Q: What are the most common allergy triggers?
Spring is truly the peak season for allergies, and our changing climate has extended its duration. Tree and grass pollen are the most prevalent this time of year. Families should consult sites like pollen.com to monitor relevant pollen levels for the areas they will be visiting this spring.

Q: What are the differences between a common cold and allergies in younger children?
Seasonal allergies typically appear after age 2, and their prevalence increases thereafter. Before that age, many of those symptoms are usually viral upper respiratory infections; however, we can look at the pattern and duration of symptoms to distinguish them. If there is a family history of atopy (such as allergies, asthma, or eczema), it helps clarify that the patient may be allergic. Sneezing, itchy eyes, and clear nasal discharge are more common in allergies, while coughing, congestion, and thick mucus are more characteristic of respiratory infections.

Q: When staying in hotels or vacation rentals, what are some potential hidden allergens?
There are several allergens to consider: pet dander, mold, dust mites, and even contact allergens in the provided personal hygiene products.

To lower these risks:

• Bring your own dust-mite-proof pillowcases or your personal pillow.
• Mold requires moisture, so inspect the property for visible water damage and ensure proper ventilation upon arrival.
• Pet dander can persist even after the animal is gone; therefore, request pet-free accommodation if allergies are a serious issue.
• If you are concerned about contact allergens, it is recommended to bring your own toiletries.
   

Q: What should be included in an "essential kit" for an allergic child who is traveling?
Dr. Waters emphasizes avoiding Benadryl due to its potential side effects, which include cognitive effects and arrhythmias (abnormal heart rates). However, there are other options for treating allergies that are more effective:

• Nasal sprays, such as Flonase or Azelastine, are excellent primary treatments.
• For additional relief, second-generation antihistamines like Zyrtec, Allegra, or Claritin are ideal, as they come in practical formats like liquids or chewable/dissolvable tablets.
• For the eyes, use preservative-free cooling drops or itch-relief drops like Pataday, but avoid Visine, as it can be irritating. Saline drops or a nasal wash bottle are also excellent for clearing out allergens.
• Finally, if your child has asthma or severe allergies, never travel without their inhaler or prescribed EpiPen.

Q: What immediate steps should be taken if a child has a sudden allergic flare-up?

• Identify and remove whatever triggers the reaction. If you know it is due to pollen or a pet, remove the child from that environment. It is recommended to administer a full dose of antihistamine such as Zyrtec, if the reaction includes hives or swelling and does not include anaphylaxis.
• If your child is asthmatic and needs an inhaler for respiratory issues, use it.
• Another over-the-counter medication is Famotidine (Pepcid), which is used to treat hives or swelling.
• If you observe an anaphylactic-type reaction and have been prescribed an EpiPen, use it immediately. Remember to always seek medical attention right after use.

It is rare for seasonal allergies to cause anaphylaxis, which include loss of consciousness or difficulty breathing/swallowing. You must monitor your child to ensure none of these symptoms are present and seek emergency care if they appear.

Q: Are there new treatments or preventive measures?

• First-line treatments remain to be nasal sprays, followed by antihistamines.
• A saline rinse helps clear mucus. By optimizing the sinuses and upper airways, it helps control any infections or allergies occurring there, as well as any subsequent respiratory issues. Additionally, nasal washes, such as rinsing bottles, neti pots, or other child-specific products, help decrease the total allergen load.
• Showering after being outdoors helps remove pollen residue.
• Keeping windows closed during peak pollen hours or when driving long distances helps reduce pollen exposure.

Long-term Options
Allergy shots exist for children with severe symptoms, but these require dedication and commitment. Children with significant allergies, asthma, or eczema might qualify for an injectable medication called "biologic." If you are facing these issues, consult your doctor about this possibility.

Other Related Stories:

• Does My Kid Have Allergies, COVID, a Cold or the Flu?
• How to Treat Your Child’s Seasonal Allergies
• Essential Oils and Their Use on Children

The holiday season is full of fun and festivities but with all the excitement, accidents can happen. By taking a few simple safety steps, families can reduce the risk of injuries and focus on what matters most: enjoying time together.

Food Safety & Allergies

The holidays often revolve around food and family gatherings but for children with food allergies, celebrations can be stressful. A food allergy reaction can cause symptoms that range from mild to life-threatening. In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting.

Tips for parents:

• Communicate clearly with teachers, nurses, family members, and friends about your child’s allergies before the event.
• Bring safe dishes your child can enjoy.
• Always have epinephrine auto-injectors on hand. It is the first-line treatment for anaphylaxis, which works to reverse the life-threatening symptoms.
• Practice at home so your child knows what to do if a reaction occurs.

With a little bit of preparation and awareness, families can enjoy a safe, joyful, and worry-free holiday season.

Car Safety

During this busy travel season, make sure everyone is buckled up correctly. According to the National Highway Traffic Safety Administration (NHTSA), motor vehicle crashes are the leading cause of death for children. NHTSA estimates car seats and proper installation of them have saved more than 11,600 children under the age of five since 1975. 

Best Car Seat for Your Child

• Rear-facing: For infants through preschoolers. Supports the head, neck, and spine until your child reaches the seat’s height or weight limit.
• Forward-facing: For preschoolers through school-age kids. Please keep them in a 5-point harness until they outgrow it.
• Booster seat: For kids who’ve outgrown a harness but aren’t ready for a seat belt. Ensures proper belt fit.
• Seat belt: The final stage is when your child is at least 4 feet 9 inches or 57 inches tall and the belt fits snugly across the hips and shoulder.

Free Car Seat Checks

Texas law requires children to ride in a safety seat until age 8 or 57 inches tall.
The Injury Prevention Collaborative offers free car seat checks by a certified Child Passenger Safety Technician (CPST). A CPST can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

Call 682-885-2634 or click this link https://freecarseatcheck.as.me/schedule/d3206e82.

Those without appointments will be seen on a first-come/first-served basis. You must have your child with you, unless you are an expectant parent.

When it comes to life-threatening food allergies at school, teachers make all the difference. 

