Meningitis occurs when a virus or bacteria causes inflammation of our brain or spinal cord. We use several different vaccines to prevent a few types of meningitis, but it’s all very confusing. Recent commercials have raised questions about what these vaccines are and if they’re needed.
Today we’ll go over what meningitis is and what types of germs cause it. Next time I’ll discuss some of the new meningitis vaccines in more detail.
What is meningitis?
Both viruses and bacteria can cause meningitis, but not everyone with these germs gets meningitis. Most people have less severe symptoms when they get these infections.
Not everyone gets all the symptoms listed below when they have meningitis. Some of these symptoms are common to many less serious infections, but if your child has these symptoms and appears more sick than normal, he or she should be evaluated immediately.
Symptoms of meningitis include:
body aches and pains
sensitivity to light
mental status changes
Viruses are the most common cause of meningitis. Thankfully viral meningitis tends to be less severe than bacterial meningitis.
Most people recover on their own from viral meningitis. As with many infections, young infants and people who have immune deficiencies are most at risk.
There are many types of viruses that can cause meningitis. It’s likely that you’ve had many of these or have been vaccinated against them.
We vaccinate against these typically at 12-15 months of age, so it is uncommon to see these diseases. The MMR and varicella vaccines can be given separately or as MMRV. (Rubella is the “R” and can lead to brain damage in a fetus, but does not cause meningitis.)
Bacteria that lead to meningitis can quickly kill, so prompt treatment is important. If you’ve been exposed to bacterial meningitis, you may be treated as well, but remember that most people who get these bacteria do not get meningitis.
Most people who get bacterial meningitis recover, but some have lasting damage. Hearing loss, brain damage, learning disabilities, and loss of limbs can result from various types of meningitis.
Causes of bacterial meningitis vary by age group:
Newborns can be infected during pregnancy and delivery as well as after birth. They tend to get really sick very quickly, so this is one age group we take any increased risk of infection very seriously.
Bacteria that tend to infect newborns include Group B Streptococcus, Streptococcus pneumoniae, Listeria monocytogenes, and Escherichia coli.
Mothers are routinely screened for Group B Strep during the last trimester of pregnancy. They are not treated until delivery because this bacteria does not cause the mother any problems and is so common that it could recur before delivery if it’s treated earlier. This could expose the baby at the time of delivery. If a mother does not get adequately treated with antibiotics before the baby is born, the baby may have tests run to look for signs of infection or might be monitored in the hospital a bit more closely.
Once the mother’s water breaks, we time how long it has been because this opens the womb up for germs to infect the baby. If the baby isn’t born during the safe timeframe, your delivering physician or midwife might suggest antibiotics. After delivery your baby might have tests done to look for signs of infection or might be monitored more closely in the nursery.
As children leave the newborn period, their risks change. Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib)are the bacteria that cause disease in this age group.
Thankfully we have vaccines against many of these bacteria. Infants should be vaccinated against S. pneumoniae and H. influenzae starting at 2 months of age. (Note: H. influenzae is not related at all to the influenza virus.)
Vaccines against N. meningitidis are available, but are not routinely given to infants at this time. High risk children should receive the vaccine starting at 2 months of age, but it is generally given at 11 years of age in the US.
Teens and young adults
Neisseria meningitidis and Streptococcus pneumoniae are the risks in this age group.
Thankfully most teens in the US have gotten the S. pneumoniae vaccine as infants so that risk is lower than in years past.
Not all ear infections are created equally. Swimmer’s ear differs from a middle ear infection. It is an inflammation of the skin lining the ear canal and is most common in older children and teens. Middle ear infections (otitis media) are caused by pus behind the eardrum and are most common in infants and younger children.
What is swimmer’s ear?
Swimmer’s ear (AKA otitis externa) gets its name because it is commonly caused by water in the ear canal making a good environment for bacteria to grow, causing an infection of the skin.
Water can come from many sources, including lakes, pools, bath tubs, and even sweat, so not only swimmers get swimmer’s ear.
Increasing the risk of swimmer’s ear:
Anything that damages the skin lining the ear canal can predispose to a secondary infection, much like having a scraped knee can lead to an infection of the skin on your knee. Avoid putting anything in your ears, since it can scratch the skin of the ear canal. This includes anything solid to clean wax out of the ear.
Excess earwax can trap water, so cleaning with a safe method can help prevent infection. A little wax is good though — it actually helps prevent bacterial growth. For more on earwax, please see Ear Wax: Good and Bad.
Yes, it sometimes hurts!
Swimmer’s ear can cause intense pain. Sometimes it starts as a mild irritation or itch, but pain worsens if untreated. It typically hurts more if the ear is pulled back or if the little bump at the front of the ear canal is pushed down toward the canal.
Ear buds (for a music player) or hearing aides can be very uncomfortable (and increase the risk of getting swimmer’s ear due to canal irritation).
Sometimes there is drainage of clear fluid or pus from the canal.
If the canal swells significantly or if pus fills the canal, hearing will be affected.
More severe cases can cause redness extending to the outer ear, fever, and swollen lymph nodes (glands) in the neck.
Swimmer’s ear can lead to dizziness or ringing in the ear.
Prevention of swimmer’s ear:
If your child has excessive wax buildup, talk with his doctor about how often to clean the wax. Wax does help keep your ears clean, so you don’t want to clear it too much!
Never put anything solid into the ear canal.
Dry the ear canals when water gets in.
Tilt the head so the ear is down and hold a towel at the edge of the canal.
Use a hair dryer on a cool setting several inches away from the ear to dry it.
If kids get frequent ear infections or are in untreated water (such as a lake), use over the counter ear drops made to help clean the canal. You can buy them at a pharmacy or make them yourself with white vinegar and rubbing alcohol in a 1 to 1 ratio. Put 3-4 drops in each ear after swimming. The acid of the vinegar and the antibacterial properties of the alcohol help to clear bacteria, and the alcohol evaporates to help dry the canal.
DO NOT use these drops if there are tubes or a hole in the eardrum, if pus is draining, or if the ear itches or hurts.
Avoiding swimming when needed
If your child has a scratch in the ear or a current swimmer’s ear infection, avoid swimming for 3-5 days to allow the skin to heal.
Avoid bubble baths and other irritating liquids that might get into ear canals.
If there’s tubes…
If your child has tubes placed for recurrent middle ear infections, talk with your ENT about ear protection during swimming.
The use of ear plugs for swimming with tubes has been controversial, but are generally not needed. Dr. Burton discusses this in 5 Fantastical Ear Tube Myths .
Treating swimmer’s ear:
If you think your child has swimmer’s ear, start with pain control at home with acetaminophen or ibuprofen per package directions.
Heating pads to the outer ear often help, but do not put any heated liquids into the ear.
Visit your doctor
Most often swimmer’s ear is not an emergency, but symptoms can worsen if not treated with prescription ear drops within a few days.
Bring your child to the office for an exam, diagnosis, and treatment as indicated. Most can go to their usual physician during during normal business hours if you can get adequate pain control at home.
When to be seen immediately
If the pain is severe, redness extends onto the face or behind the ear, the ear protrudes from the head, or there are other concerning symptoms, your child should be seen immediately at their primary care office or another urgent/emergent care setting.
