Prevent Drowning

Drowning is one of the most common preventable causes of death in infants, kids, and teens. Learn how to protect against this tragedy!

Summer is on its way. We’ll soon be visiting lakes and pools to cool off from the heat. Unfortunately drowning is the leading cause of unintentional injury-related death in children between ages 1 and 4. It continues to be a top cause of unintentional death among other age groups through the early adult years. Fortunately there are many precautions we can take to help lower the risk.

I wrote about Sun and Water Safety last summer, and want to remind everyone about the risks of drowning. I also wrote about Dry Drowning previously, but it seems that it isn’t really a thing – see the addendum in that post.

What are the risks?

About 1 in 5 people who die from drowning are children 14 and younger. Each year about 300-500 children under 5 years of age drown.

For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries. Even though they’re not fatal, they have significant consequences.

Over half of drowning victims treated in emergency departments require hospitalization for further evaluation and treatment. These nonfatal drowning injuries can cause severe brain damage that may result in long term disabilities such as memory problems, learning disabilities, and a permanent loss of basic functioning.

What increases the risks?

  • Lack of Swimming Ability: Many adults and children report that they can’t swim. Swimming lessons can reduce the risk of drowning among children. See the link at the bottom for more on swim lessons.
  • Lack of Barriers: Barriers, such as pool fencing and alarm systems, prevent young children from gaining access to the pool area. A 4-sided fence reduces a child’s risk of drowning 83% compared to 3-sided fence with the house as the forth side. A great guide on barriers is from the US Consumer Protection Service.
  • Lack of Close Supervision: Drowning can happen quickly and quietly anywhere there is water. This includes bathtubs, swimming pools, pet water bowls, and buckets. This is why non-swimming times account for most drowning accidents.
  • Location: Most children 1-4 years of age drown in home swimming pools. More than half of the drownings among those 15 years and older occurred in natural water settings, such as lakes.
  • Failure to Wear Life Jackets: Most boating deaths are caused by drowning, with 88% of victims not wearing life jackets.
  • Alcohol Use: Among adolescents and adults alcohol use is involved in up to 70% of deaths associated with water recreation. 
  • Seizure Disorders: For persons with seizure disorders, drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.

How can you recognize drowning?

Movies show people splashing around and yelling for help as they drown.

Don’t let that fool you. Movies are not reality.

Signs of drowning:

  • Head low in the water, mouth at water level
  • Eyes glassy and empty, unable to focus
  • Head tilted back with mouth open
  • Eyes closed
  • Hair over forehead or eyes
  • Not using legs – Vertical
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Appear to be climbing an invisible ladder
  • Trying to roll over on the back

Most drowning victims are silent. They don’t splash to get your attention. Watch this video from Inside Edition that captures several drowning victims:

Assign a water watcher to keep an eye on young children in water. #drowning @pediatricskc

Teach water safety

Learn how to swim and teach your children to swim as well. If your child(ren) are good swimmers, be sure to still have rules about pool use and limit pool access. Even strong swimmers can drown. See the link in the resources below for infomation on swim lessons.

No one should swim alone. If your children are not able to follow that rule, the pool should not be accessible to them. Gates and alarm systems can be used to limit access to home pools and hot tubs.

Not all teens are safe swimmers, but they don’t often fess up to their friends. They are also at risk of making impulsive decisions to drink alcohol near water, forego their life vest on a boat, jump off a cliff into water, or other things that could put them at risk. Talk to your teens about safety – in and out of the water! Encourage teens to learn CPR.

Water safety in easy-to-see graphic form

From https://twitter.com/DrEmMontgomery/status/1109249128712810497

The @AmerAcadPeds updated their policy statement on #drowning prevention this week. #watersafety pic.twitter.com/8B57ZprmvJ— Emily Montgomery, MD (@DrEmMontgomery) March 23, 2019

Making home water safer

All pools should have a 4 foot fence around all sides. This includes below-ground pools as well as portable pools. It is much less safe to use the house as one of the borders, since young children can escape out the door and into the pool, but if you must use your home, take precautions. Install an alarm system to alert you if the door to the pool area is opened. Use a pool or spa cover when the pool or spa is not in use.

