing tubes. This produces the cough and the characteristic whooping sound.

Infants are particularly vulnerable because they are not fully immune to whooping cough until they’ve received at least 3 immunization shots.

This leaves those 6 months and younger at greatest risk for catching the infection.

The pertussis vaccine one receives as a child wears off in 5 to 10 years, leaving most teenagers and adults susceptible to the infection during an outbreak.

Also, more parents are choosing not to vaccinate their children, thus lowering the number of immunized individuals. This, coupled with the fact that newer vaccines are less potent than the older ones, has increased transmission of pertussis.

The diagnosis of pertussis is often delayed or missed in infants because early symptoms are often mild and the serious cough may not begin for days or even weeks later.

A severe infection in infants can be fatal, although this is thankfully rare. Three infant deaths due to pertussis have been reported in California since the beginning of the year.

One must consider pertussis for anyone with a cough lasting more than 2 weeks, especially when the person generally feels well, coughs worse at night, and has prolonged coughing spells.

The vaccine for pertussis is combined with the tetanus and diphtheria vaccines which are routinely given to children in their first years of life, and to adults every 10 years.

Besides infants, those who especially need the vaccine protection are pregnant women in their third trimester because they will soon have contact with their unprotected infant.

Mothers have been found to be the greatest source of transmitting whooping cough to the newborn. Infants can also be protected by vaccinating those people who have close contact with them.

This “family” protection has been highly successful in protecting susceptible infants.

Tests are available to diagnose pertussis. The decision whether or not to test should be left to your doctor.

Antibiotics can be effective especially when given soon after symptoms begin. After several weeks of symptoms, they are much less effective.

Family members can also be prescribed preventative antibiotics. Remember that pertussis is caused by bacteria and can usually be treated with an antibiotic, but if you just have a bad cough from something like routine bronchitis, which is caused by a virus, antibiotics are not effective.

Your doctor will be able to determine the proper diagnosis and treatment.

Bottom line: I recommend to immunize your children and keep immunizations up to date for yourselves.

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Small pox, polio, diphtheria, tetanus, measles, mumps and rubella are all potentially life-threatening diseases that have been almost completely eliminated from our society during our lifetimes. The reason for this is the routine childhood immunization program that has been widely accepted in the United States, as well as most of the modern world.

We often hear about the supposed side effects of immunizations, but we rarely hear about children getting the very diseases that the vaccines protect against. That’s because the immunization program has worked so well in preventing diseases that could have killed millions and caused untold suffering.

In fact, we’ve been so successful immunizing children and preventing diseases that some might wonder whether vaccines are still needed.

Here’s why immunizations are still necessary:

– Newborn babies are immune to many diseases, because they have antibody protection from their mothers. This immunity is mostly gone by the end of the first year of life, leaving unvaccinated babies susceptible to the abovementioned vaccine-preventable illnesses.

– Although our country has virtually eliminated these diseases, many Third World countries with poor immunization programs are still plagued by vaccine-preventable illnesses. These diseases are only a plane ride away. An infected traveler could bring such an illness back to the States, where it could spread rapidly if people were not adequately immunized.

– In the U.S., pertussis (whooping cough) is making a comeback, and tetanus is still infecting some people.

– Widespread immunization is necessary because it helps to keep a disease from spreading within a population. This helps to protect those few who, whether by choice or by necessity, are not immunized.

Immunizations are safe. A decade ago, an unsubstantiated study tried to link immunizations to autism. A well-publicized article from England sounded the alarm connecting the measles, mumps and rubella vaccine to autism. This started a grassroots movement that has led many to reject all vaccinations. However, the majority of the authors of that article have withdrawn their support for it, and the lead author was found guilty of professional misconduct and had his license to practice medicine revoked.

Many well-controlled scientific studies have all concluded that there is no scientific or statistical relationship between immunizations and autism.

Unfortunately, the rates of immunized children entering kindergarten in Santa Cruz County are some of the lowest in the nation, with only 84 percent fully vaccinated. The San Lorenzo Valley is even lower, with just 65 percent fully immunized.

Just recently, Felton had a measles scare, prompting a major investigation. The outcome was favorable this time, as it did not infect anyone except the carrier, but a significant epidemic could spread through our area in the future because of our low immunization rates.

Until vaccine-preventable illnesses are eliminated worldwide, as with deadly smallpox — a result of the most successful immunization program ever — I strongly recommend that as many of our children as possible be routinely immunized and thus protected from potentially life-threatening diseases.

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Last year, my daughter complained to me about back pain. I wasn’t sure what was causing her discomfort until one day when I had to lift her school backpack out of my car. I almost threw my own back out.

I couldn’t believe how heavy it was. It weighed 20 pounds, and my daughter weighed 80 pounds.

Carrying a heavy backpack can be a source of low-level trauma leading to shoulder, neck and back pain in children. This is especially true for those school kids in middle and high school who have neither lockers nor desks to store their books in during the school day.

Experts recommend that children carry backpacks that weigh 10 percent or less of their body weight and no more than 15 percent.

The way a backpack is carried may contribute to the problem. Some kids wear their packs over only one shoulder, often because it’s “cool” or just plain easier. That causes them to walk unbalanced, causing abnormal stresses on their young developing spines.

A heavy backpack may make a bicycle rider top-heavy and less stable on the bike, potentially leading to accidental injuries.

A good backpack should have the following features:

– Lightweight construction

– Two wide, padded shoulder straps

– A padded back, for comfort and injury protection

– A waist belt and multiple compartments to distribute weight more evenly

We as parents need to be aware of this potential problem and be proactive in helping our children make best use of their backpacks.

Children should be taught to pick up their bags properly, by bending at the knees before lifting and using both hands.

Keeping straps tight will help with proper fit.

Remind children to use all of the backpack’s compartments, putting the heaviest items — such as textbooks — near the center of the back. They should not to carry around unnecessary personal items.

Also, take advantage of using available online books that don’t have to be carried around.

If your child continues to have back pain even after making the above adjustments, or has numbness, weakness or tingling in the arms or legs, consult with your doctor.

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