Occasionally we will remove debris from the canal or insert a wick to help the drops get past the inflamed/swollen canal.
Never attempt this at home unless you’ve been instructed on how to do it safely!
Prescription ear drops and oral medicine
The prescription ear drops may include an antibiotic (to kill the bacteria), a steroid (to decrease inflammation and pain), an acid (to kill bacteria), an antiseptic (to kill the bacteria), or a combination of these. They are generally used 2-3 times/day.
Have your child lie on his or her side to put the drops in the ear. He or she should remain on that side for several minutes before getting up or changing sides to allow the medicine to stay in the ear. They can use a cotton ball or tissue to collect and dripping when they get up.
Symptoms generally improve after 24 hours and the infection clears within a week.
Oral antibiotics are usually not required unless the infection extends beyond the ear canal.
If an infection causes more itch than pain or does not clear with initial treatment, we might consider a fungal infection. This requires an anti-fungal medication.
No swimming until the infection clears.
Swimming just adds insult to injury. Let the skin heal before getting it soaked in the pool again!
Kids (and adults) with diabetes or other immune deficiencies are more likely to get severely sick with any infection.
Did you know there’s a name for the super swollen male parts from bug bites? Actually two names: Summer Penile Syndrome and Lion Mane’s Penis. Doctors might even call it seasonal acute hypersensitivity reaction. If you’ve ever seen it, you know it can be quite impressive.
What is summer penile syndrome?
Summer penile syndrome is a fairly common concern during the summer months. It’s usually due to a chigger bite on the sensitive skin of the penis or scrotum. You can often find a small bug bite near the center of the swelling.
They can itch like crazy, but usually don’t interfere with urinating.
Despite the significant swelling, there isn’t usually much pain, only itching. Unless there’s a secondary infection, there won’t be any fever.
What is a chigger?
Chiggers are a type of mite, which is an arachnid in the same family as spiders and ticks. They are also called harvest mites, harvest bugs, harvest lice, mower’s mites, or red bugs. Chiggers are so small they often go unnoticed until several hours after they attach to our skin. They can attach even under clothing, and the most common places that we notice chigger bites are in the areas of our pants.
Chiggers live in moist, grassy and wooded areas. They are commonly found in the warm summer months.
Adult chiggers don’t bite. It’s the larvae that cause itchy problems. The larvae are red, orange, yellow, or straw-colored, and no more than 0.3 millimeters long.
After crawling onto the skin, the larvae inject digestive enzymes into the skin that break down skin cells. They do not actually bite the host even though the bumps are called chigger bites. They form a hole in the skin called a stylostome. Their saliva goes into deep skin layers, which results in severe irritation and swelling.
People usually start to itch within a few hours and often scratch the feeding chiggers away. A hot shower with plenty of soap will kill chiggers and prevent them from finishing their meal, so showering after being in grassy or wooded areas can help prevent deeper reactions.
The good news is that in the US, chiggers are not known to carry diseases.
Even though they don’t cause disease, chigger bites are something to avoid because they can cause significant itching for weeks.
Bug sprays with DEET will deter the chiggers. DEET is approved for use in children over 2 months of age.
Clothing can be treated with permethrin to avoid ticks and chiggers. Permethrin can be purchased at sporting goods stores to pre-treat your clothing. It should not be used directly on skin. Once dried into the clothing, permethrin will last for about six washings. You can also treat your shoes, which makes a lot of sense since chiggers are usually found in the grass and crawl up onto your skin.
Even untreated clothing can help a little if you don’t have time to pre-treat with permethrin. Wear long sleeves and long pants. Be sure to tuck the pant legs into your socks so they can’t enter from the bottom leg hole.
Much like any bug bite, control of the itch is important. If kids scratch any itch, it can become secondarily infected from the break in the skin allowing germs in.
Antihistamines are used for allergic reactions. We commonly use them for seasonal allergies, but they can help most allergy reactions.
Bug bites itch when our bodies react to the saliva injected into our skin with histamine. Histamine is our body’s allergic response and it itches. If you aren’t allergic to the bite, you won’t itch from it. This is the way we react to allergies, which is why we get itchy eyes and noses with allergies to pollen.
Diphenhydramine (Benadryl) is a short acting antihistamine that can help control allergic reactions, but tends to make kids tired or wired. It also only lasts a few hours, which can require frequent dosing.
I don’t like topical antihistamines, which are often sold to treat bug bites. I worry that kids will get too much of the medicine when it is applied to each bite. It’s a low risk, but still a risk. Just because they aren’t taking it by mouth doesn’t mean it isn’t absorbed. Children using a topical antihistamine for an extended time over large areas of the skin (especially areas with broken skin) may be at higher risk, especially if they also are using other diphenhydramine products taken by mouth or applied to the skin.
I am a fan of using an oral long-acting antihistamine, such as cetirizine or loratadine, to treat bug bites. Most kids with one bug bite have many. One dose of an oral antihistamine helps to control the overall histamine reaction, making each bite itch less.
Despite the significant swelling, these usually do not require prescription antibiotics.
If your child has open areas from scratching the skin, you should keep the area clean and consider using a topical antibiotic ointment to help prevent infection.
Over the counter topical hydrocortisone is a very low dose steroid. It can be used on insect bites to help stop the itch.
Stronger steroids that require prescriptions are occasionally used, but you will need to see your physician to discuss the risks and benefits of prescription steroids.
Soaking in an oatmeal bath might help the itching. It works very well for dry skin conditions and sunburn relief as well.
You can buy commercially made oatmeal bath products or you can grind regular plain oats to make it fine enough that it dissolves in bath water. Test a small amount in a cup of water to see if it’s finely ground enough before putting 1 cup of oats into the bath water.
Some people have even made a paste of oats and applied it directly to the itchy skin for relief.
Another kitchen remedy for bug bite itch relief is baking soda. Mix a pinch of baking soda with a few drops of water to make a paste. Put this paste on the bites. Reapply as needed.
Ice or cool cloth
One more kitchen treatment is ice. Many kids won’t tolerate this one, but if they can’t tolerate an ice pack placed over clothing, you can try applying a cool wet washcloth directly to the skin.
When should you see your doctor?
If your child has any of the following symptoms, talk with your doctor.
Pain or itch not controlled with the above measures.
When children suddenly start peeing all the time, we need to consider the many potential causes. There are many reasons kids have frequent urination. Sometimes it’s as simple as they like to flush the toilet or splash in the sink. This is common in newly potty trained kids. But peeing all the time can also signify a medical problem that needs to be addressed. Learn the potential risks of why children run to the restroom frequently or start to have accidents. This can help parents decide if they need to rush to the ER.
Associated symptoms to identify
Frequent urination can be associated with other things that give us a clue as to what is going on. Sometimes they do not seem connected to the urine, so you might not associate the symptoms. Discuss the issues that apply to your child with your child’s physician.
Behavioral changes can be a clue. For instance, look for signs of anxiety. Remember that anxiety does not always look like fear. The frequent urination might be due to worrying about not making it to the bathroom in time and having an accident.
Pain might also be from skin irritation due to improper wiping in girls. In uncircumcised boys, pain can develop from improper cleaning under the foreskin. Staying in wet swimsuits too long also can lead to skin irritation and painful urination.