A short word on portable pools. They can include inexpensive blow up pools and larger pools. Portable pools present a real danger to young children because they are often not seen as a threat. Portable pools account for 10% of the total drowning deaths for children younger than 15 . They should be drained, covered, or fenced to protect children. Don’t leave them in the yard unattended.

Ask neighbors to put a proper barrier around their pools or hot tubs.

Ensure any pool or hot tub (spa) you use has anti-entrapment safety drain covers.

Have life saving equipment such as life rings, floats or a reaching pole available and easily accessible.

If you have a home pool, be sure that it's protected from your kids. @pediatricskc
From https://downloads.aap.org/DOPA/Drowning-Prevention/pool_safety_english.pdf

It’s not just pools that are risks…

Bowls and buckets

Keep pet water bowls out of reach of young children.

Drain any buckets of water after they’re used.

Toilet dangers

Close bathroom doors and toilet lids to keep young ones from playing in the water.

Bath time

Monitor young kids and those with seizure risks in the bath the entire time. Do not leave the room even for a few moments.

Don’t read or check your phone when you’re watching kids in the tub, just like at the pool.

Drain the bath tub before young kids even get out. This not only helps your kids not climb back in (a common reason to need stitches when kids slip trying to climb in), but it also prevents them from drowning in left over water.

For more:

Swim Lessons: When to start and what parents should know

Infant water safety: protect your new baby from drowning

Drowning Prevention for Curious Toddlers: What Parents Need to Know

Water safety: Tips for parents of young children

Water safety for teens

Teen drowning can be prevented with safety measures: Teens don’t always follow the rules. Their impulsivity and thrill seeking behaviors put them in a unique risk for dangers.

For pool barrier guidelines and suggestions, see the Safety Barrier Guidelines for Residential Pools Preventing Child Drownings from the US Consumer Product Safety Commission. This is important for all pools and hot tubs, including portable pools.

Pool Dangers and Drowning Prevention – When It’s Not Swimming Time: Remember to keep all pools, tubs, and buckets of water secure at all times.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS)

Momo. Hoax or not, scary things happen online.

It’s not just Momo… Even if she started as a hoax, we DO need to protect our kids online.

The news is full of stories about Momo and other scary things our kids are exposed to online. Many stories say this is a hoax. YouTube has said this would be against their rules. It doesn’t really matter if this started as a hoax or if it’s against the rules. The fact is that our kids are exposed to things online.

Our kids do see inappropriate things

I recently saw a preschool aged child for a well visit. During the visit it came up that the child had been exposed to Momo online. When the mother learned that the child saw scary Momo videos, she came up with a great plan. They took images of Momo and transformed her into funny faces, much like what I did for the image above.

I think this mother’s idea is great. She took a character that was scary to her child and made it funny. She used the opportunity to talk to her child. It became a great teaching moment.

Our kids can never “un-see” what they’ve seen, but we can help them to not view it as so scary. If you are unable to do this alone, talk to your pediatrician or a therapist.

We know that traumas impact a child’s development. They can develop significant anxieties and suffer if things are not quickly and adequately addressed.

When things happen we need to find ways to help our kids process them. If your child’s mood or behavior suddenly changes, it is quite possible that they have experienced a traumatic event of some sort. If they won’t talk to you, seek professional help.

What can we do to prevent online exposures?

We can’t stop all exposures, but we can do many things to help protect our kids. This includes monitoring software, anti-virus software, and teaching our kids how to behave responsibly and safely.

Increasing responsibility

Our kids will be online, whether it’s at home or at school or at a friend’s house. They are growing up with the world at their fingertips through the internet, so we must teach them to use it wisely.

Like in other benefits and responsibilities of growing up, our kids should have fewer limits and less monitoring as they show maturity. We cannot expect them to be responsible online at 18 years of age if they never practice with supervision along the way.

