However, Cook Children’s School-Based Virtual Health Program is helping school nurses and parents ease some of that chaos.

“I see the benefit for my own family,” said Erwin, an LVN, IBCLC, and virtual health nurse coordinator with Cook Children’s.

Nurses in the Celina Independent School District now join 14 other school districts in offering virtual health appointments, with no upfront cost, through the school nurse’s office. A parent or legal guardian must register and consent before the visit.

The virtual health services can help diagnose:

• Earaches
• Fevers
• Coughs and colds
• Skin rashes
• Minor skin infections
• Abrasions/cuts/scrapes
• Sore throats
• Flu-like symptoms
• Pink eye
• Head lice

Autumn Morris, an APRN CPNP-PC and a virtual health nurse practitioner, met with Celina ISD nurses to train them on the program before the school year. Each campus nurse is provided with a stethoscope and an otoscope to use during virtual visits to help with diagnoses. Each item plugs into a laptop, allowing Morris to see inside a child’s ear and listen to their heartbeat, for example. In addition, each campus nurse is trained and certified to administer a flu and strep test if needed during the visit.

“It’s nice because then we can get the results right there,” said Allycia Cundiff, Celina ISD lead nurse.

Cundiff looks forward to the partnership and the impact it will have on the community. Morris will be able to determine if a child needs to be sent home or if they can stay in class, helping reduce absences.

Erwin says program data shows 65% of visits are due to a sore throat.

“We meet you where you're at because a lot of times it's really hard to get off work when your kid is sick,” said Morris.

Parents can choose to attend the virtual visit. Following the appointment, Morris will contact parents with information about the visit and post-care instructions. If a child must be sent home, an excuse note is sent directly to the school. A copy of the visit is also provided to the child’s pediatrician. 

Erwin explains that the virtual appointment does not replace a child’s primary care pediatrician but is a collaborative effort. Morris says the line of communication with the pediatrician can help determine if a child may need to see a specialist. 

“We want them to have a primary care physician (PCP) placement, and if they don't have that, we work hard to find them one with Cook Children's,” said Erwin.

Once the visit is completed, Cook Children’s will bill the parent’s insurance provider.

A visit to the nurse’s office

“Kids like it, too, because they think the technology is cool,” said Erwin. “They get to come in, they get to see Autumn on the screen and they get to talk.”

Morris works with more than 100 schools, providing care to them. She and Erwin lead the training with all district nurses in the program.

“I want them to know that I'm not just the provider who's seeing that kid at that moment, but I'm a resource to them (nurses) so they can reach out to me if there are any issues or concerns,” said Morris.

The program has been in place for eight years. Morris describes the partnership as the school nurses being her "hands" as she diagnoses a child's illness. If additional testing or care is required, she is able to refer the child to a Cook Children's Urgent Care or Cook Children's Medical Center Prosper, just a short drive from Celina.

“We always say, you don't just get me, you get a giant hospital system attached to me,” said Morris. “We are passionate employees of the system but we are passionate parents who love our kids.”

It is that confidence and reassurance that makes Cundiff excited for the partnership, not just as a nurse but as a parent herself.

 “We have a lot of parents that work for the district and it is really hard to leave work, especially if you're a teacher,” explained Cundiff.

Anatomy of a visit

A typical visit can last anywhere from two minutes to five minutes. Children will present themselves at the school nurse’s office, and a nurse will determine if a virtual visit may be helpful. If so:

• A parent or legal guardian is contacted for consent.
• The nurse will request a visit with Morris.
• The campus nurse will collect vitals.
• Virtual visit begins

Celina ISD began school on August 13. Parents can register for the program online.

A variety of brands on the market offer the convenience of testing for COVID-19 at home. These kits can be purchased at retail stores or online as an alternative to seeking out a testing site or busy healthcare provider for a COVID-19 test.

Alice Phillips, M.D., a Cook Children’s pediatrician, explains what parents need to know about the reliability, timing and results of the at-home COVID-19 testing options approved by the U.S. Food & Drug Administration (FDA).

First, if your child is running a fever: KEEP HIM OR HER HOME.

“Any illness with fever is likely contagious, and we don’t want to spread strep, flu or even colds,” Dr. Phillips said. “If your child feels great but with mild symptoms, at-home tests provide parents with the ability to quickly screen their kids.”

As a reminder, Dr. Phillips listed some common COVID-19 symptoms: cough, congestion, sore throat, fever, diarrhea, and potentially loss of smell or taste. However, not everyone infected with the SARS-CoV-2 virus shows symptoms.

At-home rapid antigen tests look for the presence of proteins from the surface of the virus, she explained. These tests have reported ability to accurately detect disease in the 65-85% range in patients with symptoms, Dr. Phillips said. That falls to the 35-40% range if asymptomatic.

“Timing of the test is critical,” she said. “Sometimes testing too early in the illness could result in a false negative. This is why the kits include two tests.”

The U.S. Centers for Disease Control and Prevention (CDC) considers testing a critically important tool to help reduce the spread the disease. Those who have symptoms or exposure to someone with COVID-19 should be tested regardless of whether they’re vaccinated, according to the CDC. 

Type and price of at-home kits vary. Some tests require a nasal swab, while others require a saliva specimen. Antigen tests deliver results within about 15 minutes, while the more sensitive PCR test takes at least 24 hours.

The CDC website provides these tips:

• Check the expiration date. Don’t use if past-date or if the kit’s components appear damaged.
• Read the manufacturer’s instructions completely before opening the test devices.
• Clean the tabletop or surface where the test will take place. Wash your hands with soap.
• Follow the directions step by step. Otherwise, incorrect results can occur.

Dr. Phillips gives some guidance for what happens next.

The result is positive. “Believe it! I am sorry, but your child has COVID. No repeat test is needed. The good news is most kids have mild cases. Call your pediatrician for questions or perhaps set up a telemedicine visit to discuss treatment options and for your doctor to lay an eye on your kiddo in a safe way for all.”

The result is negative. Using the second test in the kit, repeat the test in 24-36 hours to confirm the finding. In the meantime “if your child has symptoms highly suspicious for COVID or fever, keep them home to help protect your community.”

The CDC points out that the results of at-home tests might come back inconclusive or invalid due to user error or a malfunction in the device. If that happens, the CDC recommends contacting the test manufacturer for assistance.

Accuracy depends in part on the quality of the nasal/saliva sample. Whether a child undergoes the test at a clinic or at home, the process of obtaining a specimen can be… interesting, in the words of Dr. Phillips.

“Have you ever wrestled an angry Tyrannosaurus Rex? This would be what it is like to push a swab up the nose of a 3-year-old with fever and cough.

“And then there is the teenager. Tired, grumpy and does not really want to go to school anyway. You eagerly describe to them that you are going to place a swab in their nose and rotate for 15 seconds on each side. Hmmm. Not a happy customer,” she described.

A positive result on an at-home COVID-19 test should be reported to the state or local health department. This helps officials to keep accurate information on transmission rates in the community. Click here to report for Tarrant County: COVID-19 (tarrantcounty.com

Now that that’s out of the way.

They’re painful, not fun to look at and just all around annoying, for everyone, but especially for teenagers.

Which is why it’s important that parents and teens know what they are and what treatment options are available.

What are fever blisters?

Fever blisters are ulcers of the lips, usually at the border of where the lips meet normal skin. Other types of ulcers can be confused with fever blisters but these usually occur inside the mouth or on the tongue.

They are caused by a recurrence of a viral infection known as herpes simplex virus (HSV). Many families are not aware of their children’s first HSV infection because it may be mild or have no symptoms. They are contagious, so it’s not uncommon for multiple family members to struggle with fever blisters.

The sores can come and go, especially during times of stress, illness, sunlight or fever. Most commonly they’ll appear around prom or other times when pictures are super important (acne has a similar skill). Before the sores erupt, some people will feel itching or pain in the area, but not always.

How can we treat fever blisters?

There are two main considerations for treatment of fever blisters:

1. Who needs treatment
2. What strategy of treatment are we going to use

Treatment is unnecessary for most teens with fever blisters. If the pain isn’t severe and their outbreaks are small and short, it’s perfectly fine to keep an eye on them and treat pain with topical therapy or ibuprofen.

In children with more severe but infrequent issues, treatment with an anti-viral medication can be started when they first begin to feel the signs of an oncoming fever blister. This treatment has been shown to decrease the severity and length of the outbreaks.

Generally, I’m not too concerned about the exact number of your child’s temperature. “Felt warm” is usually more than enough for me to know my kid has a fever.

But, like many things in medicine, that has changed in the world of COVID-19.

Many of the protocols for screening and testing have been developed based upon knowing if you or your child has fever.

So, now more than ever, knowing which type of thermometer and the best way to take your temperature is crucial.