Pain in the abdomen, back or side can indicate problems with the kidneys or an infection. Sometimes this is due to constipation. It will require a physical exam and possibly testing to determine the cause. Schedule an appointment with your child’s primary care physician. If the pain is so severe that he or she cannot sleep, walk, or move easily, go to the ER.
Change in urine odor and color
A change in urine smell and color is important to note. Red, brown, cloudy or smelly urine can be signs of kidney damage, infection, bleeding problems, dehydration, and other serious conditions.
Some foods, such as asparagus and coffee, can change the smell of urine. Color changes can also happen as a result of foods, such as beets or berries turning urine red, or rhubarb or fava beans turning urine brown.
Many medications and vitamin supplements can change the color and odor of urine. It will be important to discuss your child’s recent foods, medicines, and supplements with his or her physician.
Other signs of illness
Other signs of illness can offer clues. Think about fevers, cough and cold symptoms, swelling of the eyes or legs, joint pains, and more.
One example to consider would be Rhinovirus. Rhinovirus typically causes upper respiratory tract infections with cough, runny nose, and pink eye. It can also sometimes cause vomiting and diarrhea or urinary tract infection symptoms.
Causes of frequent urination
Frequent urination can be a sign of diabetes. This is a potentially life threatening issue and needs to be addressed immediately.
Symptoms of diabetes will include being very thirsty and frequent urination. Kids might appear dehydrated despite the high urine volume. They can have weight loss, dry mouth, and low energy. Kids with untreated diabetes usually appear sick and tired.
When sugars reach a critical level, diabetics develop fruity breath. This is associated with a pattern of breathing called Kussmaul breathing. This is a medical emergency. Diabetes can be a rapidly developing problem. If you notice this breathing pattern, get to an ER immediately.
Testing for diabetes initially uses a sample of urine. Urine is tested for sugar. If there is sugar in the urine, blood will also be checked.
Children with newly diagnosed diabetes are referred to an endocrinologist. Endocrinologists are specialists in diabetes and other hormone issues. Newly diagnosed diabetics often spend a few days in the hospital for stabilization of medical issues and teaching of how to manage at home.
Urinary tract infection
Urinary tract infections (UTIs) commonly cause frequent urination. Other symptoms, such as fever, pain with urination, and urinary accidents, often occur. Bacteria and viruses can cause UTIs.
UTIs are more common in girls and in boys who are not circumcised.
A urine test can help to determine if there is a UTI. A quick urinalysis can suggest an infection, but a culture is needed for actual diagnosis. A urine culture takes up to 2 days to grow bacteria. Bacterial UTIs are treated with antibiotics. Viral UTIs self resolve after a few days.
Many parents are surprised at all the things pediatricians blame on constipation. I can’t say how many parents deny that their child is constipated when they are. An x-ray often shows the abdomen is full of poop even when kids poop every day.
Note: I don’t always get an x-ray to diagnose constipation. Studies are only needed to help with diagnosis if the exam findings are not clear. Usually it’s obvious from the description of the stooling pattern and the look of the poop. Kids often cannot describe their poop accurately, so I use a Bristol Scale. You can use this at home to talk to your kids about their bowel movements.
Many children with constipation don’t initially seem to be constipated so a trial of Miralax is often recommended. This treats the constipation if it exists and is part of the diagnostic evaluation. Diet changes and changes to toileting habits are also important. These take longer to make a difference so I still recommend Miralax.
If treating the constipation helps, continue to treat until it is no longer needed.
Pollakiuria = increased frequency of childhood
Increased frequency of urination, also called pollakiuria, is common and not harmful. Other terms that have been used to describe this condition include extraordinary daytime urinary frequency and increased frequency of childhood.
The cause of this is unknown but often is triggered by a stressful event. Kids with this have a normal physical exam and urinalysis.
Pollakiuria involves frequent urination during the day. Kids will feel the need to urinate frequently, even though there’s really no physical reason.
Most children do not change their nighttime urinary pattern. If they previously wet the bed, they still will. If they previously stayed dry all night, they will continue to stay dry at night.
Pollakiuria is seen more often in boys, but also occurs in girls. It’s most common between 4 and 10 years.
Despite the frustrating symptoms, it’s not a serious illness and it self resolves. It generally lasts 1-6 months and can be quite problematic due to the frequent bathroom trips needed. Some kids pee as often as every 30-90 minutes.
To diagnose this, a child should be seen to discuss the symptoms and to do a physical exam. Often constipation aggravates this issue, so close attention to stool patterns and the abdominal exam are important. A urinalysis should be done to rule out diabetes or urinary tract infection. Pollakiuria is a diagnosis of exclusion. This means there is no test for it, but we rule out other potential causes of frequent urination.
This problem typically starts suddenly and ends suddenly. It can last for months.
What can you do to help if there’s no treatable cause?
If there is a treatable medical condition, treating that condition will usually help the frequent urination. While it seems like there’s nothing to do to help if there’s no cause found, don’t get discouraged! There are things to do that can help.
Contrary to what many intuitively think, drinking plenty of water is beneficial. Don’t limit water!
Don’t punish kids for needing to use the restroom or for having accidents. It may not be under their control at all. If it is a behavioral issue, the child needs support, not punishment. Punishment or belittlement will only make them feel bad. This worsens the situation. It can be hard to not get frustrated, but take a big breath and try to remain calm. Use words that are neutral and not judgmental.
Be sure the teacher knows what’s going on. If your child needs to go to the bathroom frequently, he needs to be allowed.
Remind your child that he or she is healthy. This can help to reduce the anxiety and stress in their minds. Stress can make this condition worse, so reassurance is very important!
Show your child that it’s possible to wait for a longer period of time to urinate. Explain that there will be no urine leakage because that fear increases anxiety about not going to the bathroom. The more confidence they develop, the better their bladder control. Practice waiting a little longer before going to the bathroom and celebrate small improvements.
Foods to avoid if your child has frequent urination:
The foods and drinks listed below may or may not increase frequent urination.
Avoid these for at least for 2 weeks. Slowly re-introduce one at a time to see if they lead to increased urination.
Highly acidic foods such as salsa, sodas, teas, coffee, cranberry juice and orange juice.
Caffeine acts as a diuretic and increases urine. It’s found in coffee, tea, chocolate, sometimes ice cream or other treats.
Spicy foods such as chili peppers, jalapeño peppers, horse radish, curry and salsa.
The most important thing to remember is to first rule out medical causes that need to be treated.
Once those are ruled out, this is a lesson in patience. Don’t belittle your child or use harsh words when they need to use the bathroom again. And again. This will pass.
Work on having your child hold their urine for a few minutes longer with encouragement. Frequent urination usually stops as suddenly as it started.
Many years ago I heard about research showing that throat cultures clear within 12 hours after the first dose of antibiotic for strep throat. I’ve been waiting since then for a change to our recommendation that kids must stay home from school for 24 hours after starting antibiotics. Guess what? The new Red Book (an infectious disease book from the American Academy of Pediatrics) is out and the back to school recommendations for strep throat have changed! This can help many parents get back to work when their kids can return to school and daycare earlier. But it doesn’t mean you should rush in to demand antibiotics for every sore throat!
I have summarized the Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America previously. These official guidelines have not been updated, but the Red Book represents the AAP official recommendations.