Give your kids age-appropriate allowances for games, videos, and other online experiences. I love to use Common Sense Media to learn about movies, games, and other media.

Set up parental controls.

Research parental control software. It’s easy to search “parental control apps” or “parental control software reviews” to find the pros and cons to various brands.

One of my favorite sites that exposes safety concerns has a great post for parents: 5 tips for setting up your child’s device for safety from a tech mom.

Learn to safely monitor phones and specific apps.

Choosing the best for your family is not easy, but read several reviews to find what is best for your family’s needs.

Adult supervision and guidance

If our kids are playing outside, they will have close supervision when they’re young, less as they get older.

Online use should be no different.

Your 3-4 year old should not go to the park alone and they shouldn’t go online alone. If they are online, project the screen to the television so you can watch along or sit with them and play along with them. They should not be online when you are busy doing something else. It is not a safe babysitter.

As kids get older and can understand how to navigate the internet more safely, they can have less and less direct supervision. This does not mean they can have a free for all. Parents can still help them choose age-appropriate sites and have software to keep blocked sites from being accessible.

You can’t just avoid online use

Several parents over the years have tried to end the conversation when I bring up social media safety by saying, “we don’t allow any of that.”

It is not sufficient to simply not allow any social media. Our kids and teens will come across it, whether it’s their own account or a friends.

What things did you do as a teen that your parent didn’t know about? It’s even easier for kids to hide social media accounts than it is for them to do many of the things we used to do as kids.

As kids grow

Talk to older kids and teens about why pornography sites are harmful.

Have discussions about oversharing. Predators look for ways to identify where kids hang out. Kids shouldn’t give a team name or mention that their soccer game is tomorrow morning at 9. That innocent information can help a predator find them. Even photos with identifying information, like a school shirt or team jersey, can be risky if shared publicly.

Kids sometimes get tricked into sharing photos that are inappropriate. This includes pornographic images as well as snapshots identifying where to find them.

Talk about their digital footprint. Schools and employers will look at your child’s online history. It needs to be positive and what they post today will be there forever.

Teach kids basic right and wrong

We cannot protect our kids from everything, but we can teach them to be good decision makers.

Use real life examples and daily experiences to help your kids learn to make safe choices. Let them accept more responsibility and make more choices as they get older. Allow them to make the wrong choice sometimes. They’ll learn from these little mistakes much more than they would if you refuse to let them do that little mistake. This helps to prepare them to make the right choice with the riskier options as they grow.

For example, if your middle school child wants to stay up late to watch a movie but you know he has an early soccer game, discuss the situation with him. Let him make up his own mind in the end – without being judgmental. If he struggles getting out of bed and disappoints his teammates because he’s too tired, is that really the worst thing in the world? I bet the next week he won’t beg to stay up late so much. Just don’t play the “I told you so” game or give attitude about it. That will make him mad at you.

Let kids learn from their own mistakes without discussion or lecture. Kids learn from things like this if we let them. Trust me, there are lots of opportunities for them to learn to make safe, responsible choices as they grow.

In the end, if our kids want to find an inappropriate site or do something they’re not supposed to do, they will. If they use good judgement and make safe choices in other aspects of life, they are more likely to do so online too.

Be vigilant

It’s not just Momo… Even if she started as a hoax, we DO need to talk to our kids about risks online.

We need to keep up with online challenges and apps.

Follow your kids on their social sites. Talk about what sites they can and cannot use, but remember that it is easy for them to set up hidden accounts. That’s why it’s so important to talk to your kids and let them make their own choices as they grow. If you don’t allow options and never let them fail, they will not learn. The more you restrict them, the more they’ll hide from you.

Monitor for new apps. Learn how kids hide them. If your child has an iphone, they can be hiding them in these ways.

Keep track of the time your child spends online. Go to your app store and search “time on phone tracker” or check out these popular apps that track time:

For more:

In addition to the many links above, these articles are highly recommended:

A conversation about ADHD

Listen in as I talk about ADHD. I even throw in several stories from my own experiences in parenting a child with ADHD.

