What's Going Around?

Lyme disease is an infection caused by a bacteria called a spirochete. The disease is spread to humans by the bites of deer ticks infected with this bacteria. Deer ticks are tiny black-brown creatures. They live in forests or grassy, wooded, marshy areas near rivers, lakes, or oceans. Many people who have been infected with Lyme disease were bitten by deer ticks while hiking or camping, during other outdoor activities, or even while spending time in their own backyards, from the late spring to early fall.

Deer ticks that are infected with Lyme disease live in areas that have very low and high seasonal temperatures and high humidity. In the United States, almost all cases of Lyme disease occur in the following regions: Northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont) North central states (Michigan, Minnesota, and Wisconsin) West Coast(California)

The first and most obvious symptom of Lyme disease is a localized rash that begins as a pink or red circle that expands over time and may become several inches or larger. It may appear from 3 to 30 days after the bite occurred. Some people may have a single circle, while others may have many. Most people who develop the rash won't feel anything, but for others the rash may hurt, itch, burn, or feel warm to the touch. The rash most commonly appears on the head, neck, groin, thighs, trunk, and armpits. A rash may occur without any other symptoms or may include

• Headache
• Chills
• Fever
• Fatigue
• Swollen glands, usually in the neck or groin aches and pains in the muscles or joints

If your child develops the rash with or without any of these symptoms, call your pediatrician.

Lyme disease is treated with antibiotics (usually penicillin, a tetracycline or cephalosporin) prescribed by your pediatrician. The antibiotics are usually taken by mouth, but also can be given intravenously (directly into the bloodstream through a vein) in more severe cases. Both early and late stages of the disease can be treated with antibiotics. Patients diagnosed during early stages do not require blood tests before or after initiating treatment.

See: Lyme Disease, Lyme Disease (and Other Tick-borne Diseases)—Child Care and Schools

CDC: Ticks and Lyme Disease

Asthma is a disease caused by chronic airway inflammation. A child having an asthma attack usually has wheezing, couhg, and trouble breathing. Things like viral respiratory infections, cold air, changes in seasons, cigarette smoke, animals, strong smells and pollen can make asthma worse. Asthma is treated with a quick-acting ("rescue") inhaler that will dilate the bronchi along with inhaled steroid that will stop the over production of mucus by the lungs. Some children also need a controller inhaler (administered every day after the acute episode has resolved). The inhaled medications (pumps) should always be administered with a spacer, the nebulized medications require a mask or a mouth piece. If your child has asthma and they are having asthma symptoms, you should follow the "sick plan" using the rescue medications, and make an appointment in our office if the asthma treatment does not help, or if your child continues to cough and wheeze even after getting the treatment. If you think your child may have asthma, please call and make an appointment in our office. If your child is struggling to breath give a treatment and call 911.

Your child should have a follow-up appointment every 3-6 months to assess the severity of asthma, the response to medications and review trigger factors. It is important that you have medication available at home and school to treat acute asthma exacerbation and prevent ED visits. Call our office to schedule an appointment.

Pneumonia is a frequent respiratory infection seen in children. It can start like a viral respiratory infection with cough, congestion and runny nose then progresses to fever, worsening cough, fatigue, decrease appetite, and shortness of breath. Symptoms and signs of penumonia may be subtle particulary in infants and young children.

The combination of fever and cough is suggestive of pneumonia. The longer fever, cough and other respiratory symptoms are present, the greater the likelyhood of pneumonia. Certain children with weakened immune system or chronic lung conditions such as cystic fibrosis, asthma or cancer may be more likely to develop pneumonia. Episodes of pneumonia are more frequent during fall, winter and spring seasons, when viral and bacterial infections occur more often and children spend more time indoors in contact with each other facilitating the spread of respiratory infections from person to person.

Diagnosis

The diangosis of pneumonia can be made by clinical history and examination, some times your pediatrician may need to order a chest x-ray to assess the location and extension of the infection.

Treatment

If the cause of your child pneumoia is a virus, there is no specific treatment besides resting and fever control. Because it is difficult to differentiate if the penumonia is due to a virus or a bacteria, an antibiotic may be prescribed by your pediatrician. It should be taken for as many days as recommended to assure the full resolution of symptoms. The cough can linger for few weeks. Cough suppressants are not recommended for

children with pneumonia. since the cough is a reflex mechanism to clear the secretions caused by the infection.

