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.

With the beginning of summer well underway, I have seen many kiddos in the office with a very typical summer rash. It’s a rash that usually appears on the hands, feet, and around the mouth, giving it the name Hand, Foot, and Mouth Disease (HFMD). It’s caused by a group of enteroviruses that are common in the summer months. While this big group of viruses can cause more serious illnesses, this presentation of illness is typically mild and commonly infects infants and toddlers. While it can affect older children and adults, it is less common and these individuals typically have milder symptoms of the disease, if any. 

The most common symptom of HFMD is the rash for which the disease is named. The rash usually begins as tiny little red dots that get bigger and then look like small blisters. The areas that are typically affected include the skin around the mouth, mucous membranes inside the mouth (including tongue/back of throat), hands (including the palms) and feet (including the soles), as well as buttock and diaper area.

Other symptoms of HFMD include fever, runny nose and sore throat. Like all other viruses, treatment involves supportive care and caring for symptoms, including the use of fever-reducing medications as well as pain control. While rash is typically not bothersome or painful, the lesions in the mouth can cause sore throat or mouth pain. There is no particular treatment necessary for the rash, as it will typically self-resolve within two weeks. It is important to watch for any spots that look like they are oozing or not healing well because secondary bacterial infections can occur. If you have any worries, call your pediatrician as we can usually diagnose this by examining your child and getting a history of the symptoms. 

“Well, umm, uhhh, ummm, yeah I guess that is what I’m saying….And, now that I think about it, I will definitely be calling it that for the rest of my career.”

Group A beta-hemolytic stroptoccal pharyngitis is probably something you have heard of before…well, you might have heard it called strep throat.

But, what you probably didn’t know is that that same bacteria can cause other infections. One of the most common is an infection of the skin just around a child’s anus.

The infection can cause significant pain, itching and when you look you will see a bright red, moist rash right around the anus. You can also sometimes see some blood in the stool from scratching and skin breakdown. Some parents confuse it with a really severe form of diaper rash.

The infection is most common in children 6 months through elementary school. How do kids get it? Spoiler alert: they often scratch and touch themselves…so, if they are around someone with strep throat, they can get it on their hands and infect themselves.

If you believe your child has perianal streptococcus, your baby should be seen by a pediatrician because prescription antibiotics are required.

Related:

Is it Strep Throat or the Flu?

If you want proof, read this diverse list of our most popular stories of 2016. We hope you enjoy our look back:

10. 7 Ear Infection Myths Every Parent Should Know. Parents flocked to this blog from Doc Smitty. Can your child go swimming with an ear infection? Do all ear infections need antibiotics? If your child gets ear tubes, will the infections stop?  All this and more was answered in this blog.

9. 7 Online Challenges This ER Doctor Warns Could Be Deadly Oh the Internet. Where kids do all kinds of things to get noticed and maybe go to hospital in the process. We asked our medical director of the Emergency Department to look at seven really silly, really dangerous dares that kids (or grownups for that matter) shouldn't try at home. 

8. Almond Milk: A Nutty Fad or Healthy Alternative. Almond milk sales have gone through the roof over the past decade. But is it the right drink for your child? Doc Smitty gave the answer in this informative piece. 

7. The Death of Ethan: A Life of Chronic Pain Ends in Tragedy. This is the most recent entrant in our list of top 10 stories. Only the fact that it was published in December kept this story out of the top five. We were so honored that Ethan's parents shared their son's story of a life filled with chronic pain. They want you to read it to learn about their son and hopefully help other children who may be suffering as well.

6. New Hope In Fight Against Deadly Brain-Eating Amoeba. The Lewis family holds a special place in the hearts of everyone involed in the Checkup Newsroom. Following the tragic death of their son Kyle to a brain infection caused by a water-born amoeba, Jeremy and Julie Lewis created Kyle Cares. Read their inspiring story as they fought to bring a drug to Cook Children's and other hospitals around the nation that may save children's lives.