I was recently interviewed about parenting a child with ADHD. I encourage parents of kids with ADHD to listen.

As a pediatrician I have the benefit of seeing many families affected by ADHD, and that has helped me to be a better parent. It has also given me support when things don’t go well because I know I’m not alone.

If you’re feeling frustrated with parenting, especially when it’s related to those issues common to kids with ADHD, I encourage you to listen.

I hope that you will feel like you’re not in this alone. 

Topics discussed:

  • What is ADHD?
  • How is ADHD diagnosed?
  • Co-existing conditions
  • Things that are mistaken as ADHD
  • Ways to manage symptoms other than medicine
  • How symptoms of ADHD change over time
  • And more!

Listen:

For More Information:

Developmental Age in ADHD

Supplements for ADHD

Medications for ADHD: Starting out and titrating

Remembering Medications

Medications: Types and side effects

Alternative Treatments for ADHD

Genetics of ADHD

What does brain imaging tell us about ADHD?

Brain function 101: Why medicines help ADHD

Practical at home tips for illnesses

When your family gets sick, what can you do before running to the ER or clinic?

When cold and flu season is in full gear, it’s helpful to know common things that can help us prevent and treat whatever is in town. Many of the viruses that run around each season don’t have specific treatments, but there are things that we can do at home to treat symptoms and keep people more comfortable. There are also things we can all do to prevent the spread to other family members or back into our community.

What can be done to feel better?

Remember that nothing can be done to treat most viruses. Our body’s immune system will take care of that, but we can do things that help us feel better during the illness.

It’s hard to make them better, but we can make them feel better

Most cough and colds last several weeks. Vomiting and diarrhea can last a couple weeks as well.

During the cold and flu season, it can seem like kids are sick every day for months because they catch one on top of the other. Some of these days they might simply have a runny nose, and those days can last most of the year in young kids.

It’s when they seem uncomfortable or distressed that we need to do more. Treat the symptoms that bother them.

Identify the symptoms that are concerning, such as difficulty breathing or dehydration, and seek treatment at your doctor’s office for those.

What about fever?

Notice I did not list fever as one of those symptoms.

Doctors don’t do anything special for fever in vaccinated children over 2 months of age.

Fever can accompany other symptoms that may be concerning, but it in itself is not the concern unless it is a newborn, unvaccinated child, or one with a chronic condition that you’ve been warned has increased risks.

Comfort measures

Pain control with acetaminophen or ibuprofen may be helpful. Follow the package directions for weight. Dosing for kids under 2 years of age can be found on my office website or you can ask your physician.

Remember the goal is not to bring temperatures to normal, but to keep kids comfortable. If they’re in pain from sinus pressure, a headache, sore throat, body aches, or earaches, it is okay to give a pain reliever even with a normal temperature.

Get the mucus out

Suction your infant’s nose before feeding and before putting him down to sleep. This helps clear the mucus from the airway and makes breathing easier. Encourage nose blowing for those old enough to know how to blow.

Use saline to irrigate the nose. They sell drops, sprays, and nasal wash systems to be used, depending on age and personal preference. 

Hydrate

Encourage your family members over 6 months of age to drink more water than normal when sick. Kids often won’t eat well when they’re sick. That’s okay. It is important that they drink well though so they can stay hydrated.

Young infants should not drink water, but you can encourage more of their milk or formula when they have cough and colds.

If your child has vomiting or diarrhea, avoid cow’s milk products. These often lead to more vomiting. Breast milk can be offered in small amounts frequently to infants who are breastfeeding. Electrolyte solutions (with sugars and salts) can be given to infants and children for hydration.

Clean air

DO NOT let anyone smoke around your child or in your home. Smoke can make the wheezing and coughing worse, even if done in a separate room in the home.