What is Strep throat?
Strep throat is not just any sore throat. Many viruses can cause sore throats but strep throat is caused by group A Streptococcus bacteria, also known as Streptococcus pyogenes.
Strep throat is not common in kids under 3 years. The incidence of strep throat peaks in young childhood and is less common in teens and adults.
A strep test is needed to diagnose strep throat in kids. Physicians and other healthcare providers can use Centor Criteria for adults, but a clinical diagnosis alone is not recommended in children.
Strep throat typically causes a sore throat, fever, swollen tonsils, and swollen lymph nodes (gland) under the jaw. Some kids will get a sandpapery rash on their trunk. When this happens, it is called scarlet fever. I also see a significant number of kids who get a stomach ache and vomiting with strep.
Does strep throat need to be treated?
Most parents and kids want antibiotic treatment so that the miserable symptoms of strep go away faster, but do we need to treat strep?
You might be surprised, but antibiotics are not prescribed to treat strep throat symptoms. Antibiotics are used to prevent serious complications from the strep bacteria. Pain relievers, such as acetaminophen or ibuprofen, can be used to treat the fever and sore throat symptoms. School aged children, teens, and adults can also use throat lozenges for sore throats. (Do not use these in kids who are still at risk of choking.)
One major reason is to help delay antibiotic resistance.
Some people have allergic reactions or side effects to antibiotics, so we should not use them lightly.
They also can increase total healthcare costs. Although penicillin and amoxicillin (which are recommended for strep throat) are inexpensive, treating strep throat does increase healthcare costs. The sheer number of illnesses that present to clinics for evaluation, the cost of testing, and the cost of the treatments can all add up. Of course, returning to work a day earlier can make an impact on our economy as well.
If your child has symptoms not characteristic for strep and is not otherwise high risk, you can monitor and treat for a few days at home.
But antibiotics make us feel better faster, right?
Antibiotics tend to shorten the symptoms by about 16 hours.
They have been shown to prevent serious consequences of strep infections, but those are rare, so the risk/benefit ratio may not support treating every case of strep. (Though I still do treat strep when I see it.)
Look at risk/benefit ratio for all treatments
If you want to read an example of the risks/benefits of treating strep throat, see this (slightly technical) case report.
Remember that this report simply highlights one case, it cannot be generalized to everyone with strep throat. It shows how doctors work through the risks and benefits with everything we treat. We don’t always state things like this out loud, but they go through our mind as we develop treatment plans.
It’s common in medicine to have case reviews such as this. Any one case does not change our treatment guidelines, but they can help us start to understand issues. They often serve to initiate further studies.
Are there risks to not treating?
Untreated Strep infections can lead to complications.
The character Beth in the classic book “Little Women” died of heart complications after scarlet fever.
(If nostalgia hits you, you can get the entire series of the March family on Kindle for less than a dollar!)
Complications from untreated strep can include tonsil abscesses, ear infections, sinus infections, arthritis, heart damage, and kidney damage. While some of these can be severe, thankfully the more severe complications are rare, even without treatment.
There is also a condition called PANDAS (pediatric autoimmune neuropsychiatric disorders) that some experts think is related to strep. This can involve the sudden onset or worsening of tic disorders, obsessive compulsive disorder, mood changes, and change in quality of school work. Throat swabs can be normal, but a blood test can help to identify a recent strep exposure. Testing is not recommended for everyone with tics or OCD, but talk to your pediatrician if symptoms start out of the blue and you’re concerned.
Don’t let the new recommendations make you rush in…
Strep throat is rarely an emergency. Don’t rush to the ER after business hours to have your child checked as soon as you notice symptoms. You can use pain relievers as well as cold drinks, smoothies and popsicles to manage the symptoms at home initially. Just because the back to school recommendations for strep throat allow return 12 hours after antibiotics start, coming in too soon might not help in the long run.
About the testing available:
Do not use telehealth to get your sore throat treated.
In children it is not recommended to diagnose strep throat without a throat swab test. This should be done in a medical clinic to avoid inaccurate testing.
Strep throat is not common in kids under 3 , so it’s not recommended to test them.
I admit that if an older sibling or caregiver has strep and they have strep symptoms, I will test 2-3 year olds. The recommendation is to not bother. Even if they have strep, treating does not tend to alter their course. Kids in this age group tend to not develop the severe consequences of strep like older kids, even when not treated.
Although both viruses and strep bacteria can cause fever and sore throat, there are clues that it is not strep. When strep carriers get sick, they can have a false positive throat culture. The strep that shows on testing is not the cause of their symptoms and leads to over treatment.
If there is a cough or runny nose, the sore throat is most likely a viral illness. A strep test is not recommended.
When there are blisters in the mouth or a characteristic hand, foot, mouth rash, they have a viral illness. A strep test is not recommended.
Because the rapid strep test looks at antigens the body makes in response to strep and not the bacteria itself, recent strep can affect rapid strep testing. The antigen can remain in the throat for a time after treatment, so a strep culture is recommended for several weeks after treatment of strep throat.
It is not recommended to do a throat culture after treatment unless a person is high risk for complications, such as rheumatic fever.
contacts of someone with strep
It isn’t recommended to test people who have been exposed to strep unless they have symptoms. If they do not have symptoms, a positive test is more likely to be a falsely positive (not true) test. It could lead to unnecessary antibiotics.
If a sibling over 3 years of age develops symptoms, it is recommended to test and not just treat.
Pets do not get strep, so no need to swab your pet!
Why not just test every sore throat?
Studies show that 1 in 4 kids can have strep in their throat at any given time. They are simply carriers, but not truly infected with strep. Contrary to popular belief, strep carriers are not likely to spread strep infections.
If a strep carrier has a viral illness, they can have a positive test but the strep is not the cause of their illness. Antibiotics are not needed for this at all. A positive test leads to using antibiotics that are not needed, which can increase the risk of side effects and allergic reactions. They give a false sense of security of treatment, but if it’s a viral illness, antibiotics are not treating anything. Kids can be sent back to daycare or school while still contagious simply because they’re “being treated.”
“My child always has a negative rapid test but the culture is positive. Can’t we just treat?”
My back to school recommendations for strep throat:
If your child has some of the symptoms of strep (sore throat, fever, tender bumps in the neck, vomiting, or rash) consider strep throat.
Symptoms of typical viral illnesses make strep less likely. These might include runny nose, cough, red goopy eyes, or diarrhea. No testing is recommended.
It can be difficult to tell if a runny nose from allergies despite the strep throat or if the runny nose is part of the viral illness that includes a sore throat, so if in doubt, bring your child in for evaluation. The doctor can determine if testing should be done. Do not use telehealth for this. I recommend seeing your primary care physician during normal business hours.
If there is strep throat, penicillin or amoxicillin are the preferred treatments unless there is documented allergy.
Your child may return to school 12 hours after the first dose of antibiotic if they are otherwise well. (If they are not feeling great, they likely have something else going on!)
Constipation is one of the most common problems that affects kids. Sometimes it’s mild and changes to diet and routines can help sufficiently. Those are of course the ideal treatments. But if it’s more severe or if kids are resistant to change, Miralax is my go-to treatment. Several parents have asked me about its safety due to what they’ve seen online. I know many more are probably worried but just haven’t asked. With all the concern, I thought I’d share some of the concerns and reasons that I still recommend it.