Here is a look at 7 different types of thermometers (and a bonus one that many of you swear by) and how to decide if they are right for your family:

1. Forehead strips

Ahh…the allure of not having to wake your baby up to know their temperature. Sounds nice, right? And it might even offer you some peace of mind. But is that peace of mind false? Probably. There aren’t many studies on the use of strip thermometers but most recognize the accuracy of detecting fever at around 35 to 50 percent. What does that mean? If you don’t want to touch your child and wake them up to see if they have a fever, just flip a coin…Heads=fever, Tails=no fever.

2. Wearable thermometers

Trying to one up the forehead strips is the wearable thermometer. In theory, it will notify you via an app if your child’s temperature reaches a fever. Like the forehead strips, the accuracy of these is suspect. On top of that, if you’ve read anything I’ve written about fever before (like this post about fever myths), you might know that I don’t think it’s important to know your child’s temperature every second of the night.

3. Pacifier thermometers

Just plain “Nope.” They don’t work. Save your money.

4. Ear thermometers (tympanic)

Now we’re getting into the more common and reliable ways of checking your child’s temperature. While not my favorite, some parents like the relative ease of the tympanic thermometer. This thermometer is placed in the ear. A few important points: 1) It can’t be used in children under 6 months. 2) Placement in the canal matters. Read the directions and follow them. 3) Excess earwax can cause an incorrect reading.

5. Forehead thermometers (temporal)

This is the preferred method for most kids 3 months and over, particularly for screening when you can’t or prefer not to do a rectal temperature. That’s why you’ll find most doctor’s offices using them at check-in. Once again, the placement and the way you move it matters so follow the directions included. If you are getting a reading that doesn’t make sense, check it a few more times until you are getting consistent readings. Another nice thing about these thermometers is that they can be used for screening even before 3 months of age…before you go to take a rectal temperature.

6. Digital thermometers

A nice digital thermometer is good to have because it can be used throughout age ranges, provides accurate readings, and it's cheap.

At any age, you can use a digital thermometer under the arm and add 1 degree to get a general sense of what the true temperature might be (just don’t count on that as 100-percent reliable.)

Before age 3, the most accurate temperature will be a rectal temperature, in the bottom (see below for how to take a rectal temperature). Anything over 100.4 taken rectally is a fever. After age 4 or 5, you can start to take the temperature in the mouth (see below for how to take an oral temperature). I general consider 101.4 or above to be a fever when taken orally.

7. Non-contact Infrared Thermometers

With the recent events related to COVID-19, I've gotten a lot of questions about these thermometers. They are an option for you because they are accurate, can be used for screening at your home or office and they don't require touch.

Bonus: Mom’s hand or lips

“He feels about like the oven which is set at 350 degree.” Actual phone call. Actual quote.

Ok, this is not an actual thermometer, but I thought it deserved a mention. While touching the child might give you an idea that you should check a temp, mom’s hand is not a reliable way to determine the child’s temperature. Now grandma’s hand…I find it best not to argue with grandmas. “It felt like 102…yes ma’am.” But seriously, use an thermometer that works.

Hopefully this article will provide you some guidance for the next time you need to replace your thermometer. You have a few solid options and a few terrible ones. Some are basic but work just fine. Some have fancier features that might be useful. Others have stuff which prove that the solution to fever is not always more (cow)bells and whistles.

How to take a rectal temperature

• Clean the thermometer with soap and water.
• Place a small amount of petroleum jelly on the end.
• Place your baby across your lap face down or on their back on a firm surface.
• Gently place the thermometer about ½ inch into the anus.
• Place your entire hand around the child’s bottom, holding the thermometer in place between your fingers.
• Hold in place for about 1 minute or until you hear the beep.

How to take an oral temperature

• Wait 10-15 minutes after the child has had a drink.
• Clean the thermometer with soap and water.
• Turn the thermometer on and place under the tongue toward the back of the mouth.
• Wait for 1 minute or until you hear the beep.

“All of these children presented to the hospital with symptoms that resembled a severe case of Kawasaki disease,” said Nicholas Rister, M.D., an infectious diseases physician at Cook Children’s.

Kawasaki disease is an illness that creates inflammation in blood vessels with no proven cause, but is generally thought to follow various infections after they have otherwise resolved. Dr. Rister said the patients with MIS-C arrived at Cook Children’s following exposure to COVID-19 and had symptoms including fever, abdominal pain and outward evidence of inflammation including diffuse rashes, conjunctivitis and swelling. In the more severe cases, evidence of multi-organ dysfunction including respiratory distress, low blood pressures, liver and kidney damage and altered mental status were also seen.

“Of particular concern to us is inflammation of the heart and surrounding major blood vessels which is also seen in Kawasaki’s disease. We have seen this same thing in several of these COVID inflammatory disease patients,” explained Dr. Rister. “Minimizing the degree of inflammation in these children, while providing supportive care for any organ damage, has been a key component of treatment.”

All four patients were tested for COVID-19. Three tests came back negative and one was positive.

“We believe all of these cases are related to COVID-19,” said Dr. Rister. “The three negative results are evidence of how far the infection had progressed, resulting in the inflammatory syndrome.”

Three of the patients have been released from the hospital. One remains in the pediatric intensive care unit.

In addition to the recent appearance of MIS-C cases, the infectious diseases team at Cook Children’s is also looking closely at increased reports of unexplained fevers in our area.

“We want parents to be aware of these cases as COVID-19 continues to spread in our community,” said Dr. Rister. “Unexplained fevers for several days and evidence of generalized inflammation may be signs of this illness.”

Symptoms of more severe MIS-C cases include severe abdominal pain, shock from low blood pressure, respiratory distress and lethargy. If your child exhibits any of these symptoms, seek emergency medical care immediately.

Less severe symptoms include fever, abdominal pain and rash. Caregivers should call their pediatrician if these symptoms appear, as they overlap with many other common infections and medical conditions. It is important for these children to be fully evaluated.

COVID-19 has now been associated with a syndrome in children known as pediatric multi-system inflammatory syndrome. This condition is similar in nature to two pediatric conditions known as Kawasaki disease and Toxic Shock Syndrome.

While we still don’t know a lot about the COVID-19 related syndrome, let’s take a look at Kawasaki disease.

Kawasaki disease is a syndrome in children which is characterized by fever over 5 days with some of the following findings:

• Swelling or redness of the hands and feet, followed by peeling of the tips of the toes or fingers
• Red rash all over
• Redness and crusting of the lips or redness of the tongue (like a strawberry)
• Severe pink eye without drainage or mattering
• Swollen lymph nodes of the neck

In addition, children are commonly very irritable with Kawasaki disease. It is significant because the level of inflammation can affect multiple organs (most notably the heart) and lead to very severe illness.

While it’s still not a common condition, even with the newfound association with COVID-19, parents should be aware if their children display persistent fever with any of the associated symptoms.

The cause of Kawasaki disease is unknown. Some evidence suggests there might be an infection involved. The symptoms and complications associated with it are a result of inflammation of small to medium sized arteries throughout the body.

The most commonly known complications of Kawasaki disease involve the heart and can be inflammation of the lining or muscles of the heart, or dilation of the arteries that supply the heart.Toxic Shock Syndrome can present in the same way as Kawasaki Disease but the patient has low blood pressure and is significantly more ill.

If you suspect your child has Kawaski disease or Toxic Shock Syndrome it is important to seek your doctor’s advice quickly, as it is much easier for your physician to connect the dots when symptoms are present. Blood tests can help support the diagnosis and treatment can resolve the symptoms and help to prevent complications.

The good news is that children with Kawasaki's disease and Toxic Shock Syndrome, usually return to normal and don't suffer complications.

For more on this topic:

• Kawasaki disease (cookchildrens.org)
• Pediatric multi-system inflammatory syndrome
• COVID-19 and Pediatric Multi-System Inflammatory Syndrome (AAP)
• Kawasaki disease
• Toxic Shock Syndrome
• My Child's Fever Isn't Going Away. Should I Be Worried?
• Chest Pain. Is It Your Child's Heart or Something Else?

Just a quick reminder of my big fever rules. Click the links to learn more:

1. You don’t always have to rush off to the ER for a fever. No matter how high.

2. In a well-appearing child, it’s OK to watch fever at home, even up to 5 days.

3. You only have to treat fever to keep the child comfortable. Don’t treat the thermometer.

But what if your little one has a fever and it doesn’t seem to be going away? What should you be worried about?

Let me just start by saying this…this article is intended for children 6 months to 3 years who are fully vaccinated and are otherwise acting pretty normal. Why?

• Older kids are usually much better about telling us if something hurts.
• In children who haven’t received all of their vaccinations, we have to consider some other infections that have otherwise pretty much gone away.
• If a child isn’t acting normal (is lethargic, not drinking and peeing or has other concerning symptoms), they should be taken in for care (probably to the ER).

Sometimes it’s really obvious where the fever is coming from but other times it’s not. Here are some infections we think about when it’s not really clear:

1. Ear infection – Often kids with ear infections will have fever, fussiness, runny nose/cough and will be pulling at their ears but other times it might not be so clear.