Smoke residue on hair and clothing can cause irritation to your child’s airways. I can usually identify smokers or people who spend time with smokers when they’re in my clinic. (Thankfully that isn’t often.) It isn’t unusual for me to start coughing when they’re in a clinic room with me. If you must smoke, go outside and wear a jacket that can be removed to minimize what is on your shirt when you go inside and hold your baby.

I’ve even started coughing when around someone who was vaping. I know people claim that the vapor is safe around others, but my lungs don’t like it. Keep it away from your kids. Talk to your kids about the risks of vaping so they don’t start the habit.

Rest

Encourage those who are sick to get extra rest. We often sleep poorly at night and need daytime naps to get enough sleep when we’re sick. 

Dry air

A cool mist vaporizer or humidifier can help your child breathe easier. Change the water every day. Clean the machine per the manufacturer recommendations. 

Infection control

It just isn’t possible to keep kids from being contagious when they have a virus. They love to touch everything and share germs, so keep them home until they’re well enough to return to normal daily activities.

Stay home!

Our health department now recommends that everyone with influenza stays home for 7 days following the start of symptoms.

How long should you stay home? It varies by illness. www.questforhealthkc.com

You can return to work, school, and activities with other illnesses when the fever is gone (without using fever reducers) for 24 hours, there’s no vomiting or diarrhea, and you’re generally feeling well enough to return. If not, stay home and rest or visit your doctor.

Cover the cough!

Cover your cough properly - don't use your hands! www.questforhealthkc.com

Teach kids to sneeze and cough into their elbow or a tissue. Wash hands after handling tissues. 

Wash, wash, wash

Good handwashing can help decrease the spread of viruses.

Wash hands often. If soap and water isn’t available, use hand sanitizer. The more things you touch, the more often you should wash.

Teach kids to wash properly. Have them rub soap on their hands for 15 – 20 seconds- be sure they scrub palms, backs of hands, fingers, spaces between the fingers and even under the fingernails. 

Wash

  • Before preparing food
  • After toileting or changing a diaper
  • When they’re obviously soiled
  • Before eating
  • After sneezing or coughing into hands or wiping nose
  • Before and after touching eyes
  • When taking care of a wound wash your hands before and after washing and treating the wound
  • Often when taking care of someone who is sick
  • After touching trash or soiled objects

Consider having separate towels for each family member in your bathrooms to decrease the spread of germs when they wipe their mouth after brushing their teeth.

Hand sanitizer is a good option when washing isn’t available, but it is not helpful against some germs, so handwashing is preferred.

Use lotion as needed to keep your skin moisturized. Dry skin damages the barrier that helps prevent germs from getting into our bodies.

Germs can live on objects and surfaces for 2 or 3 hours – sometimes longer. Clean your child’s toys often with soap and water.

Don’t touch your face. Eyes, ears, and noses are the doors into our body.

Avoid handshakes and other hand to hand contact. Try a fist bump or wave!

Help prevent the spread of germs. Don't shake hands. Offer a fist bump or wave. #infectionpreventiontip

Avoid taking young children to large groups of people during the cold and flu season, especially if people are showing signs of illness.

Vaccinate.

We can help prevent many of the most serious illnesses by staying up to date on our vaccines.

Everyone over 6 months of age should get a flu vaccine. There are very few contraindications to a flu vaccine and many benefits. Really.

And finally… avoid kisses that spread illness!

For more:

Fever Is

When is a fever too high

Tamiflu

Evolution of illness

Cough Medicine: which one’s best?

Cough sounds

How long will a cough or cold last?

RSV has a bad rap… for good reason

Strep throat: new school guidelines

Sore throat: strep vs viral

How to use nose sprays correctly

Improper use of antibiotics

Why wait to see your usual doctor?

Developmental Age in ADHD

I’ve been asked what the single best parenting tip I’ve gotten as the parent of a child with ADHD is. After a lot of consideration, I’ve decided that it involves setting expectations. When we re-frame things that are appropriate for their developmental age, it alleviates so many fights and frustrations. These expectations can vary if they’re on medication at the time, how much sleep they’ve had, and more.

What is developmental age?