What is Miralax?
Miralax has been used since 2000, and since I finished my pediatric residency prior to that, I can remember the alternatives we used previously. Many of them were difficult to get kids to take due to poor taste or grittiness. When Miralax was first available, treatment of constipation improved significantly due to the tolerance and acceptance by kids. It was initially available by prescription only and expensive – thankfully both of those hurdles have been removed.
Miralax is the brand name for polyethylene glycol 3350 or PEG 3350. It is now available as an over the counter medication, so no prescription is needed. Generic versions are available. It has been used by many kids over many years, often for long periods of time, to treat constipation.
Is it a laxative?
PEG3350 is a stool softener, not a laxative (despite the name).The molecule binds to water, but is too large to be absorbed through the gut so it passes through the gut and carries the water with it. It works by increasing the water content of the stool. The more PEG taken, the softer the stool.
PEG is not a laxative and should not cause cramps. It is not habit forming. As mentioned above, it is not absorbed into the body it just goes through the GI tract and leaves with the stool.
How is it used?
PEG 3350 is a tasteless powder that dissolves in liquids. It often needs to sit for a few minutes and re-stirred to fully dissolve.
It may be dissolved in water, with a slight change to its taste, but is palatable. Be careful of adding it to drinks high in sugar (even juice), since your child may be on it for a long time, and they don’t need the added sugar. Consider making flavored water with your child’s favorite fruit. Simply put cut up fruit in water in the refrigerator for a couple hours. Infused water tastes great and is a healthy base for your Miralax mixture – or anytime your kids need a drink and don’t like plain water.
I don’t recommend adding it to carbonated beverages.
I recommend mixing a capful of powder in 8 ounces of water and titrating the amount given based on need. My office website discusses this in detail.
Why do we need medicine?
Constipation is common.
Very common. It causes pain, poor eating habits, fear of toileting, and sometimes even leads to ER trips and CT scans. It can last months to years in some kids, so it is not a minor issue when kids suffer from it.
Diet changes are hard – especially in kids!
Kids are often constipated because they have a diet that is poor in water and fiber. They need to eat more fruits, vegetable and whole grains. Many kids drink too much milk and eat too much cheese.
Changing habits is very difficult in strong willed kids. When it comes to food, they’re all strong willed! Dietary changes of course should be done so they are healthier on many levels, but if their stomach hurts all the time, they are unlikely to get out of their comfort zone with foods. Habits change too slowly to help the constipation if used alone.
I encourage first changing the diet to help constipation, but if that fails, or if it is too significant of a problem, PEG 3350 is my first choice. I have recommended it for years without any known side effects or complications, other than the kids who have frequent watery stools on it. This usually responds to continuing the medicine to release the large stool mass that has built up. Some kids just need to decrease the dose a bit.
What’s the concern?
I was quite surprised in 2015 to see that researchers were starting a study on the drug. It surprised me not only because I’ve never heard valid concerns about the safety or efficacy of the medicine (I have seen some really weird stuff online, but nothing that is valid), but also because I’ve never seen headlines that a study is starting. Usually headlines report results of studies. Why did it hit the press before the study was even done? I have no idea.
Even more interesting… it seems the study hasn’t started yet. Three years later. Not a high priority, apparently. Which fits with the low level of concern I find among general pediatricians and pediatric gastrointestinal specialists.
Yet parents still ask about the risks.
What was the proposed study?
Initial reports stated that they were going to look at the safety of other molecules in the PEG 3350.
PEG 3350 itself is a very large molecule that isn’t absorbed by the gut, but there are concerns that smaller compounds could be found as impurities in the manufacturing process of PEG 3350 or formed when PEG 3350 is broken down within the body.
The question is if these smaller compounds are absorbed by the gut and accumulated in the bodies of children taking PEG 3350.
Some families have reported concerns to the FDA that some neurologic or behavioral symptoms in children may be related to taking PEG 3350. It is unclear whether these side-effects are due to PEG 3350 since neurologic and behavioral symptoms can lead to constipation.
These guidelines basically state that not many studies are required to diagnose functional constipation after a thorough history and exam. This means that we don’t need to do expensive tests to make the diagnosis.
The common things we recommend (fiber, water, probiotics) don’t have any proof that they work. There is evidence that PEG 3350 works.
Historically once something is approved in adults, physicians start to use them in children. Companies generally don’t invest money in studies to expand uses after approval because they know that the products will be used in broader ways without the specific indication. They don’t want to spend money they don’t need to spend, which makes sense from a business perspective. It’s also more difficult to do studies in minors.
New rules encourage pediatric testing, but all the drugs previously used in children will not need to undergo this testing. Because they’ve been used for years, we rely on post-market safety data.
Are there studies in children?
Many of the news articles say that studies have not been done in children, but this isn’t true.
This 2014 research article reviews the history of PEG 3350 and compares to other medicines used in pediatric constipation. It also shows safe blood electrolyte levels while on PEG 3350 long term.
In 2001 a study was published showing safe and effective pediatric dosing.
A 2003 studyshowed safety and better tolerance than previously used medications for constipation.
If you look at the references of any of these studies, you will find more. The only side effects noted are related to diarrhea, cramping, bloating — all things that would be expected with a large stool mass blocking the new, softer, water filled stools from coming out. Once the large stool mass is out, these symptoms resolve.
For what is PEG approved?
PEG is used in many products, not just stool softeners. It is found in ointments and pills to allow them to be more easily dissolved in water. PEG can also be found in common household products such as certain brands of skin creams and tooth paste.
PEG 3350 is approved for treatment of constipation in adults for up to 7 days. Approval is based on studies available at the time a medicine is approved. Many commonly used medications are not specifically FDA approved for use in children less than 16 years due to difficulties and expense in testing drugs on minors.
How do we know it works?
There have been several studies in children and the collective experience of pediatricians around the world showing improved tolerability over other treatments for constipation because PEG 3350 has no taste, odor, or texture.
It has been shown to be either as effective or more effective than other constipation treatments. See the links to these studies above. Until children can keep stools soft with adequate amounts of water, fruits, vegetables, and fiber, long term use of PEG is well tolerated.
How long can PEG be used in children?
This is a very difficult thing to study because the longer a study follows their subjects, the more subjects are lost to follow up.
There have been studies of up to 30 months that showed safe use. Blood electrolytes, liver and kidney tests were all reassuring that PEG is safe during the study.
Pediatric gastroenterologists and general pediatricians have often recommended even longer periods of time without any known side effects.
If my child has taken PEG 3350, should I worry?
I cannot stress enough that the studies that have been done all support the safety and efficacy of PEG 3350.
After years of experience using PEG 3350 with many children, I have not seen any neurologic or behavioral problems caused by PEG 3350. I do see many kids with baseline neurologic and behavioral problems become constipated, so they often end up on PEG 3350, but if the issue is carefully assessed, the problems start prior to the treatment.
Generally if the stools are softer, you can more easily work with the behavioral issues that cause the constipation, such as loss of appetite/poor diet and failure to sit on the toilet long enough to empty the stool from the rectum.
If you decide it is time to stop the medicine, be sure to discuss this with your child’s doctor to keep them in the loop about how things are going!