“It is about prevention,” said Ankita Singh, D.O., pediatrician at Cook Children’s Pediatrics Walsh Ranch. “Teachers need to be involved from the beginning and incorporate the food-related safety precautions just like it is part of the normal school day.”

As a mom of two kids with life-threatening food allergies, I know that the school experience largely depends on the understanding and empathy of those involved. Kindness goes a long way.

One in 13 children has severe food allergies (about two per classroom), and 75% of these cases occur in children with no prior family diagnosis. Chances are most children will know someone with food allergies and could save a life.

A food allergy reaction can cause symptoms that range from mild to life-threatening. In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting. Anaphylaxis is a serious, life-threatening allergic reaction that typically affects more than one part of the body at the same time and may include hives, wheezing, high heart rate, rapid swelling and trouble breathing. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction.

Clear Communication is Key

Parents need to be very clear from the beginning with everyone at the school – teachers, nurses, administrators and other parents. They should discuss the food allergy action plan with the school nurse, informing them what foods the child should avoid and what to do in case the food was eaten, or they have been in contact with it.

“For lunches and birthday parties in the child’s classroom, the school should tell the parents not to include the allergens to avoid cross-contamination and the risk of severe allergic reactions,” Dr. Singh said. “Make sure the child is aware of what to do if there is exposure at school. Run through the scenario at home so all aspects are covered the best you can without being there.”

The nurse should also receive two epinephrine autoinjectors – the first-line treatment for anaphylaxis which works to reverse the life-threatening symptoms. A delay in using epinephrine is common in severe food allergic reaction deaths.

“Parents need to be vigilant about checking the epinephrine autoinjectors for expiration dates as well as dosage,” Dr. Singh said. “There are different doses for weight and age as children get older.”

If epinephrine is used, the child must be monitored at the emergency department as they could still have a rebound reaction.

Empowering Kids to be Kind

About one-third of children with food allergies report being bullied because of their allergies. The reported bullying ranges from verbal teasing or criticism to more obvious acts such as an allergen being waved in their face or intentionally putting it in their food. Therefore teachers leading by example can show what it means to put others before yourself. This can change the trajectory for children with food allergies.

“The best way to go about it is education such as a doctor talking to the students about food allergies or a fun presentation led by the teacher empowering the children to protect their classmates with the allergies,” Dr. Singh said. “If kids understand why food allergies happen, it can decrease bullying.”

Tips from Food Allergy Research & Education to prevent food allergy bullying:

• Encourage open communication – be sure children understand what bullying is and what to do if they are bullied. Emphasize reporting bullying to a trusted adult.
• Teach children the skills they need to stand up to bullies – saying “stop” or “leave me alone” with confidence, using humor and walking away.
• Recognize the signs of bullying – these can include torn clothing or damaged books, unexplained reactions or injuries, avoiding school, physical complaints, consistent nightmares, lower grades and loss of interest in school, social isolation and behavior changes.
• If your child is being bullied, be calm and assure him that you’re going to help – don’t encourage retaliation or confront the bully yourself. Talk to the appropriate personnel at your child’s school.
• Encourage teachers, administrators, the school nurse or counselors to offer educational programs about food allergies and bullying
• Set up a buddy system – encourage children who are bullied to stay with a group of trusted friends in high-risk situations, such as at the lunchroom or while walking home from school.

Food allergy parents have a lot to handle and may seem overprotective at times. But if they get it wrong, they don’t get to hit the reset button.

Spring is officially here! Along with the start of spring, allergies are starting back up again as well. However, at Cook Children’s there has been an increase in flu cases at CCHCS this past month and the cold season isn’t over just yet along with the COVID-19 pandemic.

Let’s figure out how to tell if your child has a cold, the flu, allergies or COVID-19.

Right now, your child’s sneezing, cough or fever may just scratch the surface as to which of the four it could be.

“Even though it’s spring, parents need to keep in mind some of those winter viruses are still circulating. There are a lot of respiratory viral illnesses still going around that we associate with the wintertime,” said Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Haslet Office said. “In Texas, the weather is not full on spring, it is still cold outside some days.”

Allergies

Allergies are caused by pollen and the environment.

“Allergies usually do not have any of the symptoms that viruses usually cause fever, body aches, or overall general ill feeling,” Dr. Soria-Olmos said. “Most kids with allergies are going about their normal day other than the nuance of symptoms. The overlapping makes things confusing.”

Cold, Flu or COVID?

Symptoms of the common cold, the flu and COVID are very similar. The main way to tell the difference is through testing.

Each of these is a virus that affects the body and can affect the way kids act. A fever is the most common symptom to monitor between the cold, flu and COVID-19.

Cold and flu typically come with additional symptoms such as a decrease in appetite, fatigue, chills, etc. Sometimes you can have a cold without fever. Flu typically causes an increase in temperature.

Parents of children under the age of 2, should contact their pediatrician if the fever continues for more than 48 to 72 hours. This is to help determine if the doctor should see the child and or if a parent can continue supportive care at home.

Although we have seen fewer COVID-19 cases in the community, it is still something to think about as a cause of fever, cough and nasal congestion or sore throat.  

“Testing is the main way to help us determine between different causes of similar symptoms,” Dr. Soria-Olmos said.

Dr. Soria-Olmos encourages parents to speak with their pediatrician on how to treat their child and identify the cause of their symptoms.

The springtime allergies are awful, y’all. Just terrible. And North Texas gets year ‘round allergies, so that’s special. Allergy symptoms include runny nose, red itchy eyes, sneezing, nasal congestion, cough, eczema flares and even hives. Here’s what I advise my patients to do during allergy season.

Start a 24 hour non-drowsy over-the-counter antihistamine such as Claritin, Allegra, Zyrtec or the newest Xyzal. Do not get medications such as Claritin-D or Zyrtec-D without specific doctor instruction. This extra decongestant component should not be used on a daily basis.

Rinse the offending allergen out of your child’s nose and sinuses by using nasal saline spray or a sinus rinse. For the sinus rinse, I prefer the squeeze bottle style for age 10 and up, but can be used with a mature younger child. NEVER use tap water for a sinus rinse, use either bottled distilled water, or gently boil water then let it cool for about 30 minutes before use. ALWAYS use the salt and baking soda packet with the sinus rinse.