Kids with ADHD have a delay in brain development that affects the ways they organize, process, and act upon information.

Chronologic age

We typically measure a child’s age by how long it’s been since they were born. This is their chronologic age.

We assume that kids will be able to understand more complex ideas and master new tasks as they get older. There are certain milestones that are associated with various ages, such as a social smile by 2 months or walking by 15 months of age.

Developmental age

Your pediatrician will ask developmental questions at routine well visits to be sure your baby is on track.

These questions help us to identify if your child is developing at a normal rate or if there is a delay. At some ages there are specific standardized developmental screening tools to be administered.

As long as a child meets expectations, their developmental age and chronological age match. If they are delayed, we can give a developmental age to help identify their stage of development.

We know that ADHD is one cause of delay of areas of the brain that are important in executive functioning. At this time there are no standard screening tool recommended at all well visits to assess this development. It is important to bring up any concerns from home or school with your physician.

What are executive functioning skills?

Executive functions are the things we use to help us use and act upon information.

Understood is a great resource for many things related to learning, attention, and behavior. They have a great page about what executive functioning problems look like at different ages – from preschool to high school.

But my child’s smart, not delayed!

Being delayed in executive functioning areas of the brain is not the same as being academically delayed or having a low IQ. Parts of our brains grow at different rates.

Even your child that excels in certain areas can be delayed in others.

A child who can do math several grades ahead of classmates might not be able to remember something as simple as turning the homework in the next day.

Another child who reads grade levels ahead might not be able understand why a certain behavior is considered undesirable.

A child who is gifted in the arts can struggle significantly remembering all the things that must happen to get ready to leave the house in the morning on time.

It’s easy to get angry at kids for having missing assignments, when they forget to brush their teeth, or when they’re always running late. It can be difficult to help kids understand why they cannot blurt out answers or tell others what to do or how to do it.

Negative feedback leads to increasing problems

Unfortunately, kids with ADHD often hear negative feedback when they fail to do what’s expected, which can lead to rejection sensitivity.

Kids often develop unproductive ways to buffer the negativity that follows their failures. They can act out, become the “class clown,” decide to stop trying because of the fear of failure, and more.

It is now recognized that kids with ADHD have a delay in brain development that affects the ways they organize, process, and act upon information. #executivefunction #adhd #adhdkcteen

Setting expectations

I’m asked all the time how to set expectations with kids, especially those with ADHD.

It’s understandably difficult to parent when your child, who otherwise looks and acts like kids of the same age, doesn’t have the same abilities in areas of focus, organizing, prioritizing, completing tasks, and self care issues.

Visible differences are easy to spot

When kids look different due to a genetic or physical condition, it’s easy to see what accommodations are needed.

If a child has an obvious trait that makes it difficult to do a task, we modify our expectations. A wheelchair bound child would never be expected to run upstairs to grab something.

Invisible differences still exist

For those who look “normal” but are neurodevelopmentally different, it’s easy to fall into the trap of setting an expectation based on the typical expectation for their age, not their level of development.

A child who has problems with working memory might also struggle to run upstairs to grab something. It’s not a form of defiance when they go upstairs and forget what they’re supposed to be getting or when they don’t return because they get distracted by something else.

Many kids are simply not there yet.

They can’t act their age because that part of their brain is not at that stage.

Most will get there, but it takes them longer.

Set appropriate expectations, and when they struggle, show patience and help them learn. This is much more effective than setting the bar too high, resulting in punishments and anger.

Delays of executive functioning

Dr. Richard Barkley has shown that kids tend to develop executive functioning skills about 30% slower than neurotypical peers. This adds up to about 3-5 years at most ages.

This might mean that your 12 year old might struggle doing what another 12 year old has already mastered. They might only be able to handle things expected of an 8 year old.

Set expectations according to skills, not age

The single tip that helps de-stress parenting more than any other that I’ve heard is to adjust expectations by skill.

Chronologic age is less important when deciding what a child is capable of and what they’re ready to learn.

this doesn’t mean letting them get by with anything…

As a child grows, you will watch their successes and failures.

