Tag Archives: illness

Doctors Know it’s Winter When…(Pedcast)

It’s really cold in Charlotte. When you listen to the news, you would think it has never been cold before 2014 and it has never snowed before. Oh well, they have to sell newspapers, don’t they? I’m your host, Dr. Paul Smolen, a board certified pediatrician with 32 years of private practice experience to date. This is my blog that I started 3 years ago that I dedicate to children and families. Topics ranging from the crib to the country club, from the womb to the workplace are discussed here as long as the topic that is relevant to children and parents. Last week I put up a post about how cold air effects a child’s respiratory system. If you missed that one, make time read or listen, and let grandma listen…I think she will agree with what I said (https://www.docsmo.com/does-cold-air-make-your-child-sick-pedcast/). In today’s post, I am going to go deep into a pediatric office in the dead of winter, when it is cold like it is in Charlotte this week.

Pediatricians instinctively learn after many winters that there are clues to the severity of illness in children that you don’t get from a medical history or a physical exam. You know it as soon as you walk into the room. When you are a pediatrician, you know it’s winter–really winter–when the children start visiting your office in their pajamas. If they have what I call the bed head… uncombed hair, things are probably a little worse. If they are wrapped in a blanket and holding a lovie, kick up the sickness index another notch. If they have both parents with them, you know that everyone is pretty anxious about their child, and the likelihood of a serious illness has bumped up a little more. Now, here is the biggest sign of significant illness to me… the child has all the things that I just mentioned, AND they are laying on the table and don’t sit up when you come in the room. They don’t greet you or acknowledge you have come to see them. The child feels so bad that they just can’t deal with the doctor. If a child has all these signs, my sickness radar is in full alert mode; pajamas with the bed-head, wrapped in a blanket, holding a lovie, accompanied by both parents, and laying on the table during the visit…Wow, watch out. For a child like this, I am going to do every test I can to make sure the child doesn’t have a serious illness. I’m going to listen to the parents tell the story of this child’s illness and repeat it to them to make sure I got all the details correct before proceeding. I’m going to do as careful a physical exam as I know how to do. I’m likely to do every test that I think is relevant that might help me sort things out. Entering a room like this is when I really earn my pay, bring my experience, and potentially can really make a difference.

So the next time you see your child’s pediatrician in the dead of winter, please be extra nice to her or him… they are undoubtedly tired and stressed. They are working hard to make sure you children stay healthy. And be careful what signals you send to the doctor about your child’s state of health:  pajamas, lovie, wrapped in a blanket, with both parents attending, oh my. That’s what winter means to me. This is Doc Smo, broadcasting from studio 1E in Charlotte, NC, hoping this cold winter chill doesn’t make your little ones ill. Until next time.

Fever- Friend or Foe? (Pedcast)

Good day and welcome to the DocSmo blog.  I am your host and the creator of this blog, dedicated to parents and children.  I am Dr. Paul Smolen, a board certified pediatrician with 32 years of experience in private practice and 36 years if you include residency and fellowship. All those years in practice has given me an interesting perspective on today’s children and families, and I hope to bring some of my insights to you today, in what I call a pedcast… that’s a podcast about pediatric subjects.  Today we are going to talk about bread and butter pediatrics, a subject that gives both pediatricians and parents many sleepless worried nights; FEVER.  A febrile child is what occupies more of a pediatrician’s life than anything else so  I am about to  share some of the things I have learned over the years about fever.  Here we go.

 

I have spent my adult life with children who have fevers.  Sweating through a high fever illness of a child with his or her parents is the essence of what pediatricians do.  As I like to tell my patients, I am a professional worrier… worry is in my DNA.  When a young child has a fever, it is my job to worry about everything.  Does that rash part of this illness?, is that lack of response to Tylenol a meaningful sign of something bad?, or does fever on day 5 of a sickness really spell trouble?  Fever is probably the number one symptom that brings parents to a pediatric visit.  Parents fear fever… we were taught to fear fever by our mothers and grandmothers because in the pre-vaccine era, fever often meant something terrible was about to happen; meningitis leading to seizure and death, pneumonia leading to a child not being able to breath and dying, or a urinary tract infection with sepsis, shock, and death.  Fortunately, in todays world where most children are immunized, these are much rarer events, but pediatricians and parents still fear fever!