Other over-the-counter products to try to reduce allergy symptoms are:

• Nasal congestion: steroid nasal spray such as Flonase, shower vapor tabs, vapo rub, and a cool mist humidifier
• Itchy eyes: antihistamine drops such as Zaditor
• Runny nose & sneezing: Benadryl
• Dry itchy skin/eczema flare: hypoallergenic soaps and lotions such as Aveeno, Eucerin or Dove, All Free & Clear laundry detergent, and ask your doctor if a prescription steroid cream is needed
• Hives: Benadryl, and call your doctor

Change of season and bad allergies can lead to an asthma attack, so make sure your child takes all prescribed daily medications for allergies and asthma. 

But, unfortunately, we also are in the midst of the COVID-19 pandemic.

Since the beginning of the pandemic, the Centers for Disease Control and Prevention (CDC) has listed fever, cough and shortness of breath as the primary symptoms of COVID-19. Recently the CDC updated its list of possible symptoms of COVID to include: chills, shaking chills, muscle pain, headache, sore throat and loss of taste or smell.

In addition, I continue to see cases of strep throat here and there in the office as well.

I know right now nothing is routine and it’s understandable to be worried at the first sign of a sneeze. So let’s take a look at the COVID symptoms and how they compare with either allergies or strep:

So, how do we know the difference?

COVID-19 generally presents with fever, cough and shortness of breath. In addition, as testing becomes more prevalent, a known exposure raises the risk significantly.

Allergies can cause cough and sore throat, but usually also cause runny nose and watery, itchy eyes. If fever is present, infections such as strep, sinus, ear infections and yes, COVID-19 would be considered.

Strep throat usually presents with fever and sore throat but, if cough and congestion are present, it is very unlikely.

Sometimes it’s not obvious at first glance what is causing your symptoms, and in these uncertain times it’s important to contact your pediatrician if you have concerns.

We look forward to hearing from you.

Stay safe,

Doc Smitty

One thing that thankfully keeps me connected with my patients is technology – I’m still doing plenty of daily video visits on MyChart. I’m actually really surprised how many emails I’ve been getting about kids getting sick.

You’d think with everyone locked in their house, this wouldn’t be happening, right?

Fevers, sore throats, runny noses, rashes, coughs – yes, some of this might be community coronavirus infection and yes, I understand freaking out right now if your child has any of these symptoms. Just remember, kids are known to mostly get mild cases.

I’m willing to bet a lot of it is just the same stuff we see all the time in the Spring: colds, allergies, strep throat, poison ivy, Hand Foot and Mouth, pinkeye, tummy bugs, etc. But how are they getting it?

I guess one of the only good things about the coronavirus pandemic is people are learning more and more about how viruses (and bacteria, and other germs) work.

My theories about why kids are getting sick during quarantine:

• Asymptomatic carrier - Sometimes a person has a virus or bacteria inside them, and for some reason, they show no signs or symptoms of it. Let’s say Dad is an essential worker and still goes to the office or warehouse. He touches a door handle that his co-worker touched. He rubbed his eye after. Let’s say it’s a cold virus. Dad then brings home a cold virus in his body – he may show absolutely zero symptoms of it – and after a week of snuggles with his son, now his son has a fever and a runny nose! What gives? Well – an asymptomatic carrier brought it home. (This is how coronavirus sometimes works too, FYI).
• Allergies are a huge culprit of many of the same symptoms we associate with illness. Sore throats, cough, fatigue, runny nose – it’s easy to confuse a respiratory infection with allergies.
• Viruses and bacteria have incubation periods – sometimes even up to two weeks. Meaning, you caught that germ, but it isn’t showing itself until now. Sometimes, this can really mislead folks in understanding when their child actually caught an illness (it may have been that picnic you went to with friends before the lockdown started).
• Kids put everything in their mouths. Read it again: kids put everything in their mouths. And if you’ve come home from the grocery store with their favorite snack, and didn’t wipe it down, there’s a small chance your kid can catch it from the item. Cardboard, metal, and plastic are all known to harbor germs – sometimes for days. Coronavirus may not be able to live on those surfaces very long, but other more robust ones may thrive on the surface!

A bit of good news we may have missed while being quarantined: The flu is nearly gone now!

I know it’s difficult right now, but try not to grow complacent – stay at home, limit your visits to the store, and wash your hands a ton. We think social distancing is working – but need more time to tell.

In the meantime, try not to worry about mild illness your kids may have. Remember we Cook Children’s pediatricians are still here for you! And are always happy to help you anytime.

Ankita Singh, D.O., a pediatrician at Cook Children’s Walsh Ranch office, said about 40% of children have allergy-related illnesses in the U.S.

But in Texas, allergies run year-round for all kinds of reasons. The most common allergies seen by Dr. Singh include outdoor pollen, pet dander, and food allergies (peanuts, milk, shellfish, eggs, tree nuts, wheat, soy, fish, and crustacean shellfish).

“Although allergies to milk, eggs, wheat, and soy can resolve themselves in childhood, children appear to be outgrowing some of these allergies more slowly than in previous decades, with many children still beyond 5,” Dr. Singh said. “Unfortunately, true allergies to peanuts, tree nuts, fish and shellfish are usually lifelong.”

Your child’s allergies can commonly cause itchy watery eyes, chronic congestion, breathing concerns, tiredness, itchy rashes, and sometimes vomiting or diarrhea with a feeling of discomfort.

Dr. Singh said you could have allergies and a cold at the same time, but there are ways to tell the two apart.

“A cold manifests with fever, congestion, cough that can resolve itself with over the counter fever reducers, hydration and time,” Dr. Singh said. “Allergies usually come and go and sometimes persist with a chronic dry cough, watery eyes, and itchy dry skin. Allergies flare up with seasonal changes or when a child is exposed to a certain allergen”

If your child is currently suffering from allergies, Dr. Singh advises parents to try over-the-counter medicines like Zyrtec, Allegra or Xyzal, which can be given beginning at age 6 months if needed. Claritin is approved after age 2. Trying them nightly for 2 weeks can sometimes help you assess if symptoms are improving or not. A teaspoon to tablespoon of honey is also great to take daily to help control seasonal allergies. Running a cool mist humidifier or air purifier helps as well.