You learn what they can and cannot handle. Help them with the things they cannot do while letting them do as much as they can.

SEt expectations and supports

One child can be expected to get dressed and brush teeth without reminders.

Another child of the same age will need a chart listing all the routine things that need to be done.

And yet another child of the same age may need reminders to look at the chart.

All of these same age kids can be smart and have good intentions, but they need different levels of reminders.

Recommended Video

I recommend this video to parents often. It shows very clearly what it means to parent a child who is delayed in executive functioning. Parents of kids with ADHD will most likely identify with it.

RSV has a bad rap, for good reason

Bronchiolitis (often called RSV) is an infection of the respiratory tract that leads to wheezing and difficulty breathing. Learn why it’s scary to many parents and what you can do about it.

Bronchiolitis is an infection of the respiratory tract that leads to wheezing and difficulty breathing, most often in infants and children under 2 years of age. It’s often called simply “RSV.” While it’s often caused by a virus called Respiratory Syncytial Virus (RSV), it’s not always. Let’s talk about what it is and what we can do about it.

Symptoms of bronchiolitis

Bronchiolitis often starts off just like a common cold, with a runny nose or congestion. In older children and adults it progresses just like a cold. Because it is.

In infants and young children symptoms can progress to make them more significantly sick. Day 3-5 of illness often is the worst.

Symptoms include (but not everyone has all):

  • Rapid heavy breathing (more than 60 breaths per minute – always count for a full minute in babies because they can pant or hold their breath, which throws the count off)
  • Wheezing (tight breathing with a whistling sound)
  • Retractions (the skin between ribs suck in during inspiration)
  • Nasal flaring (where the nostrils widen with breathing)
  • Belly breathing (the abdomen moves up and down more than usual)
  • Fever
  • Cough (which can occasionally cause vomiting)
  • Lots of mucus from the nose and mouth (lots!)
  • Decreased appetite (which can lead to dehydration, so offer frequent liquid feedings)

If you’re wondering what type of cough your child has, check out The sounds of coughing.

Causes of bronchiolitis

Most cases of bronchiolitis are due to viruses.

RSV is a common cause, which is why the condition is often simply called RSV. Most of us have had RSV by the time we’re 3 years old. It doesn’t always cause the symptoms of bronchiolitis. Sometimes it just looks like a common cold, especially in older kids and adults. This is why it’s really important to protect young infants around people who are just a little sick.

Bronchiolitis can be caused by many of the viruses that cause upper respiratory tract infections. Rhinovirus, metapneumovirus, adenovirus, influenza, parainfluenza, and coronavirus are some of the other culprits.

Who’s at risk?

Symptoms tend to be worst in babies who are higher risk. This includes infants who were born prematurely, those who have certain heart defects, the very young, or those with other chronic conditions.

Infants are more at risk of having simple cold viruses cause the more severe symptoms of bronchiolitis. Their narrow airways contribute to this because they become plugged with mucus more easily than larger airways.

All viral illnesses are more common among infants who are in daycare or around lots of people. The more people, the more likely they’ll be exposed to a person sharing germs. Infants also put their hands and toys in their mouth often, which helps them get germs into their body.

Those who are around cigarette smoke are also more at risk because of the chronic airway irritation caused by smoke. Even babies who are around people who smoke prior to being with the child can get third hand smoke exposure from hair and clothing.

Prevention

Standard infection control protocols can help avoid spread.

Wash hands frequently or use hand sanitizer. Teach kids to get all parts of their hands clean. Wash hands even when you’re not feeling sick… we share germs before we know we have them and we need to protect ourselves from catching new ones!

Avoid being around people who are sick and when you’re sick, stay home! If you’re the one who’s sick, check out Help! I’m sick and have a baby at home.

Have separate towels (or disposable towels) in the bathroom. After brushing your teeth, you don’t want to wipe on a towel that was used by someone who’s brewing germs!

Don’t kiss babies on their face, hands, or feet. The top of the head is best!