2. Pneumonia – Most children with pneumonia will have symptoms such as rapid breathing or difficulty breathing but not always.

3. Urinary tract infection – This is actually one of the most common reasons for kids to have fever without symptoms in this age group. They just can’t tell you that it hurts when they pee.

4. Meningitis – The younger you are, the more likely a child is to have meningitis only presenting with fever.

5. “Viruses” – This might be the answer you don’t like to hear but, besides ear infections, it’s probably the one you want to have. Sometimes a child will present with just fever or fever and very little else until a few days into the illness when viral symptoms like runny nose, cough or rash become more prominent.

So, if your baby’s fever doesn’t go away after 3-4 days, what should you expect?

Your doctor should take a thorough history and do a full physical. If the diagnosis isn’t clear, here are the tests that are likely to be run:

1. Blood work – A blood count and some markers of inflammation will help determine if the infection is more like viral or bacterial.

2. Urine sample – Even though it’s not fun because urine catheterization in this age is no fun for anyone, getting a urine sample is critical because UTI is such a common cause.

3. Chest X-ray – Due to the fact that pneumonia can be a cause, getting a chest x-ray will usually be necessary.

4. Other – Depending on the baby’s story, physical exam and the results of the initial lab work, further testing may be necessary.

When your little one has a fever, it can be really scary. Keep in mind that most fevers have obvious causes or go away quickly on their own. But when they don’t, now you’ll know what to expect.

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.

One of the first things I like to know when ascertaining the seriousness of a child’s condition is whether the child is playing, smiling eating or drinking. If a complaint is brought up regularly, interferes with play or a child really cries, parents should consult a physician.

High Fever

New parents might find the recommendations for when to seek treatment for a fever daunting, but it gets easier with time.

For infants 3 months and younger, any fever is serious and parents should see a physician’s help immediately.

For children older than 3 months, a high fever combined with symptoms such as lethargy, changes in fluid and/or difficulty breathing require prompt medical attention.

Children who are 3 months or older with fevers of 102 degrees Fahrenheit or higher that don’t respond to fever-reducing medicine should see a doctor.

Fevers up to 101 can often by managed with fever-reducing medicine, fluids and rest. However, if your child also has a harsh cough – which may indicate croup – you need to consult a doctor.

Stomach Hurts

If your child has a stomachache, there are three red flags that may warn parents of a serious illness such as appendicitis:

1. Your child has a tummy ache and a fever.
2. Your child can point with one finger to where it hurts.
3. Your child has been vomiting.

Children don’t need to have all three symptoms for parents to seek help because any one of these symptoms can indicate that appendicitis might be a possible diagnosis. Parents should also not wait too long. If symptoms worsen in six to eight hours, consult a doctor.

My Head Hurts

Headaches and even migraines can occur in children as young as 3 years of age. Parents can give their child a nonsteroidal anti-inflammatory medicine, such as ibuprofen, or eliminate headache pain caused by hunger, fatigue or dehydration with food, rest or fluids.

Talk to your pediatrician about his or her treatment recommendations, particularly if you’ve never treated your child’s headache before.

If headaches occur at the same time each day, parents should consult their pediatrician. Headaches can occur with the flu or fever, but we become concerned if a headache is serious enough to make a child cry, interferes with play or is so bad the child is vomiting.

Related Topics:

• Let's Learn About Fevers
• Is It Strep Throat or the Flu?
• Let's Learn About the Flu
• Probiotics for Tummy Bugs: Do They Help Your Chlid?
• My Child Poops Every Day. How Can They Be Constipated?
• Is Over-The-Counter Medication Causing Your Child's Headaches?
• When It Comes To Your Kids, It's Never Just a Virus

Fever has been recognized as being around for thousands of years. And yet it’s never gone away. We’ve just not evolved it away. Which must mean it benefits us, right?

The process of a fever, simplified/Dr. Diane-ified:

1. A germ (virus or bacteria) enters your body. One of your immune cells floating around notices it. It freaks out. It makes a whole bunch of chemicals to freak everybody else out. HIGH ALERT, EVERYONE!

2. The chemicals reach your brain (the hypothalamus, in particular). The hypothalamus says OK GUYS, GET THE ARMY OUT THERE, STAT. DO YOUR THANG. I'LL MAKE THIS PLACE REAL HOT TO HELP OUT!

3. The brain thermostat is set at a new number. Instead of 98 F, he’s now gonna re-set at 102 F.

4. Heart rate speeds up. Breathing speeds up. Blood vessels open, flush. The body is physically pushing the blood around faster, to get the white blood cells there quicker.

5. Muscles shiver, generating heat. You start making more immune cells. They travel around faster. They talk to each other more effectively. They “stick” to the bad guys better.

6. You feel cold, because your new “set” thermostat wants you to be 102F. You're not there yet, so your body is trying to get you there. You shiver. Your muscles ache.

7. Soon, the germ can’t replicate as much as it wants to. It can't divide and conquer. Maybe even its protective coating starts to break down a little bit.

After a few days of fever, you beat the germ! Thank you, glorious fever and fabulous immune system!

Studies have shown (in rats and iguanas) that there is even a higher success rate at overcoming a virus or bacteria if a fever is allowed to burn rather than when they're given medications to bring it down.

Oh my gosh. Aren’t our bodies amazing? And are you feeling a teeny bit better about that number on the thermometer?

Most of the time, fever is just a sign that the body is fighting something, and you just need to try to keep your kiddo hydrated and comfortable.

You do not have to run to the ER, or my office, at the very first sign of a fever if your child is over age 3 months.

But sometimes, fever isn't OK.

My son once woke up with a fever of 105.7F. I remember the day clearly. I totally freaked out, just like you do. Then I asked myself – what do I tell my patient families to do?

Once I tried a few different thermometers and they all read the same number, I gave him a dose of ibuprofen and put him in a warm bath (NOT cold – warm) and let him play.

I watched him closely. I made sure he was breathing OK, and able to drink. He seemed fine, just super grumpy.

After about 45 minutes, I re-checked his temp. It was 102F. He was sitting on the couch, drinking water and talking comfortably. I was OK with this. And he did fine. He had a fever for three days, and a runny nose and a little cough, and it went away. He had a virus, and his body took care of it.

6 Types of Thermometers:

1. Thermometer forehead “strips”, pacifier thermometers, and wearable thermometers - don’t buy them. Save your money. 

2. Forehead “temporal” thermometers – they’re OK. We use this kind in the office. Good days and bad days, and I think they’re usually as accurate as the ear ones.

3. Tympanic (ear) ones – easy to use. Pretty accurate. Don't use under 6 months, ear canals too tiny.

4. Rectal - most accurate (good luck)

5. Oral - second most accurate, if they can hold their mouths shut

6. Armpit - least accurate

Yes, you add one degree to the armpit temp measurements. Although again, I dislike the math.

But what I want to drive home is: if the child looks fine otherwise, the number often doesn’t matter too much to me.

Febrile seizures:

Something like 2-4 percent of kids between the ages of 6 months and 5 years have febrile seizures. This means they may have a seizure when they have a high fever spike. They usually stop by age 5.

These are super scary, but actually don’t cause any brain damage. The child should be rolled onto his side, and watched closely. Don’t stick anything into his mouth.

VERY rarely, unrelenting and long febrile seizures may indicate a bigger problem like something neurologic or genetic going on. But again, this is super rare.

Febrile seizures may run in families. If the seizure lasts longer than 5 minutes, call an ambulance. Again, these are rare, and usually very benign.

Whew. OK. I hope this helps you understand fevers better!

Education is empowerment in your child's health! The more you know, the better you feel!

Want even more on beautiful science of fever? It's all laid out here, with lots of big words and acronyms.

Have a great day, friends!

Dr. Diane

“Wear shoes outside.”

“Put on your hat.”

Does any of this really matter? Is any of it true?

Between well-meaning friends and family members and the wealth of websites devoted to health, parents are bombarded with tips and tricks to keep their kids healthy year round, but especially during the winter. This can make separating fact from fiction difficult.

Not all old wives’ tales are fictitious – some are grounded in truth. However, if you have questions or hear health advice that doesn’t make sense to you, always ask your children’s pediatrician before acting on the information or simply believing a statement is true.

Let’s take a look at the facts on these weather health myths.

Myth 1: Sudden changes in the weather make you sick

One day you are wearing shorts and the next day you are dragging out all of your winter gear. Welcome to Texas. So doe the fluctuating weather make you sick? In general terms, the answer is no. I know no matter how much science I use in my answer, many of you won't believe me. The truth is there's no scientific proof that changes in the weather will make you sick or keep you from getting better. 

But as usual there are exceptions. The changes in the weather can be really hard on your child's skin. Moisturizing children's skin during the winter is important and that includes wearing protective lip balm. Also, make sure your child uses sunscreen when playing outside whether it's cold or hot outside. 