Hand, foot, and mouth disease is a very common illness, but there is a lot of confusion about it. It is caused by several different viruses in the enterovirus group. It can make kids (and some adults) miserable, but like most viruses we don’t have a specific treatment to fix it. There are things we can do to help kids stay more comfortable and to decrease spread.
Hand, foot, and mouth disease can look different in different people.
Of course the name gives a clue: there’s often a rash on the hands and feet, and in the mouth. If there is a classic rash, you’ll know what you’re dealing with. The rash can look like red spots or blisters, classically on the palms and soles, but it can extend up the arms and legs. I often call it hand, foot, mouth, and butt disease because bumps in the diaper region are common. You might not recognize the blisters unless you can get a good look in their mouth to see blisters on the gums, tongue, or throat.
This photo shows typical blister-type lesions around the mouth of a toddler. Notice the drool at the chin. Many kids have these blisters on their throat, which makes it painful to swallow. They often refuse to eat or drink – or even swallow their saliva!
Are there any serious complications?
Most kids recover completely within a week or so, but some can have a more significant illness.
Some kids refuse to eat or drink and may require hospitalization for dehydration.
A rare complication is viral meningitis, an inflammation around the brain. Symptoms can include fever, headache, stiff neck, and irritability. Viral meningitis might require hospitalization to help with comfort measures or to treat with antibiotics while ruling out bacterial meningitis.
Even less commonly children can get encephalitis or a polio-like paralysis. Encephalitis is an inflammation of the brain. Symptoms include fever, seizures, change in behavior, confusion and disorientation, and related neurological signs depending on which part of the brain is affected.
One consequence I tend to see every few years is fingernails and/or toenails falling off weeks after recovery from hand, foot, and mouth disease. While this is not serious and the nails eventually grow back normally, it can be distressing to parents. Simply knowing that this might happen can hopefully stop your worry before it starts!
How is it spread?
Most enterovirus infections in the US are during the summer and fall. Enterovirus infections are common worldwide. Most kids have been infected by the time they’re school aged. Pets do not get infected with enteroviruses.
The virus easily spreads from person to person. This happens through contact with saliva, nose and throat secretions, fluid in blisters, or stool of an infected person. The virus can spread from mother to infant prenatally and in the newborn period.
Enteroviruses may survive on environmental surfaces for periods long enough to allow transmission from fomites.
Respiratory tract shedding usually only occurs for 1-3 weeks, but the virus can exist in the stool for months after infection. Careful hand washing after all diaper changes is essential. In most cases it is not possible to keep kids home from daycare until they are “no longer contagious.”
Infection and viral shedding can occur without signs of clinical illness, especially in adults. This means many parents and daycare providers can unknowingly spread the virus to susceptible infants and children.
The incubation period (time from infection until symptoms show) for enterovirus infections is typically 3 to 6 days.
What treatment can be given?
Because this is caused by a virus, there is no specific medicine that is needed to make it go away.
Fluids are very important. Some kids refuse to swallow due to pain, so they are at risk of dehydration. Giving pain relievers, such as acetaminophen or ibuprofen, can help to decrease the pain and improve how well they will drink. Offer cold drinks, smoothies, and popsicles if age appropriate.
Older children and adults can use throat lozenges or mouth sprays that numb the pain.
A mixture of liquid diphenhydramine (a common antihistamine) and a liquid antacid, such as Maalox, in a one-to-one ratio can help alleviate pain. Give the amount that equals the diphenhydramine dose per weight.
For example, if a child’s dose is 2.5 ml of diphenhydramine, mix 2.5 ml diphenhydramine with 2.5 ml of the liquid antacid. If a child can swish, gargle, and spit the mixture, it can help numb the sores. When younger children swallow the mixture, it may also help if it coats the sores in the mouth adequately.
Control measures to prevent hand, foot, and mouth disease
Hand washing, especially after diaper changing, is important in decreasing the spread of enteroviruses.
Don’t share foods or drinks. Avoid contaminated utensils.
During the winter months more people get sick, so more people are treated with antibiotics. While antibiotics can help treat bacterial infections, they do carry risks. One of those risks is an allergic reaction. This is one of the reasons pediatricians avoid using antibiotics liberally. Most of the time our bodies can fight off the germs that cause illness and antibiotics don’t help treat viruses at all. How do you know if it’s an antibiotic allergy or just a rash?
Rashes are common
When someone is on a medicine and they develop a rash it can sometimes be hard to sort out if symptoms are part of the illness, a non-allergic drug reaction, or an allergic reaction.
There are many people who had a rash while taking an antibiotic as a child and were told that they are allergic to that antibiotic, but really aren’t. Unfortunately this can lead to more expensive and broader-range antibiotics being used inappropriately and unnecessarily.
About 2% of prescription medications (not just antibiotics) cause a “drug rash”. The rash usually begins after being on the medicine for over a week (earlier if there was previous exposure to the medicine), and sometimes even after stopping the medicine.
It can look different in different people.
Some get pink splotchy areas that whiten (blanch) with touch.
Often the rash seems to worsen before it improves, whether or not the medicine is stopped.
Skin can peel in later stages.
It can itch but doesn’t have to.
Some people have mild fever with these symptoms.
Adults vs kids
In adults this type of rash is often a sign of allergic reaction, but in kids a rash is most often a viral rash – meaning they have a virus that causes a rash but they happen to be on an antibiotic (or other medicine).
This is why diagnosing allergy versus drug reaction is tricky.
These symptoms can mean allergy to the drug, but (especially in kids) is often just a symptom of a virus (or some bacteria, such as Strep or Mycoplasma).
Up to 10% of children taking a penicillin antibiotic (which includes the commonly used amoxicillin and augmentin) develop a rash starting on day 7 of the treatment. (It can be earlier in people who have had the antibiotic previously.) This rash tends to start on the trunk, looks like pink splotches that can grow and darken before fading. It does not involve difficulty breathing, swelling of the face or airway, or severe itching.
Because of this reaction many people live their life thinking they have an allergy to penicillin, even though many of them don’t.
Up to 80 -90 % of people who have mono develop a rash if they are treated with a penicillin antibiotic (like amoxicillin).
This is common since symptoms of Strep throat and mono are very similar, and penicillins are the drug of choice for Strep throat. Some people with mono have a false positive test for Strep throat, meaning they do not have Strep but the test is positive.
This is why it is very important for the medical clinician to take a careful history of symptoms and do an exam, even with “classic” Strep symptoms. (If I had a dollar for every parent who says the symptoms are just like all her kids when they get Strep, can’t I just call it in…) Always be sure to get a Strep test and full exam to evaluate if it is really Strep or possibly mono. Blood tests for mono can be ordered if clinically indicated.
Never treat a sore throat without a full evaluation.
Doctors will take a careful history of all symptoms of the illness, the timing of when the rash developed during the illness and when the medicine was given.
If it is a classic viral rash, nothing further needs to be done. If there are symptoms (see below) that help identify a true allergy and make a clear diagnosis, then avoidance of that medication should be done.
Be sure all your doctors and pharmacists know of this allergy.
Not only is an antibiotic NOT needed for viral illnesses, but taking them when not needed can increase problems.