“Mast cell stabilizers can be prescribed at times. Nasal corticosteroids like Flonase is safe for kids after the age of 2 and helps if taken daily for months for prevention,” Dr. Singh said. “Many parents use Benadryl, but it makes a lot of kids very groggy, so only reserve it for night time or if kids need it for severe itching. It is not my go to for allergies, more so for allergic reactions or hive like rashes.”

Dr. Singh said call your pediatrician if you notice any of the following:

• Chronic watery eyes or stuffy nose
• Itchy skin
• Dry, persistent cough for weeks
• Difficulty breathing
• Rash turning into raised bumps that’s not improving with over-the-counter allergy meds

Avoidance of allergens is most important to help kids with allergies, especially for kids who have asthma and/or eczema.

“Make sure to get rid of carpets in your home if you can. If not, vacuuming often and having carpets deep cleaned every 6 months is beneficial” Dr. Singh said. “Some kids might need medications to control their asthma and allergies at the same time. It’s important to have them seen by a doctor to discuss further treatment options if this is the case. Avoiding allergens, taking a shower after playing outdoors, and keeping clothes, bedding and flooring clean are key to minimizing symptoms.”

In more severe cases, epinephrine is vital for kids who have a diagnosed allergens and are undergoing anaphylaxis. This presents as a severe skin reaction, lip/tongue/throat swelling, shortness of breath or wheezing, dizziness, stomach aches or vomiting, and/or diarrhea. If a child does undergo these symptoms, it is important to know the cause and if not to get allergy tested to avoid the trigger in the future.

Other medication options as discussed above include:

• Antihistamines or nasal corticosteroids
• Topical steroid creams/ointments
• Immunotherapy in the form of injections to train your immune system not to overreact

“You might ‘Ah-choose’ to stay indoors, but don’t let allergies take over your life,” Dr. Singh said. “You can overcome them with the above and if not, you can always come talk to me!

For more on this topic:

• Food Allergy
• Hay Fever
• Insect Allergy
• Seasonal Allergy
• 7 Ways To Ensure Your Child With Food Allergies Is Safe At School
• 'Does My Child Have a Cold Or Allergies?

Food allergies are a frequently discussed topic among parents and medical professionals. If you are not a parent of a child with food allergies, chances are high that someone you love, or someone you see daily may be dealing with this challenging diagnosis.

According to FARE (Food Allergy Research and Education), 32 million Americans are living with food allergies. If you take the statistic a little further, that means 1 in 13 children have food allergies. For a parent, it can be terrifying to have to think about leaving their child at school all day.

Now that school is in full swing, you may have questions, or may be wondering if there is more you can do to keep your child safe. As a pediatric ER nurse and parent of two with food allergies, I am here to tell you that knowledge and preparation are keys to a smooth year! Here are some ways to ensure your child is safe at school.

1. First and foremost, visit your child’s allergist every year. (If your child is newly diagnosed and awaiting your first allergist visit, your pediatrician can help you.) Make sure your child has an updated prescription for Epi-Pens. Make sure you have 2 sets; one for home and one for school to keep with the nurse.
2. Ask your child’s allergist or pediatrician to fill out a personalized action plan. The FARE website has action plans that are simple to understand, and can be found at www.foodallergy.org. Make multiple copies of these plans. Give them to your child’s teachers and the school nurse. These are absolutely essential to have! They outline exactly what to do in the case of accidental exposure to an allergen.
3. Know your rights as a parent. Your school should be accommodating your child in the best way possible. Your child is protected by law due to their food allergy. You can request a 504 meeting at your school. During this meeting, you meet to determine how to best meet the needs of your child at school. As an example, in my children’s 504 plans, we specify that they need to not be seated around anyone eating nuts during the lunch period.
4. Make sure your children know to never, ever eat food that you either did not pack for them, or did not provide for the classroom. Get your kids in this habit early, and it will become second nature.
5. Prepare for classroom celebrations. Elementary school especially seems to have many, many food centered celebrations. Provide a box of safe treats to keep in your child’s classroom so that they are not completely left out.
6. Read every label! Food companies are not required to label for allergens, so it is essential to read every ingredient, even if it’s a food your kiddo has consumed before, as production lines can change.
7. Take care of yourself. Caring for a child with food allergies can be stressful. Take heart in knowing it will get easier over time. Reach out to other food allergy families and know you are not alone.

The time has come. You and your kids spent time at the park on a beautiful spring afternoon. A few hours later, at home, the symptoms start (cue M. Night Shyamalan strange horror music). Or heck, for those really allergic, the symptoms began at the park!

• Itchy, watery eyes
• Congestion
• Draining, watery, itchy nose
• Sneezing
• Itchy roof of mouth (is this just me? Seriously? Anyone else get this?)
• Clearing the throat
• Coughing
• Complaining of a sore throat (this is due to drainage)

Congrats. See that bright green dust coating your trash cans and car? That’s pollen, and it’s now stuck to all the tiny hairs inside your nose, throat, and lung airways.

And the symptoms you’re having? That’s your body reacting to the certain pollens it doesn’t like.

Kids don’t really get seasonal (grass, plant and tree) allergies until at least age 2. I always tell parents, “your kiddo has to be EXPOSED to the planet’s seasons a few times before it can become allergic to them!”

Your child can become allergic to things like foods, pets, mold, and dust earlier than age 2 – because these are things they are exposed to daily in their home.

To help control your kid’s symptoms, there are a lot of over-the-counter medications you can try.

Listen – I’m a doc that usually says “less is more” when it comes to medication. But I do usually recommend daily meds for kids who suffer allergies, because I don’t want it to affect their happiness, or ability to get good exercise.

Start with a daily antihistamine – Allegra, Claritin, Xyzal, Zyrtec, Benadryl. If your child suffers from a lot of nasal problems like sneezing and congestion, add on a nasal steroid spray like Flonase or Nasacort.