The other concern would be kids with asthma. People have different triggers for their asthma. The most common ones tend to be weather changes, viral infections and exposure to certain allergens. Cold, dry air can cause bad flare-ups and viral infections are the most common trigger this time of year. Parents should stress to their children the importance of handwashing, especially this time of year.

Myth 2: If children go outside with wet hair or without shoes, they’ll get sick.

Many people believe that cold temperatures are responsible for the spike in illness that typically occurs during late fall and the winter months. People get sick in the winter because they spend more time in close proximity to one another, not because they’ve been exposed to cold weather.

The truth is it’s not really going to matter that much if your kids go outside without socks and shoes – except maybe if you don’t want dirty feet or if it’s extremely cold, your child runs the risk of frostbite.

It’s true we do see more colds, flu and flu-like viruses during the winter. Both the life cycle of common viruses and the fact that people are more likely to be clustered inside their homes and schools when it’s cold outside, which causes viruses to circulate, contribute to this increase.

Myth 3: People lose most of their body heat throughout their heads, so children should wear hats while playing outside in cold weather.

This tale originated in response to several studies conducted by the United States Army in the 1950s. Further research has since debunked this claim, but it’s true that your face, chest and head get colder faster when you’re exposed to winter weather.

Your face is particularly sensitive to the cold. If your children’s faces are cold while playing outside, they should wear warmer clothes. But colds come from germs – not cold temperatures – so children aren’t going to get sick if they don’t wear a hat.”

Myth 4: Feed a cold and starve a fever.

We’ve all heard this and probably most of us can’t even keep the saying straight. But there’s no scientific evidence to support the idea that children should fast when running a fever. Children who are sick should eat when they feel up to it and drink plenty of fluids to prevent dehydration.

Even if children don’t feel hungry, we ask parents to encourage their kids to drink as many liquids as they can. I’ve also heard an old wives’ tale that says you shouldn’t drink milk if you’re running a fever, but milk works as well as other fluids when it comes to keeping kids hydrated. Other good choices include water, Pedialyte and Gatorade.

Myth 5: All fevers should be treated with medicine because high fevers are dangerous.

As parents, it’s only natural to rush to the medicine cabinet at the first sign of a high temperature, but fevers aren’t always a cause for concern. In fact, they help your child’s body fight infection. According to the American Academy of Pediatrics, children’s demeanors are often better indicators of illness severity than the numbers on the thermometer. If children aren’t fussy or complaining of feeling badly, there’s no need to treat a fever unless their doctor says otherwise.

Myth 6: You can’t prevent your child from catching a cold.

While there’s no cure for the common cold, you can take steps that will reduce your child’s risk. In this case, grandma is right. These are the same steps she told you. Wash your hands after you sneeze. Wash your hands after you blow your nose. Wash your hands after you eat. See a theme? Children should sneeze into the crook of their elbow and not their hands. They should blow their nose to get rid of the mucus. For children too young to blow their noses, parents should use a blue bulb syringe and drain the child’s nose with salines. If a cold lasts longer than a week, bring your child in to see his or her pediatrician. It could possibly be a sign of acute sinusitis and may need to be treated differently than the common cold.

Don’t buy into the weather myths. Here are some tips for preventing health issues:

• Help your child eat healthy and get good sleep.
• Get your child up and active in some way every day.
• Teach your child to wash their hand and cover their coughs.
• Get your child a flu shot (it’s still not too late).

When should you be worried? The biggest issue is context. You can read the other posts to see all about that.

Another reason you should be more concerned with fever is if it is lasting more than 5 days. Of course, if you end up with a diagnosis where fever is known to last more then 5 days, no big deal, but otherwise, most fevers should be gone by then.

This situation is called fever without a source.

There are many different definitions of fever without a source but I use: fever greater than 101 for eight days in a child in whom there is no obvious source of the fever through the patient’s story or physical exam.

Because children can often have back-to-back viral infections, it is important that this fever be present daily or near daily. For instance, it doesn’t count if they had fever for 3 days then were better for 2 days and then had fever again for 3 days.

The different things to think about are all over the place and can range from very serious to the “no-big-deal.”

Infections - The most common diagnosis in this instance is “unknown” but the fever goes away on its own. While often not intellectually satisfying (to either me or the parent who wants to know what is going on), this is probably the best outcome for the patient. Most of those are probably viruses for which we don’t have or don’t think to run specific tests. Bacterial infections can also cause long-standing fever.

Rheumatologic - Less commonly, children with prolonged fever can have rheumatologic causes, an example is juvenile rheumatoid arthritis. Often these children will have exam findings like swollen, painful joints or swollen lymph nodes that will help point towards their diagnosis.

Malignancy - Fortunately, this is a very rare cause of prolonged fever but it does happen so we all need to keep it in the back of our mind. The most common type of cancer in children is leukemia.

The workup for fever without a source involves a few things:

1. Repeat histories and physical exams - Often things are discovered over time.
2. Preliminary screening labs - Check these in just about all kids with it.
3. Specific tailored labs and exams - Check some of these based on a child’s story or exam.

Kawasaki disease

One specific cause of fever over five days deserves specific attention. Because many parents are not aware of it and because the diagnosis can be tricky, I thought it deserved its own specific mentions.

Kawasaki disease (KD) is characterized by the characteristic fever over 5 days along with some of the following findings:

• Swelling or redness of the hands and feet, followed by peeling of the tips of the toes or fingers
• Red rash all over
• Redness and crusting of the lips or redness of the tongue (like a strawberry)
• Severe pink eye
• Swollen lymph nodes of the neck

One of the other things to note with KD is that these children are very, very irritable. Not kinda irritable, but noticeably irritable even to a pediatrician who hears crying babies and children all day long irritable.

The cause of KD is unknown. There is some evidence to suggest that there might be an infection involved. The symptoms and complications associated with it are a result of inflammation of small to medium sized arteries throughout the body.

The most commonly known complications of KD involve the heart and can be inflammation or the lining or muscles of the heart or dilation of the arteries that supply the heart.

If you suspect your child has KD it is important to seek your doctor’s advice quickly, as it is much easier for your physician to connect the dots when symptoms are present. Blood tests can help confirm the diagnosis and treatment can resolve the symptoms and help to prevent complications.

The good news is that children with Kawasaki's disease, like the child in the photos with this blog, usually return to normal and don't suffer complications.

Effectiveness/General Use

Do they really work or is it a mind over matter thing?

I think that there are probably some uses for oils that will be studied and proven to work. I think these will be pretty rare and only a small fraction of the claims that are currently made.

So, is it mind of matter (placebo)? Here are some of the most common uses I see for oils in kids:

Teething - It’s not even clear what symptoms teething causes …fussiness, fever, runny nose, etc have all come into question. But, if you give an oil and a symptom goes away, does that mean the oil fixed it? Not likely.

Fever - Fevers come and go during the day with illness, even without medication.

Cough/congestion - The regimens I see where children have oils placed frequently basically make it impossible to know if they do anything for these symptoms. Cough/congestion will be worse at certain times of day and better at others treatment or no.

How close are we to having actual research on the use of oils?

I still think we are quite some time away. Those that are currently doing research are often biased, are not doing high-quality studies and are using small sample sizes.

Marketing

Why are they sold through multi-level marketing (MLM)?

It’s a fast way to get a product out there and make a lot of money. Since I’ve been on social media, I’ve seen several of these types of MLM ideas crop up. The difference with these is I have some specific knowledge about the conditions they are being used for and specific concerns about how their use could harm a population of people that I care very much about. I know very little about bags and good smelling wax that can be melted with a light-bulb so I haven’t gotten involved until now.

In many ways, it protects the big company because they are not the ones out there making claims about the oils and what they can do. That falls to their independent distributors. If someone were to have a bad outcome because of their use of essential oils, who is responsible? If I prescribe a medicine that someone is allergic to, that responsibility falls squarely on my shoulders, not the makers of amoxicillin. If I prescribe the wrong medicine for a kids asthma and something bad happens, that responsibility falls to me.

Are they an increasingly popular trend or just something I was not aware of?

I’m not sure but it certainly does feel like they are gaining in popularity. Social media makes it seem that way at least.

Do you believe the claim that certain brands of oils are superior to others?

I’m sure there are differences but since we don’t even know what they do for the most part, it’s hard to answer this question.

Philosophy/Opinion

Regarding writing about essential oils: Are you mad, man?

Yes, in fact, I think I must be.

What’s the number one reason you see parents using oils instead of medicine?

In general, people are becoming less trusting of experts and organized institutions. Medicine and doctors are no different. The gap between what a doctor knows and what patients know shrinks every day. People can find out information about their conditions and know basically the treatment options that exist. People are looking to live more natural lives and most who use them feel that oils fit within that idea. When you combine these two issues, right or wrong, essential oils seem to step in the gap.

What is a good way to communicate with your doctor about your use of essential oils (for specific conditions and generally)?