Risks of antibiotics involve diarrhea, yeast infections, allergic reactions, and more.
Every time we take an antibiotic, we assume the risks associated with the antibiotic. If we have a significant bacterial infection, the risk is warranted. But if we have an infection that the antibiotic will not kill, it is an unnecessary risk.
Most of us have heard of superbugs, but there is a misconception about how they work.
Using antibiotics inappropriately can allow bacteria to learn to evade the antibiotic, which makes it ineffective. This means that new antibiotics need to be used to treat infections, which increases the time of illness, the cost of treatment, and the risk of untreatable illnesses. Some bacteria develop resistance to all known treatments, which can lead to death.
“The Last time amoxicillin didn’t work and we had to use something else. Can we use that one again?”
A lot of parents think that if one antibiotic failed with a previous infection, they need a different one. This is not true.
The bacteria develop resistance to an antibiotic. Bacteria can share their genetic material with other bacteria, leading to the quick spread of resistance.
Even someone who has never used an antibiotic can be infected with a resistant bacteria, which makes it harder to treat their infection.
Unfortunately, without a bacterial culture it is impossible to know what the best antibiotic is for any specific infection. We use the type of infection and the bacterial resistance pattern of the area to make the best choice.
It’s not the person that becomes immune to an antibiotic
Very often parents request a different antibiotic because “amoxicillin never works for my family.”
A person does not become immune to a type of antibiotic.
Start with an antibiotic that has a narrow coverage usually
A first line antibiotic is an antibiotic that covers the type of infection that is present, but isn’t so broad that it includes more bacteria than needed. It can also be called narrow-spectrum.
One infection with a superbug might require a strong antibiotic, but the next bacterial infection in the same person might respond well to a first-line treatment, such as amoxicillin.
It’s always wise to start with the first line antibiotic for the type of infection unless a person’s allergic to that antibiotic. It doesn’t matter if it worked the last time or not.
Broad spectrum antibiotics are needed for some serious infections
Remember that broad-spectrum antibiotics that have great killing power can increase the risk of killing the good bacteria that your body needs.
If you have a serious infection, they might be needed. In this case the benefit outweighs the risk.
Each new infection is a new bacteria.
The type of infection will determine the most likely bacteria. A culture from the infection (if possible) will specify exactly what bacteria is the cause and which antibiotics will work.
First line antibiotics are chosen based on type of infection as well as local resistance patterns. Upper respiratory tract bacterial infections tend to use different antibiotics than urinary tract infections or skin infections because different bacteria cause different types of infections.
Most people can tolerate antibiotics, but allergic reactions can be serious. It’s not worth the risk if the antibiotic isn’t needed in the first place.
Talk to your doctor about any drug allergies you suspect your child has and why.
Many kids will get loose stools when they take antibiotics.
Probiotics can help re-establish a healthy amount of good bacteria in the gut and slow the diarrhea most of the time.
Unfortunately there is a type of bacteria commonly called C. diff that can overpopulate after antibiotics and cause severe diarrhea. C. diff causes thousands of deaths every year in adults and children, most often following antibiotic use.
If diarrhea develops during or after antibiotic use, talk to your doctor’s office during regular office hours for advice. If there are signs of dehydration, severe pain, blood in stools, or other concerns you should have your child seen quickly.
Antibiotics kill not only the bacteria causing an infection, but also the “good” bacteria (gut flora) in our bodies.
Our bodies are a habitat for healthy bacteria and yeast. I know this seems unnatural or unhealthy to many people, but we need these bacteria and yeast in a healthy balance.
Gut flora is made of many types of healthy bacteria. These bacteria help us with many functions, such as digestion and weight regulation. Good bacteria make products that lower inflammation in the intestines. They also make neurotransmitters which affect our mood.
Different “good” bacteria can be affected depending on which antibiotic is used.
As mentioned above, our bodies are an ecosystem of bacteria and yeast. When bacteria are killed off with an antibiotic, it throws off the balance and allows the yeast to overgrow.
Yeast keeps the digestive system healthy and helps our immune system. It can help our body absorb vitamins and minerals from food. Despite what you read online, yeast are very beneficial to us – as long as they remain in healthy balance.
There are a lot of people selling products to treat overgrowth of yeast, which is said to cause all kinds of problems. These types of overgrowth are not recognized as true overgrowth by most physicians, but there are true yeast infections.
Yeast can cause infections of your skin (ringworm), feet (athlete’s foot), mouth (thrush), and penis or vagina (yeast infection). At risk people can develop blood infections with yeast. These can be life threatening. Serious yeast infections tend to occur in diabetics, immunocompromised people and those who were treated with antibiotics.
If you suspect a yeast infection, talk to your physician.
Risk vs benefit
When antibiotics are needed to fight a bacterial infection, it is worth the risk of taking the antibiotic.
The balance flips if you have a common cold – don’t take the risk for something that isn’t needed or beneficial.
Antibiotics do not and will not help treat a cold. Ever.
Don’t try to use an antibiotic to prevent a cold from developing into something else.
Improper use of an antibiotic simply has too many risks and will not help, so there is no benefit.
Prevention is key!
If you’re not sick, you don’t even think about looking for an easy fix for a viral illness.
Use proper handwashing, vaccinate against vaccine preventable diseases, and stay home when sick!
Spring is a beautiful time of year. The flowers bloom, the birds chirp… it’s like we’re all awakening after a long, cold winter. But with the flowers (and birds) comes pollen. And with pollen comes allergies. I don’t want anyone to be afraid to enjoy the beautiful outdoors, so learn to control allergies.
Why treat allergies?
I often hear parents say that they don’t want to give their kids medicine to treat allergies because, well, it’s medicine. They prefer to be natural and the symptoms don’t seem “that bad”.
Before you decide if the symptoms require treatment or not, be sure to recognize all the potential consequences of allergies. It’s not just a runny nose and sneezing.
For people with asthma, allergies are a known trigger. It’s especially important that people with wheezing tendencies keep up on allergy prevention and treatments.
Some will chronically mouth breathe, which can affect the growth and development of their jaw, lead to bad breath, and increase the risk of cavities. Dr. Deborah Burton, an ear, nose, and throat specialist, discusses these and other consequences of mouth breathing in one of her DrMommaSays blogs.
How do you know it’s allergies?
Allergies can cause runny nose, headache, congestion, sneezing, watery eyes, itching eyes, sore throat, itchy throat, and itchy skin. Not all symptoms need to be present.
An upper respiratory tract infection (AKA common cold) can also cause a runny nose, headache, congestion, sneezing, watery eyes, and sore throat. The difference is the cold symptoms tend to not last as long as allergies. There also could be a fever, body aches, and a general feeling of “not well” with viral infections.
Seasonal allergies tend to follow a seasonal pattern, so they can be easier to recognize than allergies to indoor allergens.
These days it’s easy to track pollen counts online. If you realize that every day the counts for one type of tree or grass is elevated you have symptoms, that’s strong support that you’re allergic to that plant.
Of course, it’s possible to get a cold on top of your allergies, which adds to the confusion sometimes.
Treatments to control allergies
It is best to treat before the symptoms get bad. Treatments include not only medicines, but also limiting exposure.
Use what you can to prevent and treat allergies, which most often means using more than one of the following treatments.