There are also many types of antihistamine eye drops out there you can use daily to treat or prevent the itchy and watery eyes.

Here’s the thing – they’re often PREVENTATIVE. So, use them DAILY during the times of year you or your child suffer to PREVENT the symptoms from showing up.

You can dive further into treatment with your pediatrician – there are a few prescription options you can try to further help the problem.

If your child has asthma, it’s even more important to come up with a treatment plan with your pediatrician. These kids sometimes can have full-on asthma attacks this time of year if that’s a common trigger for them.

And do what an old, wise allergist once told me – “the minute you and your kids come in from playing outside, hold your heads over the sink, and spray nasal saline up in the nose to irrigate the nose and rinse out all the pollen!” You could also try this in the shower.

Makes sense to me! Try it! And good luck out there!

When I first started practicing medicine, this line rolled right off my tongue, “Don’t give nuts, eggs or fish until 1 year of age.” The classic teaching was that by avoiding these foods we would prevent the development of food allergies.

But, several studies have been released during the last 10 years that have significantly challenged and changed the advice I have been providing patients.

The new theory is that by exposing babies to new and different foods, they will develop tolerance for those foods and be less likely to present with allergies later on.

Last week, the American Academy of Pediatrics released further guidelines that support the new and emerging science.

Here’s what you need to know about the new guidelines:

1. There’s no evidence that delaying foods will prevent allergies. In fact, it probably causes more harm than good.
2. All children benefit from the introduction of highly allergenic foods before one year of age. And these foods should not be restricted, but fed according to family and cultural preference.
3. Children with higher risk for allergic disease (severe eczema or egg allergy) SHOULD have peanuts introduced between 4 and 6 months and other allergenic foods introduced around 6 months.

I know parenting is never easy, but hopefully the new guidelines will help ease your mind when it's time to introduce your baby to new foods. 

But, does your child have a cold or allergies?

After all, the mountain cedar pollen count is the highest it's been all season in North Texas and is in the "very high" category for the first time since January 2017. 

We're also in the middle of the cold and flu season. 

Determining the difference between colds and allergies can be very difficult, but knowing which it is can be helpful for treatment, expectations for how long it should last and for determining if your child is contagious.

Colds are caused by viral infections which are spread from person to person. They can occur year round but are going to be more common in winter months. Symptoms usually last 3 days to 2 weeks but remember that kids can get several colds per year so it’s possible for them to be sick for long periods if they catch a few colds back to back.

Allergies are caused by an overreaction of the immune system to allergens. Dust, pollen or molds can all be potential triggers. Allergies can occur year-round depending on what your child is sensitive to. Usually fall and spring are busy allergy seasons but pollen counts were moderate to high many days in December.

So, how can you tell the difference?

Symptoms with a cold usually build up over a few days but allergic symptoms can start quickly after the child is exposed to the substance they are allergic to.

Here are some of the symptoms that can be present and whether they are more likely a cold or allergies:

This time of year, if your child has cold symptoms but also have significant body aches or high fever, you should also consider if they might have flu (because they probably do).

Treatment for colds is treating the symptoms. Nasal saline and suction for babies. Honey for kids over 1. Make sure they are drinking plenty of fluids and getting rest.

Treatment for allergies should usually start with a long acting antihistamine like Zyrtec or Claritin. If that doesn’t seem to be helping, talk with your doctor.

I read the paper during my lunch hour this week. It seems to be a decent study (sometimes studies aren’t that good. Remember that the next time you see an inflammatory headline and try to always read the study, or at least the fine print, for yourself!)

The researchers claim that children who are given antacids or antibiotics in the first six months of life are more prone to “allergic conditions” – like allergies, eczema, asthma, food/medicine allergies, and so on.

The study looked at over 790,000 kids in the Military Health System database from 2001 to 2013. It was a pretty big study.

What it concluded was that if a child got an antacid medication (like Ranitidine or Lansoprazole, amongst others) or an antibiotic (Amoxicillin, Augmentin, Bactrim), the kiddo had a higher chance for those problems listed above.

Antacids in the first 6 months doubled the chance of food allergy. Antibiotics doubled the chance of asthma.

The general thought is that antacid medications and antibiotics mess with our “gut biome.” Those are the living organisms in our gut that help us digest food and help our immune system to know friend from foe.

We want lots of different “good gut bugs” living in there to help us out. When you use antacids or antibiotics early in life, the theory is that this diversity is reduced.

As a mom, I asked myself, “Did those two months my son was on ranitidine cause him to have his awful cantaloupe allergy?” The guilty feelings were already sinking in.

Stop right there! Let’s not feel guilty about this. We are always learning and medicine is always changing. Let’s move forward. Yes this study seems solid, but what questions can we ask about their study methods?

Maybe we’d have more knowledge of a true connection if each individual medication was studied, instead of all of them lumped together?

Maybe kids who deal with reflux or infections as babies are just more prone to allergies and illness in general later on in life?

Are military families living in or with environmental conditions which may predispose the kiddos to allergic conditions?

I don’t know the answers to these questions. But boy, is this article making me think!

Like any “big discovery,” do we need more studies on this same topic to reduce any bias and truly know if there is a connection between these medications and allergies? Absolutely. We’ve done similar studies on animals in the past, but now it’s time to do more studies on humans.

For me, as a pediatrician, I’m going to walk through these risks with my patients a little more thoroughly.

Children with reflux suffer. I watched it happen in my own kid. Do some of them need the antacids to survive? Absolutely (some kids lose weight with reflux). Will I try to talk parents of children with more “mild” cases of reflux out of it? Probably.

Children with bacterial infections need antibiotics. Will I make sure to be certain to use the “least strong” antibiotic I can muster so as not to kill off too many of the important gut biome? Absolutely.

This article will no doubt cause some strong opinions. If, in the end, we are using less medication to treat our children’s mild infant illness, I think it will be better for everyone. I look forward to reading more research on this in the future!