I think it’s important to be honest with you doctor about your use of essential oils. As new information is uncovered it would be important for your doctor to be able to show you new research etc, especially if something shows a particular oil to be unsafe. They can only do this if they know about your use of them. Also, as doctors are prescribing medications, we need to know anything you might be on that could cause a drug interaction.

What is your take on the potential political barriers to the study of essential oils given that they are not backed by super profitable pharmaceutical companies?

Young Living is a very profitable company. They are big and profitable and will only continue to be more profitable. There is no reason that they could not start testing their own products or set up independent testing.

After your research as a pediatrician, would you use them on your children?

People will read all of this information or even do further research and come to different conclusions from me but here are two reasons I won’t:

1. I do not treat my kids with unnecessary medications. Since they are recommended for symptoms and given with the hopes of reliving those symptoms, I consider these oils to be medication.

2. I believe that, due to the lack of good studies, the use of them in children should be considered experimental at this point.

Summary

• The use of essential oils seems to be growing.
• The evidence for their use in children is slim.
• Talk with your doctor about the products you are using so that they can be aware of potential safety issues and medication interactions. 

Previous articles on this topic:

• New York Times Report: Are Essential Oils Safe For Kids?
• Essential oils and their use on children
• How safe are essential oils for children?

But when it comes to newborns, forget everything I’ve always taught you about fever. If an infant has a fever, it is a sign something is wrong and a serious cause for concern

In older children, fever is almost never an emergency, the exact degree of the temperature doesn't really concern me and unless there are other reasons to do so, a workup isn't indicated.

In babies up to 3 months of age, the opposites are true.

Fever in a newborn is an emergency. When a newborn has a fever, parents should have a sense of urgency.

An accurate temperature really matters for newborns. You don't need to go around checking your baby for fever randomly. But if they feel warm, are not eating well or you're otherwise worried, we recommend taking a rectal temperature. Rectal temperature is important because it's the most accurate way to determine the temperature and the studies that tell us what to do with your baby are based on rectal temperatures.

Once you have an accurate temperature, I recommend that you call your doctor with any temperature over 100 degrees. Technically fever is anything over 100.4, but it's good to let us know so we can coach you on what you should be looking for. It also helps us decide what should prompt a visit to the emergency room if it rises overnight.

Fever is such an emergency in babies because they can be an early sign of serious, even life threatening infections and babies can't tell us if something hurts. Babies can have blood stream infections, meningitis or urinary tract infections with little other symptoms. They also can get all the other things that older kids get too like stomach bugs, flu and other viruses but we would rather be safe than sorry.

Because of these risks, babies with fever will typically receive some type of lab work to determine if infection is present. This can include blood work, urine test and possibly a spinal tap to rule out meningitis.

While it's scary and no one wants to think of your baby needing this work-up, the fear of missing one of these serious infections or leaving them untreated, even for a short period, is even scarier.

Most babies with fever will be started on antibiotics while we wait in results from the test. This prevents babies from getting worse while we wait for results to come back.

So, as you can see, fever in newborns is a LOT different.

But, the important thing to remember is to call your doctor if the fever is over 100 and we'll help you keep your baby safe from there.

Related Topics:

• My Child's Fever Isn't Going Away. Should I Be Worried?
• 7 Types of Thermometers and to what Degree You Should Trust Them
• My Child has a Fever. Should We Go to The ER?
• 5 Days of Fever. Now What Should I Do?
• When It Comes to Your Kids It's Never Just a Virus
• Let's Learn About Fevers
• 4 Reasons Why This Pediatrician Doesn't Alternate Tylenol and Motrin for His Kids

But, does it help? Is it necessary?

I personally don’t think so…and here are 4 reasons why:

1. I don’t treat numbers, neither temperatures nor times.

When your child has fever, sometimes it’s not such a bad idea to let it be. If the child isn’t too uncomfortable and they are drinking well, it’s reasonable not to treat even if their temperature is high. If you’d like more information, read this great post from Dr. Paul Offit called, “The Case for Letting Fever Run It’s Course.” The bottom line is that treating fever may in fact cause the symptoms to last longer and the child to be contagious longer than just letting it run it’s course.

Bottom line: If treating the thermometer is not the best idea, should we be treating a child every three hours, around the clock, just in case? Maybe not.

2. It might keep the temperature lower, but it doesn’t make kids feel better.

There have been a few studies that suggest treating fever on a scheduled basis might keep the child’s temperature lower. So, it probably does work to do that. The interesting thing with those studies is that when you ask the parent how well they thought the fever was controlled, both groups reported that their fever control was adequate.

Bottom line: Even if the temperature was lower, the parents couldn’t tell the difference in how the child felt.

3. It increases the risk of extra doses.

When your child is sick, you are tired and stressed, things are complicated enough. The risk of extra doses is significantly higher when you are alternating medications. While the risk of an extra dose here and there probably isn’t high, if there is little to no benefit, I choose not to risk it.

Bottom line: If you are going to do alternating doses, write them down somewhere to keep track.

4. I’m lazy and it’s too much trouble for me.

This is not one of those issues that I’m willing pick a big fight with another doctor or patient over…but given the three points above combined with my desire to keep everything as simple as possible, I don’t personally alternate fever reducers for my kids and I don’t routinely recommend it for my patients.

The Dallas Morning News reports that person from another state who had mumps traveled to Dallas for the National Cheerleaders Association All-Star National Championship, which took place Feb. 23-25 at the Kay Bailey Hutchison Convention Center. 

At this point no Texas residents have developed mumps in connection with the case, but people are urged to watch for symptoms. 

This is another reminder about the value of vaccination in preventing what can be serious illness. Mumps cases decreased 99 percent after the introduction of a successful strategy for vaccination.

Here's a quick look at mumps cases over the years according to the CDC:

*Case count is preliminary and subject to change

** Cases as of Jan. 27, 2018 Case count is preliminary and subject to change

1. I’d be Terrified the Day my First Child was Born. Guess what? Reading tons of books about the health of children makes you no less prone to the paralyzing fear that arrives when that new cute little elephant-in-the-room appears. I wish they came with an instruction manual instead of a placenta.
2. Breastfeeding Ain't Easy. I had a lot of difficulties breastfeeding one of my children. He had horrible reflux, a poor latch, and a stubborn disposition. I thought, "hey – breastfeeding shouldn’t be that bad, right? You just put the baby on the boob and they figure out the rest!" Nope. It’s no wonder there are some wonderful people out there who dedicate their whole career to helping women breastfeed. And guess what? I had to use some formula to get my kid through his first year. And that’s OK.
3. Children Sometimes (All the time) Don’t Go By the Book. First teeth don’t always appear when the books say they do. Weird rashes never look like the pictures online. My daughter had lots of motor delays, way past when the books said she should….and she’s fine now. It takes the experience of a good pediatrician to let you know when to worry, since all kids are so different. We gain experience via treating thousands of patients with time. I had to take off my pediatrician hat and only wear my mama hat when it came to my kids. And had a great pediatrician reassure me that everything would be OK.
4. Fevers Make Me Worry, Too. My son once woke up with a 105.6F temperature when he was a toddler. Of course I was supposed to be seeing patients in the office 20 minutes later. That was one of the most difficult mornings of my life. I had to choose who to care for – my son, or my patients? I took some deep breaths and tried to talk myself through what I tell my patient’s parents. Warm bath, dose of ibuprofen, lots of snuggles (with Daddy). He was fine. But it reinforced why I’ll never judge a parent who is worried even about the tiniest of temperature elevations. 
5. Living with a Toddler is Like Living with an Irrational, Angry Drunk Person. I’d read all the books about effective behavior management. Learned techniques for distraction, offering choices, creating reward charts. But when your three year old is flailing on the floor, mopping the tile with his Oscar-worthy tearfest all because I offered the blue plate instead of the red one…one questions how many bottles of wine to buy for the week.
6. Explaining Simple Things Can Become Very Difficult. “Why is that man in a wheely-chair, Mommy?” “Why did Harper’s dog die? Where did he go?” “How do planes work?” “How come kids go to different churches?” Being a board-certified pediatrician doesn’t mean that I don’t struggle with how to explain things to my kids. I want to be fair and accurate and informative…and somehow word it in a way that my little people understand it. It’s hard, I know. And I can’t promise I do it any better than you. But like you, I’m trying my best!
7. The Online Mothering Community Can Be Both Supportive and Judgmental. It really does take a village to raise a child. And I really hadn’t dabbled in the online world of mothering until I became one. What are the best breast pumps available? Where are the best parks in town? Which restaurants are most kid-friendly? I loved all the readily available advice I found online, but with that help also came the judgmental comments, the guilt, and the unintentional comparing of myself to others. I quickly put a stop to the latter in my mind – and now understand how to better reach my patient moms, who struggle with this dichotomy of feelings social media can conjure.
8. Becoming a Mom Doesn’t Mean I Have to Change Who I Am and What I Love. I was fiercely independent and very driven before I had kids. This hasn’t changed since my two little turkeys came into the world. It did however change how much time I’d have to practice my hobbies and be the best doctor I could possibly be. My lifestyle had to change a bit, but I’ve found that staying true to what you need to be happy – whether it's picking up a camera, a book, getting some time at the gym – makes you a better mom. Do it, and don’t feel guilty about some time to yourself.