Prevention

Your child can be vaccinated against pneumococcal infection, a bacterial cause of pneumonia. The American Academy of Pediatrics recomends that all infants and children receive this vaccine starting at 2 through 59 months of age. It is called pneumococcal conjugated vaccine or PCV 20. Talk to your pediatrician if you child did not receive this vaccine.

Anoher pneumococcal vaccine (PPSV23) is recommended for older children (2 through 18 years of age) with chronic medical problems that increase the risk of developing an invasive pneumococcal infection.These children should receive a single dose of PPSV23 at least 8 weeks after the most recent dose of PCV13. A second dose of PPSV23 is recommended 5 years after the first dose, no more than a total of 2 PPSV23 doses should be administered before 65 years of age.

Colds, upper respiratory infections, and URIs are common terms we use to describe viral illnesses that cause nasal congestion, runny nose, sneezing, sore throat, fever, and cough. The fever usually lasts for 2-3 days, and the cough with congestion and runny nose may last for 5-10 days. The typical preschool-age child may experience 6-10 colds per year. Most colds resolve on their own with rest and fluids, but some may lead to ear infection, sinus infection, asthma attack, or other complications. If you are concerned about the possibility of one of these complications, please have your child seen in our office for an evaluation.

For more information: See also Colds, See also Sinus Pain or Congestion

We are currently seeing cases of croup, a viral respiratory illness that most often is caused by the parainfluenza virus. The cough and breathing that are associated with croup make it distinctly different from other viral colds or respiratory illnesses. This is because the parainfluenza virus infects and irritates the voice box, the vocal cords, and the windpipe. The cough is worse at night, and it has a distinct bark that sounds much like a seal's bark. Associated with the barky cough, your child may have difficulty when inhaling air, making a labored and whistling sound when breathing in -- called stridor. Humidified air and fluids often are the most helpful treatments.Please call the office to have your child evaluated by the doctor if he/she has symptoms of croup.

For more information: It doesn't sound like croup, see Cough, See also Cough, See also Croup, Tight purring sound when breathing out, see Wheezing (Other Than Asthma)

We are currently seeing viral illnesses that cause vomiting and diarrhea. Usually called viral gastroenteritis, the virus causes inflammation and irritation of the stomach and the intestines, leading to vomiting and diarrhea. This illness, often called the "stomach flu" typically lasts 1-2 days, with diarrhea lasting a few days longer.

It is important to make sure that your child does not get dehydrated with this condition. Offer breast milk on demand if your child is breastfed, or Pedialyte, or Gatorate, in small amounts every 20 minutes until your child can keep liquids down, after 1 hour increase the amount and frequency. If they are unable to keep liquids down, back off for 1-2 hours, then try the small amounts again. For fever or abdominal pain associated with gastroenteritis offer your child Acetaminophen, avoid Ibuprofen or related medications to prevent gastric irritation. If your child has few wet diapers and does not make tears, or appears limp or lethargic, crying without tears, he or she may be dehydrated and we will need to see them in our office. Other worrisome sings are blood in stools and high fever (104 F or 40 C) along with the gastroenteritis.

Seasonal allergies, or hayfever, are very common at this time of year. Typical symptoms include watery, itchy, red eyes; a clear runny nose; sneezing; and an itchy palate or throat. The most common triggers are trees and pollen in the spring, grasses in the summer, weeds in the fall, and indoor dust & mold during the winter season.

Effective non-sedating medications are now available for children over the age of 2 without a prescription for treatment of seasonal allergies. These include loratadine (generic Claritin), Cetirizine (generic of Zyrtec), Fexofenadine (generic of Allegra). They are preferred to Benadryl that is more sedating and has a shorter effect. These medications can be given daily for allergy symptoms, ideally starting before the allergy season approaches.

Check the website of the American Academy of Asthma Allergy and Immunology (AAAAI) for information about pollen and mold levels in the area. There are multiple websites to help you learn about environmental control of allergens at home. If you think your child has seasonal allergies and he or she is not responding to medication, OR if you are not sure, please make an appointment in our office.

Many children do not require allergy testing if they respond to treatment with medication as needed.