Both allergies and colds share a lot of similar symptoms:

• Sore throat
• Runny nose 
• Sneezing 
• Coughing 
• Feeling tired 
• Feeling achy

Honestly, it can be hard even for us to tell the difference when we examine kids.

HOWEVER, you don't get a fever with allergies. If you have a little fever (or a big fever), that's most likely a cold.

ALSO,  "itchiness" in general of nose and eyes, makes me think more allergies than cold.

AND, the time is important - Did  it come on really quickly? That's most likely a cold. Has it been going on for months with a slow onset? Most likely allergies.

Both allergies and colds can make you more susceptible to other problems like ear infections and sinus infections. That's why we say if your symptoms are lasting longer than 2 weeks, come in and see us so we can help.

"How do I know what to do?" Well, that depends on a lot of things.

Is your child under age 1? If so - this is more likely a cold than allergies (a child has to be alive longer than a year to develop allergies to their environment). Elevate the head of their crib. Stick a blanket under the mattress. Would you want to lay flat on your back with a bad cold? Suck out all that snot with a Nose Frida (dont knock it til you try it). Use saline drops. Tylenol (or ibuprofen if over 6 months) for the headaches and throat pain. Run a hot shower and sit in a steamy bathroom for a bit. And lots of lovins. There ain't much you can do for the tiny ones. They just have to push through it.

If they're over age 1 and they have what seems to be a cold, try some honey along with all of the above. It's been proven to help just as much as medication. There are some over-the-counter medications that have honey in them too. I wouldn't try cold medicines until they're at least 4. Studies don't even show that they help much.

If it's allergies - you have lots of over the counter options like Benadryl, Zyrtec, Claritin, and Allegra. Some nose sprays are also very helpful and we can prescribe those in the office. And there is a prescription medication called montelukast that I find can help some kids.

Also, a wise allergist once told me that if you rinse out your kid's nostrils when they come indoors, it helps a lot (it washes away all the allergens/pollens clinging to the hairs in the nose and really helps symptoms go away faster). You could also try nasal saline spray here and just have them hold their head over the sink.

Hugs!

Dr. Diane

Commonly recommended ways to prevent constipation are to drink water, exercise, and eat fruits, vegetables and fiber-rich foods. Yet even when we use these techniques, our children still sometimes get constipated. Whether its contributing to stomach ache, delayed toilet training, bedwetting, or missed school, constipation is no laughing matter.

“But my child poops every day! My child can’t be constipated!”

Even if your child stools every day, he or she may be constipated. Think about your office desk; you may clear papers off regularly, but if you are not clearing as many papers as are building up, you will soon have a messy desk. Children may poop every day and still not be fully emptying their intestines. When constipation develops, the extra stool causes the intestines to stretch. Once this happens, the intestines may not be able to move as well, which leads to more constipation, and it becomes a vicious cycle. In infants constipation can be particularly hard to recognize because in this age group it is can be normal to have less than one stool per day.  Parents should look for a change in the frequency of stools along with firm stools when considering constipation. 

“What now?”

The good news is that constipation can often be treated with dietary changes. The key to making the treatment stick is continuing it long enough. If you stop too soon, the intestines have not had time to heal, and the constipation returns. As a physician who often sees this condition, I recommend treating constipation for as long as it has been a problem. For example, if constipation has been an ongoing problem for one month, treatment typically lasts at least one month. Treatment also depends on your child’s age.

• For infants over the age of two months, ask your pediatrician about giving small amounts of prune juice or pear juice.
• For a toddler, in addition to pear, apple, or prune juice, consider adding high fiber foods such as pears, peaches, and whole-grain cereals to his or her diet.
• School age children or teenagers can learn about which foods will help improve their symptoms and can then get involved in choosing foods that are fiber-rich and appealing to them.
• In cases that do not respond to dietary changes or are more severe, your pediatrician may recommend a medication to help treat the problem.

Contact your child’s doctor if you have any questions or concerns about your child and constipation.

It can be really hard to determine the cause of a cough just because of the sound. But here are some different types of coughs and the clues that might help you or the doctor know what is going on.

1. Short time period: Most coughs that last a few days are due to infection, most commonly viruses.
2. Long time period: Coughs that last longer bring up other possibilities, including sinus infections, allergies, asthma, or reflux.
3. Wet cough: Wet coughs with congestion can caused by a variety of reasons but are more commonly infections (most of which are viruses) or allergies. The presence of fever points towards infection while itchy or watery eyes suggest allergies.
4. Tight cough: A tight sounding cough can often be a sign of asthma. If your child has a history of wheezing or the cough is associated with exercise or weather change, think asthma.
5. Cough after eating: Yes, reflux can be a cause of chronic cough and it’s actually more common than you might think. Pay attention the timing and if certain foods might be triggers.
6. Barky cough: Think like a dog or seal. Croup is the most common cause of this type of cough. Usually the child will have runny nose and they can have fever as well. Steam is a good way to treat this cough so use a humidifier or the bathroom with the shower going. If severe or difficulty breathing, the doctor can provide steroids and other treatments.
7. Whooping cough: This cough is severe and comes in terrible spells that end in a whooping sound as the child breathes in. It requires a doctor’s visit and treatment so get it checked out soon.
8. Annoying, chronic throat clearing cough: This can be caused by many reasons but an important one to think about is tics. Children can have vocal tics that sound like throat clearing or even a mild cough.

There are lots of reasons why a child might be coughing but hopefully some of these tips will help you determine what you need to do next.