I share these pieces of vulnerability and advice with you so that you know you’re not alone. Being a great mom means many things, and know that even childhood experts have their daily struggles. I’m still learning every day. And I always tell my patient’s moms: my two best teachers are my kids. At the end of the day, no matter how many arguments and challenges have ensued, if your kids know they’re loved, you’ve reached beautiful success.

• Make sure your hair is dry.
• Wear shoes outside.
• Put on your hat.

But does any of this really matter?

Between well-meaning friends and family members and the wealth of websites devoted to health, parents are bombarded with tips and tricks to their kids healthy year round, but especially during the winter. This can make separating fact from fiction difficult.

“Not all old wives’ tales are fictitious – some are grounded in truth. However, if you have questions or hear health advice that doesn’t make sense to you, always ask your children’s pediatrician before acting on the information or simply believing a statement is true,” said Justin Smith, M.D, a pediatrician and medical advisor for Digital Health at Cook Children’s.

And now, let’s let Dr. Smith give us the facts on these five winter health myths.

Myth 1: If children go outside with wet hair or without shoes during winter months, they’ll get sick.

Many people believe that cold temperatures are responsible for the spike in illness that typically occurs during late fall and the winter months. According to Dr. Smith, people get sick in the winter because they spend more time in close proximity to one another – not because they’ve been exposed to cold weather.

The truth is it’s not really going to matter that much if your kids go outside without socks and shoes – except maybe if you don’t want dirty feet or if it’s extremely cold, your child runs the risk of frostbite.

“It’s true that we do see more colds, flu and flu-like viruses during the winter,” Dr. Smith said. “Both the life cycle of common viruses and the fact that people are more likely to be clustered inside their homes and schools when it’s cold outside, which causes viruses to circulate, contribute to this increase.”

Myth 2: People lose most of their body heat throughout their heads, so children should wear hats while playing outside in cold weather.

This tale originated in response to several studies conducted by the United States Army in the 1950s. Further research has since debunked this claim, but it’s true that your face, chest and head get colder faster when you’re exposed to winter weather.

“Your face is particularly sensitive to the cold,” Dr. Smith said. “If your children’s faces are cold while playing outside, they should wear warmer clothes. But colds come from germs – not cold temperatures – so children aren’t going to get sick if they don’t wear a hat.”

Myth 3: Feed a cold and starve a fever.

According to Dr. Smith, there’s no scientific evidence to support the idea that children should fast when running a fever. Children who are sick should eat when they feel up to it and drink plenty of fluids to prevent dehydration.

“Even if children don’t feel hungry, we ask parents to encourage their kids to drink as many liquids as they can,” Dr. Smith said. “I’ve also heard an old wives’ tale that says you shouldn’t drink milk if you’re running a fever, but milk works as well as other fluids when it comes to keeping kids hydrated. Other good choices include water, Pedialyte and Gatorade.”

Myth 4: All fevers should be treated with medicine because high fevers are dangerous.

As parents, it’s only natural to rush to the medicine cabinet at the first sign of a high temperature, but fevers aren’t always a cause for concern. In fact, they help your child’s body fight infection. According to the American Academy of Pediatrics, children’s demeanors are often better indicators of illness severity than the numbers on the thermometer. If children aren’t fussy or complaining of feeling badly, there’s no need to treat a fever unless their doctor says otherwise.

Myth 5: You can’t prevent your child from catching a cold.

While there’s no cure for the common cold, you can take steps that will reduce your child’s risk. In this case, grandma is right. These are the same steps she told you. Wash your hands after you sneeze. Wash your hands after you blow your nose. Wash your hands after you eat. See a theme? Children should sneeze into the crook of their elbow and not their hands. They should blow their nose to get rid of the mucus. For children too young to blow their noses, parents should use a blue bulb syringe and drain the child’s nose with salines. If a cold lasts longer than a week, bring your child in to see his or her pediatrician. It could possibly be a sign of acute sinusitis and may need to be treated differently than the common cold.

Ear pain can be caused by many different factors. Often kids just play with or point to their ears. If the child is otherwise cranky, sick or not sleeping well, parents will assume there is an ear infection. However, a study from 1998 showed that parents only identified 70 percent of their children with ear infections and when they suspected an ear infection, it was only present 50 percent of the time. (Translation-they could have just flipped a coin rather than trying to guess.)

This is why getting an antibiotic called in when your child has ear pain is a bad idea - whether it is from your doctor or from one of the new insurance nurse lines that many people are using. Every exposure to antibiotics is a potential risk for allergy or side effects. Unnecessary exposure is not worth it.

2. All ear infections have fever.

Studies are all over the place about what percentage of ear infections have fever. They generally fall between 1-2 out of 3. Regardless, that means a lot of kids with ear infections won’t have fever.

3. Having your child in the wind or under water causes ear infections.

The location of an ear infection is behind the ear drum way back in the inner ear. External exposure like wind and water don’t affect that area. Grandma will have to come up with another reason for their grandbaby to put on a hat when it is cold outside.

What are risk factors?

• Age (6 months-2 years)
• Family history
• Day care
• Not breastfeeding
• Smoke exposure
• Pacifier use (small effect)

4. You can’t go swimming if you have an ear infection.

Related to the previous myth, there is no reason to avoid swimming if you have an ear infection. Unless the ear drum has ruptured the space where the ear infection is located is walled off from the water. Don’t skip the swim party! If the child feels discomfort or pain while swimming, they can play in the shallow end or just have a snow-cone.

5. All ear infections need antibiotics.

Many children with ear infections will get better without antibiotic treatment. The latest treatment guidelines give the following advice for treating ear infections:

• Children of any age with severe pain, fever or ear drainage should receive antibiotics.
• Children 6 months-2 years with both ears infected should receive treatment.
• Children 6 months and up with 1 ear infected and with mild symptoms can be watched for 2-3 days to see if symptoms improve or worsen prior to starting antibiotics.

6. Amoxicillin is not strong enough for ear infections.

Many studies have looked to compare different antibiotic treatments for ear infections. The bottom line is this, there is nothing better at getting rid of infections than amoxicillin. Other antibiotics may work as well, but they are typically more broad spectrum - meaning they cover more different types of infections that those that typically cause ear infections. Because of this, we should reserve those antibiotics for those situations in which they are necessary. Amoxcillin is cheap, well tolerated by most kids and effective. Therefore, except in penicillin allergic patients, it should be used unless the child has been on the medication in the last 30 days.

7. If your child gets tubes, their ear infections are guaranteed to stop.

After a few ear infections, some parents are eager to move forward with placement of tubes. Tubes can be a life saver with kids who have had multiple ear infections and can prevent recurrence of ear infections, but they aren’t perfect. They are a surgical procedure and the inherent risk associated with anesthesia need to be fully explained to a parent. Continued ear infections occur in about 20 percent of children even after they have had tubes placed.

Once people have heard my reasoning, they can get on board that fever isn’t as big of a deal as they once thought except for one MAJOR question:

What about febrile seizures?

The bottom line is that febrile seizures for the most part have to do with genetics and other uncontrollable issues. It has very little to do with the parent’s treating or not treating fever. Basically some kids are simply more likely to have them than others. You might just consider it a bit of bad luck.

On that note, here are 13 facts about febrile seizures:

1. Seizures can only be classified as febrile seizure if they happen when the child has fever.
2. Most febrile seizures occur on the first day of illness (often before the family knows the child has a fever).
3. The child cannot have a history of seizures or an infection that causes inflammation of the brain (like meningitis).
4. Febrile seizures occur between the ages of 6 months to 6 years (most commonly 12-18 months).
5. Boys are slightly more likely to have febrile seizures.
6. About 1/3 of all kids who have a febrile seizure will have another febrile seizure in their lifetime.
7. Kids with febrile seizures are only slightly more likely to have non-febrile seizures (only 1-2 percent).
8. Febrile seizures involve whole body shaking. If it’s just one sided or one body part, other causes should be considered.
9. Most febrile seizures are less than five minutes.
10. Head imaging (CT or MRI) and EEG (which look at brain activity) are not necessary with febrile seizures.
11. Treatment at the time of a febrile seizure is not necessary if less than 5 minutes.
12. Children with febrile seizures do not need to be admitted to the hospital unless the underlying cause of the fever makes it necessary.
13. Trying to prevent febrile seizures by treating fever aggressively has not been shown to be effective.

These are the 13 facts that I walk through with all of my families who have experienced a febrile seizure.

Hopefully knowing the facts will decrease some of the fear and relieve some of the guilt that has been placed on them for not preventing febrile seizures by catching fever in time.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.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.