 

It is important to highlight that a fever in and of itself is not usually a danger to an overall healthy child.  Most fevers only last a few days and help to protect your child.  Its your bodies way of making things happen faster, shortening an illness.  Here is a DocSmo pearl A fever is not an illness, usually just a shortcut to wellness.”  It is a physiologic mechanism that fights infection by speeding up a child’s own natural defenses to bacteria and viruses.  Therefore, the main objective of treating your fevered child is to improve his or her overall comfort, not to focus on normalizing his or her body temperature.

 

Many parents and doctors don’t like fever hence their obsession with lowering a febrile child’s temperature.  Fever phobia only makes sense since children who are well don’t have fever, therefore, artificially lowering the temperature of a child with fever must make them well, right?   NO, NO, NO.  In most cases, it simply makes them more comfortable but can actually slow down the sick child’s recovery by a few hours.  Yes, you heard me right…treating fever in most virally caused illnesses actually prolongs the illness.  According to many pediatricians including this one, fever reducers, such as acetaminophen (Tylenol) and ibuprofen (Advil), should only be used for temperatures high enough to make your child uncomfortable, probably the 102 or higher range, especially at night when they need to get comfortable to sleep.     Additionally, unless your child has some special health problem, you should not wake your sleeping ill child only to give him or her antipyretics.  And remember, be aware that cough-and-cold medications may also contain acetaminophen and ibuprofen so be careful not to give your child a double dose of fever reducing medicine… that can be dangerous, especially when they are sick and dehydrated.

 

 

 

The take home message here is that fever is not the primary illness, and doesn’t have to be treated.  A fever is a physiologic mechanism that helps your child’s body fight infection… it accelerates healing by enhancing their natural germ killing ability.  This is not to say, however, that all fevers are harmless.  Parents should be extra mindful of fever if:

  • The fever is in a very young infant, especially in children less than 3 months of age.
  • Or if the fever is 104°F or greater
  • Or if the fever is accompanied by a rash
  • Or if the child is acting particularly ill
  • Or if the fever is accompanied by any localized pain, such as neck pain

A fever certainly can be a sign of a serious infection, but… it is usually not, especially if they have had all their shots.   Your child’s fever may actually be of benefit to him or her, thus the goal of fever reducing medicine use is to improve your child’s comfort not to cure any disease.

 

I hope you found some practical advice in today’s pedcast.  I thank you for joining us.  If you think a friend or relative would benefit from this or any of my podcasts, just hit the send button at my website. Its easy. And, I would love to hear your comments and stories on iTunes, Facebook, or my blog docsmo.com.  Go ahead, express yourself. Connect with the blogging community or simply ask a question. This is Doc Smo, broadcasting from my cutting edge studio 1E, hoping that the next time your little tot is hot, you hit the treatment, right on the dot.  Until next time.

 

 

 

Sources:

 

 

Does a Failure to Respond to Antipyretics Predict Serious Illness in Children With a Fever?
Arch Dis Child. 2013;98(8):644-646. © 2013 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health

://pediatrics.aappublications.org/content/127/3/580.full

 

http://emedicine.medscape.com/article/801598-overview#aw2aab6b5

 

http://www.aafp.org/afp/2001/1001/p1219.html

 

Fever Facts (Pedcast)

Fever is a problem that every parent is likely to encounter.  Understanding why children get fevers, what they mean, how to accurately measure them, and whether treatment is necessary are the subjects of this podcast.  Listen to Dr Smolen give practical advice to parents about fever in children of all ages.

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Understanding Your Child’s Ear Infections Step by Step (Pedcast)

Ear infections, or otitis media, are a painful part of childhood. Understanding the biology behind the development of ear infections can help parents see the warning signs and take preventative measures. Thus, in this pedcast, Doc Smo walks you through the stages of ear infections and provides listeners with ways to help prevent them.

Transcript:

 

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By some estimates, 40% of visits to pediatricians are for ear infections.

Most children have otitis before the age of 2 years.

I Thought today, we would talk about why children get them, should they be treated, and can they be prevented?

Parents have these questions all the time.

So lets get started with our discussion with a trip down, you know where, science lane.

 

There are loads of germs in our nose that can cause ear and sinus infections…all the time!  That’s right, sinus and ear infections are usually an overgrowth of germs we already carry.

So why don’t we have ear infections all the time?

To understand the answer to that question, need to know how our noses work.  That’s right, our noses.

Remember the structures that are attached to our noses, our sinuses in every direction around our nose, our ears through the Eustachian tubes, our eyes up through the lacrimal ducts, and our throat pulling up the rear.  