1. Make sure your house is safe while you are away. Alert the neighbors that you will be out of town. Stop the mail and newspaper from delivering or make sure a neighbor can pick it up for you. Now there’s even technology available to set a timer on the lights in your house. The timer lets you keep your lights on and turn them off the same as you would if you were actually at home, making any potential bad guy think you are there.
2. Don’t let everyone know your plans. Remember it’s not only old high school friends and co-workers following your every move. Crooks are definitely Facebook and Twitter savvy. Don’t announce to everyone that you are taking off soon or that you are trying to get packed tomorrow. Do things the old fashioned way and call the people who need to know you will be out.
3. Get your rest. A report released by the AAA Foundation for Traffic Safety states that drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as drivers who get seven hours of sleep or more. Crash rates increase with every hour of lost sleep.
4. Make sure your child is secure in their car seat or booster before you travel. You can’t be too careful on the road, both in the U.S. and out of the country. Motor vehicle crashes are the No. 1 killer of kids 14 years and under in the United States.
5. And secure on the plane too. Buy the extra ticket for your baby and make sure your child is properly protected in an approved safety seat. The No. 1 way children are injured in planes is due to turbulence. For safety, children need to be either restrained in their safety seat or in the lap belt in the plane seat.
6. Bring a current picture of your child with you on your trip. Have a very specific description of what your child is wearing in case your son or daughter gets lost. In this day and age of cameras on your phone, it’s easy to take a picture of your child that morning.
7. This is an uncomfortable one, but so important. Let your child know it’s OK to scream and fight if someone tries to grab them. However, just throwing a fit may not work. We’ve all seen kids screaming and crying as parents carry them out of the store. If the child is old enough they need to know to scream “this isn’t my Mommy or Daddy, help me” instead of just screaming like they are upset because they were told “no.”
8. Traveling with asthma. Be sure to pack your child’s quick-relief medicine and long-term control medicine. Keep them where you can reach them and not packed away. Pack your peak flow meter, health insurance cards and your asthma action plan. Consider purchasing a portable nebulizer. Call ahead to where you are traveling and discuss your child’s triggers. Bring your child’s pillow and blanket from home.
9. Childproof your grandparents’ home. Make sure they know about any nut allergies or any other allergy they should know about during your stay. Check all the rooms for any electrical cords, cleaning supplies and loose pills on the floor. Grandparents usually leave them out so they can remember to take them. Don’t let this happen. Put the pills away. Often times they aren’t child proofed and kids can easily mistake them for candy. Also remember to unpack and put away any medications that you bring with you.
10. Avoiding food allergies takes extra prep work. Research local hospitals and medical care wherever you are traveling. Also call ahead or go online to find out about area grocery stores, restaurants and any other place you may stop along the way. Make your family aware. Yes grandma makes the best pecan pie, but make sure everyone knows your child has allergies and one bite can mean horrible consequences. Pack your own food if necessary. Stay alert and be prepared with your child’s medications
11. Be aware of the new surroundings for your kiddo. If they have a family pool without a fence, talk to your children about them. Make them aware of the dangers of stairs and banisters, and go outside with them to point out dangers, such as rakes, power tools, spots where there may be snakes and other critters.
12. Be safe. Cook Children's Trauma team sees lots of ATV/4-wheeler injuries during the holiday break. If your child is on an ATV, please make sure it's built for a child. No child under 5 should be on one at all, let alone driving it. If your child is on a bike, hover board or skateboard, please be sure your kids have on the proper safety equipment (helmets please) and establish the rule of safety first. With family over, it can be easy to think someone else is watching your kids. Mom and dad, make sure you are the ones responsible for supervision.

Hope this list helps during this busy time of year. Happy holidays from Cook Children’s.

You can read more on the FDA report from earlier today: It should be fairly easy to distinguish as the containers have “a Rocky Road pint with a Cookies 'n Cream lid, and contain Cookies 'n Cream Ice Cream.” They also will contain Cookies ‘n Cream ice cream and not Rocky Road, which should be hard to miss.

This mixup might be important for families with soy and wheat allergies which are contained in the Cookies ‘n Cream variety but not Rocky Road. Parents of children or adults with celiac disease should also be aware.

Children with soy and wheat allergies who ingest these substances present similar to other food allergies. Symptoms might start as itching around the mouth or hives which is a large, red and circular rash that covers the whole body.

Children with celiac disease who ingest gluten (which is present in wheat) can have with a wide variety of symptoms. These might include symptoms of belly pain, bloating, vomiting or diarrhea. Other issues that can be attributed to celiac disease are fatigue and behavioral changes or irritability. Other long term health consequences can result from untreated celiac disease.

If you have any of the mis-packaged product, you can return them to the place of purchase for a full refund.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, TX. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnesroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the Fall of 2016.

Poisoned candy?

We’ve heard these scary tales since we were little kids. Parents make sure you check your kids’ candy before they begin munching on their treats, but know that many of the stories you’ve heard are meant to scare your little brother.

Are there some particular dangers you should be aware of for the last day in October? Yes! Here are a couple of other Halloween treat issues you should know:

Food allergies

Children with food allergies can have a particularly challenging time during all holidays, including Halloween. Their desire to feel included in the rite of passage that is trick-or-treating doesn’t always mesh well with the risk of getting food that could harm them.

Many of the most common food allergies are frequent ingredients in Halloween treats (nuts, milk, egg, soy and wheat).

Over the past few years, there has been a movement towards providing non-food options for trick-or-treaters. You can designate your house a food-allergy friendly house by painting a pumpkin teal or for those of you are aren’t as crafty (or are just too lazy or don’t have enough time), you can print out this flyer and tape it to your door.

Listeria in caramel apples

Besides being a risk for ripping my front teeth out, caramel apples can harbor Listeria. Remember Listeria, you guys? It’s why I haven’t had Blue Bell in months. According to a recent study from the American Society for Microbiology, it seems that when the apple is punctured by the popsicle stick, the small amount of juice that comes out can become infected with Listeria.

Listeria is a particular concern for pregnant moms, the elderly and newborns so please don’t let your newborn munch on a caramel apple.

Some stores are pulling caramel apples off the shelves in response to this study.

Halloween can be a great time of fun for all kids.

For more information, check out our Halloween safety page.

What are the most common causes of a runny nose? How do you treat one? When should you call a pediatrician?

Doc Smitty is back with the latest My Kid Minute. Watch the video to find out all the answers.

Here's why:

There has been an outbreak of severe flu among dogs in the Midwest. Cases of the H3N2 strain have now been seen in dogs in Texas.

Most dogs have cough, runny nose and fever, but it has been severe and resulted in death in some.

So you may be wondering, “Is my child at risk if our dog has this flu?”