The biggest challenge with vomiting and diarrhea is keeping the kids hydrated. After a big episode of vomiting they feel thirsty, and you want to replace the fluids. As a parent in this situation, you have to go against your instincts and not give them fluids right away. It is best to wait 1-2 hours after the vomiting episode before trying to give them fluids, otherwise it will all come back at you from a very irritated tummy.

To rehydrate, and keep the new fluids down:

• Give the stomach time to settle, we recommend waiting 2 hours.
• Start with just sips of water, electrolyte drink, breast milk, formula, or other fluid based on the age of your child.
• Offer sips every 20 minutes for 2 hours, and if they keep this down increase the amount of fluid slowly.
• Once they have kept down fluids for 8 hours then you can offer food.

The vomiting usually passes in the first 24-48 hours of the viral illness, and then can be followed by diarrhea for another 5-7 days on average. The diarrhea can last up to 2 weeks with a viral stomach bug. During this time use good hand hygiene, and avoid sharing food and drink so that the virus does not spread.

Watch for signs of dehydration:

• Urinating less than 4 times in 24 hours.
• The area under tongue looks sticky instead of moist with saliva.
• They are crying without tears.

If your child is having signs of dehydration or the diarrhea is lasting longer than expected, has blood in it, or other concerning signs then call your pediatrician to see if your child needs to be evaluated in the office.

While dealing with a stomach bug can be a miserable 24 hours or more, I can reassure you that you can get thru it safely at home in most cases. Just stick to your hydration plan, and prepare for many loads of laundry.

If you make a mistake, it could be harmful.

Myths about fever are common. And, no, you don’t have to go to the ER for fever. Treating a fever at home is often the right thing to do. But, we can’t get so comfortable treating fever that we forget that medicines can be dangerous, even over-the-counter fever reducers.

Here are 7 mistakes parents make when treating their child’s fever:

1. They treat normal temperatures. A child that has a 99 degree temperature does not have a fever. There’s no need to give them medicine. If one of our children has a 101 temperature but is playful, I don’t stop them to give medicine.
2. They wake kids up to give them medicine. If a child is sleeping, it’s OK to let them sleep.
3. They give aspirin. Aspirin should never be given to children with fever. It can cause a rare, but serious condition known as Reye syndrome which leads to confusion, brain swelling and liver damage.
4. They don’t give enough medicine. It is so common for children to be under-dosed by parents. Maybe it’s the psychological barrier to seeing your children grow up, especially when they are sick but giving the same dose to your child at 6 months and 6 years won’t work. Know their weight and dose accordingly.
5. They give too much medicine. Again, know your child’s weight and use a chart. Measure twice, dose once. If you think that you gave too much, you can call poison control to see if you should be worried: 1-800-222-1222.
6. They give too many doses. The old standby of alternating Tylenol and Motrin for fever goes way back but the reality is that overdosing and extra doses occur much more frequently with this strategy. I have quit recommending it for families altogether. Again, if this occurs, call poison control.
7. They leave the fever medicine out and kids get into it. This mistake is common and completely understandable. Often when kids need fever medicine, it’s a high-stress-low-sleep situation; a mental state where we are more prone to let down our safeguards. Don’t do it! Find a place up high to store your medicine and droppers so that they are in a convenient place and put them right back after you pour your dose. If you kid does get into the medicine, any ideas what you can do? 1-800-222-1222.

Here are the two major takeaways for treating fever:

Know your child’s weight and have a chart handy. Use it every time.

Stop right now and store the poison control number into your phone. Here it is again, in case you forgot: 1-800-222-1222.

Leaders from the Who called Zika a “public health emergency of international concern,” earlier in the week, because how fast the virus is spreading and the continued investigation into its link to babies born with abnormally small heads (microcephaly). Experts are also looking into the possible connection between Zika and a neurological condition called Guillain-Barré syndrome, which can cause paralysis.

No vaccine exists to prevent Zika virus. Mosquitoes that spread Zika virus bit mostly during daytime.

Click here for prevention information from the CDC.

Here's what we know from about the Zika virus from the Centers from Disease Control and Prevention:

1. The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosqutoes that spread dengue and chikungunya.
2. The mosquitoes are aggressive daytime biters, prefer to bite people and live indoors and outdoors near people. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes then spread the virus to other people through bites.
3. A mother already infected with the Zika virus can pass on the virus to her newborn around the time of birth, but this is rare.
4. The CDC has not found any reports of the Zika virus spread through breastfeeding.
5. The CDC believes the virus could spread through blood transfusion. At this time, there have been no reports of this happening.
6. There has been one case of the virus spread through sexual contact.
7. The most common symptoms of Zika virus disease are fever, rash, joint pain and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week and severe disease requiring hospitalization is uncommon.
8. However, the Zika virus can be dangerous, especially to babies. Doctors are studying the link to the virus and microcephaly, a birth defect that causes abnormally small heads and brains.
9. There is no vaccine to prevent or medicine to treat Zika.
10. The CDC recommends “that all people, especially pregnant women, who are traveling to Brazil and other areas in Latin America, should take precautions to avoid mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses such as dengue and chikungunya.”
11. The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

“There is still a lot to learn about Zika virus and the potential risk to cause this particular birth defect,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “However, because it could spread to the United States, it is important that doctors and patients are aware of it. Like other diseases that were once thought to be isolated to tropical areas like chikungunya, many patients and doctors forget to think about them.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

I hear statements like these:

1. “She must’ve been about 103 because she felt really hot.”

Touching a child to determine if you should check their temperature is valid, but skin temperature can vary based on what the child has been doing. If they feel hot after playing hard, being outside or waking up, give them a few minutes to cool off because you get too concerned.

2. “He had a 99 which is a fever for her because he usually runs around 97.”

Everyone’s temperature varies throughout the day, but we have to have a real cut-off for fever. You’ll see definitions vary but that cut off for me is 100.5 in children less than 3 months and 101.5 in children older than 3 months. (Remember that any child under 3 months that has a fever warrants a call in to your doctor right away.)

3. “He had a low-grade fever of 100.”

See above…it’s either fever or it’s not.

4. “I was worried because I know that fevers above 104 can cause brain damage.”

Temperatures that the body is generated because a child is sick are internally driven. The fever will stop rising at some point. Children are at risk for complications if their temperature rises because they are in a hot car or other external factors, but not because they are sick.”

5. “I knew something must be seriously wrong because his fever was so high.”

I think of fever like an on/off switch. A child has fever or they don’t. If they have a fever I need to look for the source, but the height of the fever does not indicate that something more dangerous is going on.

6. “I didn’t give him any medicine, because I wanted you to see how high the fever is.”

Nooooo ... If your child has fever and is uncomfortable, don’t leave them miserable until you come in to see me. I trust you if you say your child has a fever. If you’re worried I won’t trust you, take a picture of the thermometer.

7. “He was doing fine, then he had a fever of 102 and when I woke him up to give him some medicine, I couldn’t get him back to sleep.”

Another nooooooo ... never wake a sleeping baby to treat their fever. Never interrupt a playing baby to treat their fever. Treat fever based on the child’s comfort or to help them drink if they won’t. Otherwise, it’s fine to let the child have a fever.

I know it’s hard when your child is running fever. You feel worried and helpless.

Hopefully, dispelling some of these myths will help you treat your child with confidence.

* Read Dr. Smith's previous blog: "My child has a fever."

The DSHS has received reports of 205 cases of Cyclosporiasis in Texas. No cases have been reported at Cook Children's. In Cook Children's six-county service region, the following numbers have been reported:

The U.S. Food and Drug Administration's alert says cilantro from the Mexican state of Puebla may be the cause for the recent outbreaks.

Symptoms usually begin 2 to 14 days after ingestion of contaminated food or water.Mary Suzanne Whitworth, M.D.,medical director of Infectious Diseases at Cook Children’s, advises parents to contact their Cook Children’s pediatrician if they have a diarrhea-like illness lasting more than a few days or diarrhea accompanied by severe weight loss or fatigue. Those are symptoms of Cyclospora.

Symptoms include severe diarrhea that can last a week to months, and if not treated, the person may relapse. Additional symptoms may include fatigue, severe weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and low grade fever. If your child is experiencing these symptoms, do not wait. Contact your Cook Children’s pediatrician. If your child is diagnosed with Cyclospora, an antibiotic can be prescribed.

However, most cases of diarrhea or an upset stomach do not need treatment with an antibiotic. Usually, diarrhea is caused by viruses, so time, rest and diet will take care of the problem.

“Past outbreaks of Cyclospora in the U.S. have been caused from imported, fresh produce,” Dr. Whitworth said. “The best way to prevent Cyclospora in your household is to wash your fruits and vegetables as thoroughly as possible. Let fruits and vegetables soak for a few minutes in clean water in the sink, and then drain and spray them off with clean water before eating them. Thorough washing of fresh produce is highly recommended, but it may not remove the risk of someone in your family getting Cylospora entirely. If your child has these symptoms, it’s best to see a pediatrician and get treated as quickly as possible.”