Normally every time we take a breath through our nose, we put fresh air into our sinuses and ears. If our noses are working properly, each breath opens the windows and lets in fresh air into our sinuses and ears and at the same time equalizing the pressure with the ambient pressure around us.

In addition, the cells that line our nose, sinuses and ears secrete a steady trickle of mucous that is kept moving by our cilia, little brooms that constantly sweep the mucous into our throats.  A gentle river of mucous flows through our noses, sinuses, ears and bronchioles all the time cleaning and moving away dirt and germs away from our healthy respiratory system.

The combination of moving mucous and fresh air keeps germs from ganging up on us.

 

Now think of a child, especially a baby.  A cold means a swollen nasal passage without air moving and loads of extra mucous. Babies don’t blow their noses, remember! This is the recipe for a sinus and ear infection.

Stagnant mucous in airless places.

Here is the sequence of events:

Virus attaches itself to the nasal membrane causing swelling lining cells.  The medical jargon for this is apoptosis or swelling of cells.  We can feel that at the beginning of a cold.

The children’s tiny sinus and ear Ostia become obstructed from airflow causing a VACUUM to form in the ears and sinuses.

Your body doesn’t like a vacuum and fills up these spaces with mucous (when your child’s doctor says, fluid in ear…this stage).

Remember that bacteria in the nose, now it has warm, sugary pockets of stagnant fluid to grow in and BAM, a hot ear infection.

Since bacteria grow so fast, it can be only a matter of hours between fluid in the ear and a raging infection.

The body’s natural defenses, moving mucous and fresh air are not there to keep the germs from taking over.

Children who carry the allergy gene have all the same events occur but the swelling inside their noses is from both dust and pollen allergy and viral infections.  These children are especially prone to ear infections.

So what’s the perfect storm for ear infections?

Under 2 years of age….Promotes…Small nose and no blowing.

Remember this Doc Smo pearl, “Rivers that don’t flow are nasty!”

Being in an environment where infection with respiratory viruses is frequent…..  Being around a lot of other young children.

Remember this Doc Smo pearl…. “Infectious diseases are contagious!”

 

Being a child with eczema, food allergy, or recurrent wheezing…  having the allergy gene which means lots of swelling in the nose and loaded with mucous.

 

If your child is prone to ear and sinus infections…practical tips that might help.

 

1. Avoid crowds of children to play with especially when they are very young and put things in their mouths.  Touch is the method of spread.

2. Be especially careful with group care if your child exhibits signs of allergy.

3. Play with other children outside whenever possible, even when it is cold.  Unlikely to transfer germs outside.

4.Unless your child has clear allergy, Avoid cold medicines with antihistamines, which can make nasal mucous thicker… poor flow means more infections.

5. If your young child has loads of otitis media, try a milk free diet for 2-4 weeks to see if it helps.

6. Hose those little noses with saline a lot… water is a natural cleaner.  Use it!

7. Try and avoid treating ear infections in children older than 2, after your child can talk.  More on this subject listen to “Bugs and Drugs”

 

 

That wraps up todays “Pedcast” Thank you for listening.  I hope your understanding of ear infections is better now.

If you enjoyed this talk, try some other DocSmo episodes which you can find at my website, DocSmo.com, at my face book page or on ITunes.

Comments are welcome.

 

This is Dr. Paul Smolen.

Recording in full digital sound from studio 1E in Charlotte, NC.

Wishing your children noses full of warm breezes and years without sneezes

 

Until next time
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Going Public with Your Newborn, How and When! (Pedcast)

Doc Smo here. Thanks for joining me today. One of the most frequently asked questions that I get in the newborn nursery is, “When can I take my newborn to church, when can I take my baby to the mall, and when can I have my friends over?” Well you will find varying opinions on this subject and the truth is that there is no science behind any of this. I don’t believe that there is a right answer to this question. Different cultures have developed different norms. For instance in traditional Greek society, I am told that babies are isolated from public exposure for the first 60 days of life and in traditional Japanese culture, the isolation period is one year. To my knowledge, the Academy of Pediatrics does not have policy regarding this subject so I thought we would take a little time to explore the subject of when should newborns venture into public places. Continue reading

Making Sense of Your Child’s Next Virus (Pedcast)

Young children seem to get a lot of sickness, way more than adults do. Most of this sickness is caused by common respiratory viruses and have no specific treatment. These illnesses usually clear up on their own, but sometimes there’s trouble. Today’s episode helps parents understand patterns of illness which can give them and their doctor clues to more serious health problems. It’s all in those patterns, if you know what to look for.

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

All Rights Reserved.