The answer, according to the CDC:

“To date, there is no evidence of transmission of canine influenza viruses from dogs to people and there has not been a single reported case of human infection with a canine influenza virus.”

That’s fortunate, but what are some health dangers associated with pets?

Bites

I’ve seen too many severe dog bites in my training to not mention bites first. The most common statement I hear about the dogs who bite is, “We just never thought he/she would do that.”

Dogs can be a great addition to a family but use caution:

• Be careful of rough play. Even a playful snip can be dangerous if it happens near the eye or a fingertip.

• Stay away from dogs when they are likely to be defensive: when they are eating, sleeping or taking care of puppies.

• Stay away from unfamiliar dogs or dogs that seems scared or anxious.

Here are some more tips from the ASPCA on how to avoid dog bites.

Allergies/Asthma

This is actually one of the most common questions I get regarding animals. It’s very intuitive. People can be allergic to dogs and cats, so wouldn’t owning one increase my child’s risk for allergies?

I have seen several studies that suggest the exact opposite. Often by having animals in the house early, kids may have slightly decreased risk of developing allergies. That said, if your child has frequent allergy and asthma symptoms, it may be reasonable to attempt to isolate the animal from the child for a bit to see if symptoms improve.

Infections

Infectious diseases are transmitted through animals frequently; think about the number of diseases that tics and mosquitoes can carry. Although it can happen, they are less frequently transmitted from pets.

Here is a list of pets and some of the diseases they can transmit:

Cats

Cat-scratch fever:

This disease is caused by bacterial infection (Bartonella) of an open wound or a bite that results in the breaking of skin. It is more commonly transmitted by kittens than older cats. Symptoms of the infection in humans are fever, headache and fatigue. There is often a large and tender lymph node near the site of the bite.

Toxoplasma:

Toxoplasma is usually a foodborne illness, but can be transmitted from cat feces. In people with normal immune systems, there are often no symptoms of toxoplasmosis. Pregnant women (and fetuses) are especially susceptible and, for that reason, should not handle cat litter boxes.

Dogs

Hookworms:

Dogs infected with hookworms can have bloody stools; which in severe cases can lead to anemia. Humans are infected by walking barefoot on contaminated soil and develop an interesting rash which consists of red, squiggly lines where the larvae have migrated under the skin.

Reptiles

Salmonella:

Salmonella is one of the most common pet-associated infections. It is estimated that 70,000 people will contract salmonella from pet reptiles. Salmonella generally causes bloody stools but in children and in people with weakened immune systems can be serious. The CDC recommends that houses with children less than 5 and with any household members with weakened immune systems not own reptiles as pets.

Many Animals

Campylobacter:

Ingesting food contaminated with the bacteria transmits most infections of campylobacter, but cases can occur from the handling of dog or cat feces. The main symptom of campylobacter infections is diarrhea (which can be bloody) and usually lasts about one week.

Ringworm:

The fungus that causes can be transmitted from many different animals but most commonly occurs from puppies and kittens. The appearance of the rash on human skin is a circular rash with a raised edge. It can be difficult to distinguish from eczema which sometimes causes circular patches as well.

Pets can be great additions to your family and, in most cases, will not cause any harm to your children. Be aware of the specific risks associated with certain types of pets and take caution to protect your children when appropriate.

Unfortunately, for many children, allergies are simply a way of life in Texas. Usually, allergies occur in kids beginning at the age 2 years and older.

Physicians don’t know why some children suffer reactions when exposed to allergens such as pollen, ragweed and mold that can cause allergic symptoms, while others experience no problems at all.

Sometimes parents aren’t sure if their child has a cold or allergies. Some say you can tell by looking at the mucus. That’s not really the case. The only way to tell for sure is by seeing your pediatrician. But if your child develops cold-like symptoms at the same time every year (now for instance), he or she probably suffer from seasonal allergies.

Symptoms of allergies are often times similar to a cold – sneezing, itchy nose and/or throat, nasal congestion, clear, runny nose and coughing. With a cold, the symptoms run its course over a matter of days. With an allergy, the symptoms last as long as the child is exposed to allergens.

Parents should be especially careful that their child doesn’t develop wheezing and/or shortness of breath. That may mean your child’s allergies have progressed into asthma.

It’s possible to relieve allergy symptoms by eliminating or reducing a child’s exposure to allergens. A key, as you hear so often with colds and flu, is for your child to wash his or her hands often. Also, children should change clothing and shower after playing outside. Please don’t let your child mow the lawn during this time of year if they suffer from allergies.

Educating your child early about what causes allergic reactions and allergy symptoms is a crucial step in helping your child reduce or prevent allergic reactions.

Sometimes no matter how much you try to prevent allergy symptoms in your child, they still occur. Fortunately, various treatments are available to help your child when an allergic reaction happens, including:

• Over-the-counter medications. Some decongestants, antihistamines and nasal sprays can be purchased without a prescription. But even if you are thinking about picking up something from the drug store, please do not do so without contacting your pediatrician.
• Prescription medications. Those with more severe allergies might need stronger versions of over-the-counter medications prescribed by their pediatrician.
• Immunotherapy. Also known as allergy shots, these injections of allergens into the body help patients build tolerance to help relieve symptoms.

Eventually, your child might grow out of his or her allergy. However, until he or she does, talk to a pediatrician or allergy specialist to determine the best treatment option for your child.

A few days later we went to an allergist who had to prick his back 100 times to tell me he is deathly allergic to tree nuts, peanuts, fish, shellfish and eggs. I learned this information almost 10 years ago and despite my best efforts to educate my son and everyone in my family, I still make mistakes. These *#!@ foods can be hidden.

Here’s my top 5 list of the strangest places to find deadly allergic foods:

1. Hamburger patties and meatballs. Eggs can be used as a binder in these.
2. Kids multivitamins. Check these for fish oil.
3. Frying oil. Ask every restaurant every time if they use peanut oil. Someone different could order the oil from the last time you ate there.
4. My own mouth. I stopped eating all nuts in case he drank after me or I gave him a bite from my fork.
5. Read all food labels. I have found egg in bubble gum.

Where have you found allergic foods? Please share.