5. 11 Tips That Could Save Your Daughter's Life.  In Janaury 2016, Rylie Whitten made national headlines after suffering one of the worst cases of toxic shock syndrome (TSS)  that her doctors had ever seen. Rylie's story moved us to run this informative piece on TSS that we hope every parent of a daughter reads.

4. A Sign From Heaven: Family Travels Across U.S. For Care at Cook Children's. A family's desperate search for answers on Google led them to Cook Children's. Read the fascinating story of what led this family to travel from Detroit, Mich. to Fort Worth, Texas, to be treated for a rare condition called hyperinsulinism.

3. The Most Common Rash You Never Knew About. Ever heard of molluscum contagiosum? We hadn't when Dr. Diane Arnaout wrote this blog for the newsroom. Dr. Diane's informative blog "that will save you and your child pain, money, time and anxiety" went viral quickly and became our third most read story of the year.

2. RSV On The Rise: 6 Things Every Parent Should Know. Here we are at the beginning of 2017 and we have been lucky in that we haven't seen much flu yet at Cook Children's. But we have seen plenty of RSV (respiratory syncytial virus), which explains the popularity of this great blog from Dr. Lizy Varughese.

1. Let's Learn Something: Bouncers, Jumpers and Walkers. Dr. Diane Arnaout's "Let's Learn Something" series was a big hit this year and none were bigger than this tale of caution. Dr. Diane's blog on how baby bumpers, bouncers and activity centers could play a role in your baby's motor delays is our most read new story of 2017. You've probably read this blog. But if you aren't one of the more than 117,000 readers who took a look, now's the time. And if you have read it, feel free to click again.

Well, that's it for 2016. Thank you all for reading. We'll be back with plenty more stories to tell in 2017.

I’m going to teach you about a rash that we see weekly in our office at Forest Park – often many times a day.

It freaks parents out, looks weird, and (always surprising to me)….none of the parents I speak with daily have ever heard of it.

Let’s learn about – molluscum contagiosum!

Ugh, molluscum. People stress so much about these little guys. And honestly – they’re usually no big deal and are totally harmless.

Molluscum contagiosum is the name of a rash that looks like fleshy little bumps. They’re caused by a virus and they can be found anywhere on the body.

They’re round, shiny, vary in size, and look like a cuter, cleaner version of warts. They can be white, pink, or flesh-colored. They often have a little “pit” or dot in the middle of them. They also sometimes have cheesy white stuff in them – this isn’t pus. Try not to pop them – this can lead to infection and scarring.

They spread from person to person very easily. They are passed by skin-to-skin touching, sharing towels or clothes, or using wrestling or gymnastic mats. They are also a common STD. I find that water is a common transmission source – baths, pools, hot tubs.

In my experience, they typically last 6 months to 2 years. The CDC mentions they can last as long as 4 years, but I’ve never seen that.

I always tell folks, if they can, to just leave them alone and let the body get rid of them. There is less scarring that way. Molluscum usually look a little inflamed right before they go away, because the body is finally paying attention to the virus and fighting them off.

Like I mentioned before – molluscum are usually harmless. They can, however, cause kids and parents to worry about their appearance, get irritated by clothing, and can get infected by scratching.

There are different ways to go about getting rid of them. Treatment is designed to irritate the spots. This is to encourage the body's immune system to recognize the virus and destroy the infected cells.

Just like with warts, we can freeze them in the office, or apply a blistering compound (“beetle juice”) to hopefully cause enough irritation to make them go away. Sometimes if they’re really bad, I’ll send kids to the dermatologist where they can inject yeast antigen into the lesions to make the body pay attention and get rid of them! Isn’t that crazy cool? This works sometimes for warts as well.

Other ways to approach getting rid of them involve creams we can prescribe. There are even oral medications that sometimes help (although I haven’t had the best of luck with these). You can also try a compound called Zymaderm. I’ve had some patients have luck with tea tree oil. And I’m a big fan of apple cider vinegar for both warts and these guys.

Bottom line is – they’re pretty benign, they typically are just annoying, and I promise you they will go away eventually. If you’re really worried about it, come on in and we will walk you through some treatment options.

Hugs,

Dr. Diane

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.