Hand-foot-mouth disease is a common viral illness caused by the Coxsackie A-16 virus (a member of the enterovirus family). Its name describes the location of the rash during the illness.

Typically children experience fever and small blisters in the mouth in the first few days followed by small blisters on the hands and then feet.  Sometimes the rash is seen in the diaper area as well.  The mouth blisters can be painful.  Ibuprofen or acetaminophen can be given as needed for pain relief.  It is important to make sure your child receives plenty of fluids.  Cold liquids may provide pain relief as well.  

Call our office for an appointment if you think your child may be showing symptoms of dehydration during this illness (urinating less than every 8 hours, dry mouth, or lethargy); if the fever persists after the first 3-4 days; or if you cannot keep the pain under control.

We are currently seeing quite a bit of strep throat. If your child has a fever, sore throat, headache, or stomachache without any other viral symptoms like congestion or cough, it may be strep throat. Bacteria, called Group A strep, cause this type of sore throat. To diagnose strep throat, your physician will require a swab of your child's throat, and antibiotics will be needed if the strep test is positive.

For more information: See also Sore Throat, See also Strep Throat Exposure

Infections from ticks are on the rise in the United States. But while many parents know about Lyme Disease, children can be treated during the first 72 h of tick removal to prevent Lyme Disease; fewer parents may be aware of other illnesses children can get from ticks. Fever, headache and other flu-like symptoms a week or two after being bitten by a tick, for example, could be symptoms of human ehrlichiosis infection. Human ehrlichioses infections are caused by at least 3 different types of bacteria that are spread through bites of infected ticks—Ehrlichia chaffeensis, Ehrlichia ewingii, and Anaplasma spp.

Ehrlichiosis infections have signs and symptoms similar to influenza (the flu), including:

• Fever
• Headache
• Chills
• Muscle and joint aches and pains
• Generally feeling sick and fatigued (malaise)
• Poor appetite
• Nausea and vomiting

In some cases, the child may also develop a rash, cough or confusion. These symptoms typically begin 5 to 10 days after the tick bite. It is important to remember that tick bites often go unnoticed. Many people with tick-borne infections do not realize that a tick has bitten them.

What Parents Can Do:

• Call the pediatrician. Children, or their parents, may not notice if they've been bitten by a tick. Call your pediatrician right away if your child has these symptoms—especially if the family recently spent time in nature areas. Your child may need lab tests and may receive a prescription antibacterial medication, usually doxycycline, if it turns out he or she has a human ehrlichiosis infection. Most children with ehrlichioses who are treated will recover completely within 1 to 2 weeks.
• Prevent exposure. Limit your child's exposure to ticks and bacteria they may carry as much as possible. Steps that can help include:
• Stick to the beaten path. Try to stay on the trail in wooded areas where ticks are known to be a problem. Avoid playing in tall grassy areas or those with a lot of leaves on the ground, habitats that ticks also love.
• Backyard basics. Keep lawns where children play mowed and raked. Try to set up play equipment, such as swing sets, in sunny, dry areas away from wooded edges of yards.
• Cover up. Dress your child in a hat and long-sleeved shirt and long pants that cover most of the body. Tuck pant legs into his or her socks.
• Use insect repellent. Apply an EPA-registered insect repellant to exposed skin in a ventilated area. For example, repellents containing 20-30% DEET are safe and effective when used as directed for children. Products containing plant-based picaridin can also be used on skin and can help keep ticks off. Reapply every 6 hours or according to label instructions. Permethrin products can be used to treat clothing and gear, but should not be applied to skin.
• Don't forget pets. Treat pets with tick repellents as advised by your veterinarian.
• Wash off. Bathing or showering after coming inside makes it easier to spot ticks that may be crawling or attached to the skin. Be sure to check less visible spots such as folds of skin, behind the ears, and the scalp.
• Remove ticks. Gently remove any ticks you see as soon as possible to minimize exposure to the bacteria they may carry. Using tweezers, pull straight out without twisting. After the tick is removed wash the area with soap and water.
• Use the dryer. To help kill ticks, put clothing right into the dryer, if possible, on high heat for at least 10 minutes.

CDC: Ticks and Lyme Disease

Diseases Spread by Insects and Ticks