Limiting exposure can help decrease symptoms.
Avoid Bringing allergens into the Home
Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.
Keep the windows closed. Sorry to those who love the “fresh air” in the house. For those who suffer from allergies, this is just too much exposure!
Beloved pets cause unique issues
If someone’s allergic to animals or suffers from year long symptoms, learn if your family pet is a problem.
When you have pets that go outdoors and then into the home, bathe them regularly.
Don’t let pets on the couch or beds and keep them out of the bedrooms of allergic sufferers.
If you know a family member is allergic to an animal, don’t get a new pet of this type!
If you already have a loved pet someone in the home, consider allergy shots against this type of animal. Talk to your pediatrician and consider a trip to an allergist.
Wash and clean
Wash towels and sheets weekly in hot water.
Vacuum and dust weekly. Consider cleaning home vents. Consider hard flooring in bedrooms instead of carpeting.
Wash stuffed animals and other toys regularly and discourage allergic children from sleeping with them.
Keep smoke away. Smoke is an airway irritant and can exacerbate allergy symptoms.
Remember that the smoke dust remaining on hair, clothing, upholstery, and other surfaces can cause problems too, so kids can be affected even if you don’t smoke near them.
And for those of you who vape, it’s not better. We’re still learning the risks of e-cigarettes because vaping is relatively new, but early data supports staying away from e-cigs!
Wash it off of you!
Wash hair, eyelashes, and nose after exposures — especially before sleep. They all trap allergens and increase the time your body reacts to them.
Learning to rinse your nose
I have found the information and videos in Nasopure.com‘s library to be very helpful. You can teach kids as young as 2 years to wash their noses. Note: I have no financial ties to Nasopure… I just love the product and website!
I am an Amazon Affiliate member, so if you buy from this Amazon link, I do get a small percentage.
If you wear contacts
If itchy eyes are a problem for contact lens wearers, a break from the contacts may help. Talk with your eye doctor if eye symptoms cause problems with your contacts.
I don’t want kids with outdoor allergies to be afraid to go outside, so taking medicines to keep the symptoms at bay while out can help.
Antihistamines work to block histamine in the body. Histamine causes the symptoms of allergies, so an antihistamine can help stop the symptoms.
Some people respond well to one antihistamine but not others, so sometimes you must use trial and error to find the right one.
In general I prefer the 12-24 hour antihistamines simply because it’s very difficult to cover well with a medicine that only lasts 4-6 hours, such as diphenhydramine (Benadryl) and they’re less sedating. Long acting antihistamines include loratadine -Claritin (24 hour), fexofenadine- Allegra (12 hour for kids, 24 hour for teens and adults), and cetirizine- Zyrtec (24 hour).
Different antihistamines work better for some than others. Personally loratadine does nothing for me, fexofenadine is okay, but cetirizine is best. I have seen many patients with opposite benefits. You will have to do a trial period of a medicine to see which works best.
If they make your child sleepy, giving antihistamines at bedtime instead of the morning might help.
Prescription antihistamines are available, but usually an over the counter type works just as well and is less expensive. Insurance companies rarely cover the cost of antihistamines these days.
Antihistamine and decongestant combinations
Antihistamine and decongestant combinations are available but are not usually recommended. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age.
Once control of the mucus is achieved, a decongestant isn’t needed. Giving a medicine that isn’t needed just increases the risk without increasing the benefit.
If you need a decongestant initially, you can use one with your usual antihistamine.
Most decongestants on the shelves are ineffective. If you ask the pharmacist for pseudoephedrine, it is available behind the counter. It was replaced by phenylephrine years ago due to concerns of methamphetamine production, but works a little better than phenylephrine.
Decongestants do NOT fix a cold, they only dry up some of the mucus.
They are available both as over the counter allergy drops and as prescription allergy eye drops. If over the counter drops fail, make an appointment to discuss if a prescription might help better. Most insurance companies don’t cover prescription allergy eye drops well, so you might want to check your formulary before asking for a prescription. This is usually available on your insurance website after you log in.
If your child resists eye drops
Tips to administer eye drops include washing hands before using eye drops, put the drop on the corner of the closed eye (nose side) and then have the child open his eyes to allow the drop to enter the eye.
It helps control both allergies and asthma and is best taken in the evening.
Once a person has been on montelukast for a couple of weeks, they usually don’t need an antihistamine any longer.
Montelukast is available only by prescription, so make an appointment to discuss this if your child might benefit.
Steroids decrease allergic inflammation well. These include both oral steroids for severe reactions (such as poison ivy on the face or an asthma attack) and inhaled corticosteroids for the nose (or lungs in asthma).
The nasal steroids are discussed above and are highly recommended for kids and adults who tolerate putting a spray in their nose.
Other steroids require a prescription, so a visit to your provider is recommended to discuss proper use.
What if all of the above isn’t helping to control allergies?
Maybe it’s really not allergies.
There are many things that can seem to be allergies but aren’t. If proper treatment is not working, reconsider the diagnosis.
It’s possible that the allergy treatment is working, but you caught a cold on top of the allergies. Both are common, so they can occur together.
Allergies to things other than foods are rare before 2 years of age. If you’re treating allergies in an infant or toddler, be sure to keep your pediatrician in the loop.
I’ve known people who are treated for years by an allergist for allergies, but when they’re tested due to a poor response, they have no allergies. They might have frequent infections or other irritants like smoke exposure. Learn to control these issues too, starting with good hand washing, avoid touching your face, and avoiding smoke.
Allergy testing is possible by blood or skin prick testing, but can be costly. Not to mention the fact that kids tend to not like needles, which are used with most testing.
Allergy testing isn’t recommended for most allergy sufferers. It can be used to guide allergy immunotherapy, which involves routine allergy shots. Most suffers don’t need allergy shots, but if you think your child would benefit (and allow them), talk to your doctor.
In most cases I don’t find test results very helpful for environmental allergens because you can’t avoid them entirely. You can limit exposures as discussed above, regardless of test results.
Tracking patterns and symptoms to identify allergies
By tracking seasonal patterns over a few years can identify many of the allergens. You can still treat as needed during this time. Reports of pollen and mold counts are found on Pollen.com.
Rather than testing, note animal exposures and household conditions and any symptoms seen with exposures.
Write symptoms and exposures weekly (or daily). It often doesn’t take long to see patterns. Testing is important if allergy shots are being considered.
Need help tracking allergy symptoms? There’s an app for that! Here’s one review I found of allergy apps. I don’t have any personal experience of any, so please put your favorite in the comments below to help others!
Wrong medicine or wrong dose.
Some people have more severe allergies and need more than one treatment. I personally use eye drops, nasal spray, and an oral antihistamine in addition to nasal washes and daily (sometimes twice daily) showers when my allergies flare.
Switching types of medication or adding another type of medicine might help. If you need help deciding which medicines are best for your child, schedule an office visit with your PCP for an exam and discussion of symptoms.
Some kids outgrow a dose and simply need a higher dose of medicine as they grow. Talk to your pharmacist or physician to decide if a higher dose is indicated.
Is Nothing working?
Consider allergy shots (immunotherapy) to desensitize against allergens if symptoms persist despite your best efforts as above.
Schedule an appointment with your pediatrician to discuss if this is an option for your allergy sufferer.