Cyclospora is generally not transmitted directly from person-to-person, however children with diarrhea should always avoid swimming in pools to avoid the spread of infection.

The Centers for Disease Control and Prevention has more information about Cyclospora.

When should you call your pediatrician about diarrhea? Watch this video from Justin Smith, M.D., for more information.

Well, it is not from teething but it could be from the treatment you are using for it.

Fever, congestion, diarrhea, fussiness, putting things in their mouth, not sleeping well, you name it and someone has attributed it to teething.

So how do you treat the pain associated with teething?

There are lots of products available most of which are not helpful and can be potentially harmful.

Avoid products with benzocaine and lidocaine (oragel and other gels). These have been known to cause a problem in babies called methemoglobinemia where your child will turn BLUE. I mean smurf crazy blue and is obviously a medical emergency. Also, avoid products with belladonna (teething tabs) as this has known to be poisonous and doesn’t have studies proving that it decreases pain anyway.

This quote comes from the healthychildren.org article on teething (click to see full article):

“To ease your baby’s discomfort, try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber. The teethers that you freeze tend to get too hard and can cause more harm than good.) Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. Some medication you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount.”

So what symptoms really do come up before babies cut their teeth? When can we expect teeth to erupt? What can we do for our children when they are teething?

The best study I have found about teething was done in 2000 and included lots of kids and 475 tooth eruptions. Click here to see the study.

The symptoms that they found to be associated with teething were the following:

• Biting
• Drooling
• Gum-rubbing
• Sucking
• Irritability
• Wakefulness
• Ear-rubbing
• Facial rash
• Decreased appetite for solid foods
• Mild temperature elevation

The following symptoms were NOT associated with teething:

• Congestion
• sleep disturbance
• stool looseness or increased stool number
• Decreased appetite for liquids
• Cough
• Rashes other than facial rashes
• Fever over 102 degrees F
• Vomiting

I have seen some studies that will include congestion in the symptom list for teething. I think one of the main misconceptions is about fever. I commonly have parents ask if 102-103 temp could be caused by teething and the studies are pretty clear that if the fever is that high, it probably isn’t just teething.

If our children are particularly fussy from teething, we will occasionally use Tylenol^® and if more than 6 months old Motrin^® according to weight appropriate dosing sporadically for a day or 2 until symptoms subside.

The main thing is that you have to be flexible with your child and allow them a little extra grace for changes in sleep and feeding habits. Teething is normal and should be consider a normal developmental stage. It can be disruptive to schedules and the extra fussiness can make things stressful. Hang in there, this phase is temporary.

Related article:

4 teething myths every parent should know

“Mom, my legs hurt.”

It wouldn’t be so concerning except that it’s happening four nights a week, for months. Right?

So, what do you do?

Watch The Doc Smitty in Cook Children's latest My Kid Minute video on growing pains:

To learn more about growing pains from The Doc Smitty, read his blog on the topic.

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.

Flu Myth #1

The flu shot can give you the flu.

Nope. Not true.

http://www.usatoday.com/story/news/health/2013/01/14/can-flu-vaccine-cause-the-flu/1833793/

Flu Myth #2

The only time I got the flu was the year I got the flu shot.

This may be true, but it’s completely coincidental. There’s no mechanism where the shot would make you more susceptible to getting the flu.

Flu Myth #3

The flu is annoying, but harmless.

This is true for many children, but we should watch for dehydration and difficulty breathing. Kids with asthma and other chronic medical conditions should be monitored closely.

Flu Myth #4

I had the “stomach flu.”

If you had vomiting and diarrhea only, you probably had another virus. Flu symptoms are fever, cough, congestion and body aches but rarely stomach problems.

Flu Myth #5

Because the flu shot is only covering 2 strains, you should skip it.

Getting coverage for 2 strains is better than 0.

http://www.checkupnewsroom.com/does-my-child-still-need-a-flu-shot/

Flu Myth #6

Over the counter cough and cold medicines help kids with the flu.

Cough and cold medicines do not work very well for anyone and can be harmful in kids. Just skip them. Run a humidifier and if over one year, give them some honey at bedtime.

Flu Myth #7

If you suspect your child has the flu, they need to see the doctor right away.

If they are drinking OK and staying hydrated, home care can be appropriate. Certainly call your doctor before going to the emergency room unless they have symptoms other than fever, cough and congestion.

http://www.checkupnewsroom.com/more-flu-longer-waits-in-the-ed/

Flu Myth #8

Every child who has the flu needs Tamiflu.

If your child is healthy (no asthma), the benefits of Tamiflu are minimal if anything, it is expensive and there are possible side effects. Consider these factors when and have a conversation with your doctor.

About the author

 is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

The flu season is upon us once again ... what do you need to know as a parent?

1.What are symptoms of the flu?

The flu may start like the common cold with symptoms of cough, congestion and runny nose, but may also be associated with prolonged fever, muscle and body aches and fatigue. It is spread from person to person when an infected person, coughs, sneezes or talks and droplets are released into the air. It can also be spread less often from touching surfaces where drops are present. The flu virus is contagious from up to 1 day before the person presents with symptoms and up to 5-7 days after the symptoms resolve.

2. How can you protect yourself?

The best way to protect yourself is by getting the flu vaccine as soon as it becomes available. Most doctors’ offices and clinics currently do have the flu vaccine available. Last year, flu activity peaked at the end of December to the beginning of January, but you may start seeing it as early as September-October this year.

Other means to protect yourself are effective hand washing and wiping down surfaces with anti-bacterial/viral cleansers.

3. Why get the flu vaccine?

In the United States each year, more than 200,000 people are hospitalized from seasonal flu-related complications. Last year, there were more than 105 pediatric flu related deaths in the United States. On average the effectiveness of the flu vaccine last season was about 61 percent.

4. Who should get the flu vaccine?

• Everyone over the age of 6 months.
• Higher risk populations include those between the ages of 6 months to 5 years, children with asthma or other chronic disease, pregnant women, people with immune problems and adults  more than 65 years old.
• Children under the age of 8 MAY require 2 doses of the vaccine 4 weeks apart from each other depending on their previous immunization status.

5. Which flu vaccine is recommended?

There are several options for flu vaccines this year. For 2014–15, U.S.-licensed influenza vaccines will contain the same vaccine virus strains as those in the 2013–14 vaccine.

Trivalent flu vaccine protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. This is only available in the injectable form.

The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The quadrivalent form is available as an injection and a nasal spray.

Specific Age Recommendations

• 6 months to 2 years: injectable flu vaccine only.
• 2 years to 8 years: nasal form is preferable according the Centers for Disease Control and Prevention (CDC). There was 50 percent more effectiveness with the nasal form vs. the injectable form in this age group. If the child is between the ages of 2 and 4 and has asthma or wheezed in the last year, then the injectable form is recommended.
• 8 years and above: either form is acceptable.

6. What happens if you get the flu?

See your health care professional as soon as possible because if it is treated with anti-viral medications in the first 48 hours, the duration as well as the severity of the illness can be decreased. The CDC does not recommend treatment of healthy individuals with anti-viral drugs, but certain high risk populations will benefit from treatment.

One of the first things I like to know when ascertaining the seriousness of a child’s condition is whether the child is playing, smiling eating or drinking. If a complaint is brought up regularly, interferes with a play or a child really cries, parents should consult a physician.

High Fever

New parents might find the recommendations for when to seek treatment for a fever daunting, but it gets easier with time.

Children who are 3 months or older with fevers of 102 degrees Fahrenheit or higher that don’t respond to fever-reducing medicine should see a doctor.

Fevers up to 101 can often by managed with fever-reducing medicine, fluids and rest. However, if your child also has a harsh cough – which may indicate croup – you need to consult a doctor.

For infants 3 months and younger, any fever is serious and parents should see a physician’s help immediately. For children older than 3 months, a high fever combined with symptoms such as lethargy, changes in fluid and/or difficulty breathing require prompt medical attention.

Tummy Aches

If your child has a stomachache, there are three red flags that may warn parents of a serious illness such as appendicitis:

1. Your child has a tummy ache and a fever.
2. Your child can point with one finger to where it hurts.
3. Your child has been vomiting.

Children don’t need to have all three symptoms for parents to see help because any one of these symptoms can indicate that appendicitis might be a possible diagnosis. Parents should also not wait too long. If symptoms worsen in six to eight hours, consult a doctor.

My Head Hurts

Headaches and even migraines can occur in children as young as 3 years of age. Parents can give their child a nonsteroidal anti-inflammatory medicine, such as ibuprofen, or eliminate headache pain caused by hunger, fatigue or dehydration with food, rest or fluids.

Talk to your pediatrician about his or her treatment recommendations, particularly if you’ve never treated your child’s headache before.

If headaches occur at the same time each day, parents should consult their pediatrician. Headaches can occur with the flu or fever, but we become concerned if a headache is serious enough to make a child cry, interferes with play or is so bad the child is vomiting.