Stop the spread of germs! Don't kiss the face!

Avoid cigarette smoke – even second hand and third hand smoke (on surfaces) can cause airway irritation. This irritation makes it harder to fend off germs, which leads to more infections.

Germs can live on surfaces and objects for 2 or 3 hours or longer. It’s a good idea not to share toys because babies put them in their mouth all the time. Clean your child’s toys often with soap and water.

Cover coughs and sneezes properly.

Coughs spread germs. Cover!

Testing

Virus testing

There are tests that can be done on mucus from the nose to see which virus is the culprit, but they aren’t usually required.

Knowing if it’s RSV or another virus doesn’t make the symptoms change. We treat symptoms.

Testing can be used for infection control measures when babies are admitted to the hospital, but aren’t always necessary.

Tests are expensive, and unless they change something we’ll do, they aren’t generally recommended. Why waste your money? (Even if you think insurance will cover it, the money comes from somewhere… you’ll pay more in premiums if you spend more.)

Oxygen levels

It is common to check oxygen levels when kids (and adults) are sick. Pulse oximeters are an inexpensive tool to help us assess how well a person is compensating when having trouble breathing.

Chest x-ray

Most infants and children with bronchiolitis do not need a chest x-ray, but they are sometimes used to assess for pneumonia or foreign bodies (such as a swallowed coin) that can cause wheezing.

Blood work

Blood tests are not usually needed to diagnose or treat bronchiolitis but they can help to identify if there’s a need for antibiotics due to a bacterial infection. Sometimes we check blood if we’re worried about dehydration.

Treatments

The virus must run its course and symptoms can last several weeks, so what can you do to help ease symptoms?

Home treatments

Comfort measures

You can use fever reducers if your baby is uncomfortable. These include acetaminophen if your baby is over 2-3 months and ibuprofen or acetaminophen if your baby is over 6 months. I don’t recommend fever reducers before babies get their 2 month vaccines because you can mask symptoms of serious disease. See your physician if your unimmunized child has a fever!

Remember that a fever is the body’s immune system at work, so your goal is comfort, not getting rid of the fever.

More on how to recognize if a fever is too high and the scary facts of fever.

Suck out the snot!

Babies with bronchiolitis often seem as if their nose is a faucet. All that mucus interferes with breathing and feeding. They can’t blow their nose, but you can suck it out!

I’m not a fan of bulb syringes as a nasal aspirator. I find that they have too narrow of a tip to get an effective seal in the nostril until you force it up so far that it causes trauma in the nose. They also run out of suction power before the mucus is all out, which means you must break the seal, empty it out, and resume. This gives your child a chance to suck back some of the mucus you brought forward. Not to mention some of the really gross photos I’ve seen of what grows inside those things!

Here’s a review of various nasal aspirator types and brands. I like the review in general and have no ties to it. She does link to sales, but you can buy from your favorite retailer.

Use one of the aspirators to suction your infant’s nose as they need it. It’s especially helpful before feeding and before they go to sleep, but think of how often you blow your nose when you’re sick. It can be helpful quite often!

Use saline

Saline can help thin out mucus and decrease the swelling of nasal tissues.

It can be used with or without sucking afterward. I talk a bit more about the benefits of saline in How to use nose sprays correctly.

Elevate the head

Raise the head of the bed to help with drainage of mucus. Don’t put your infant on a pillow because that can obstruct breathing. Raise the head of the bed by putting something solid under the legs of the bed or roll a blanket or towel and place it under the mattress at the head of the bed.

I remember many nights of sitting up holding my children when they were sick so they could be upright and sleep. That doesn’t mean I slept well, but that’s what moms do sometimes. You do need to be careful with this – babies can be dropped if a parent falls asleep holding them.

Fluids

Encourage your child to drink fluids in small amounts. This can be breast milk or formula, or water for older infants and children.

Many babies tire out drinking, so they need to drink more frequently than normal to get in a decent volume.

If your baby isn’t drinking well and looks dehydrated, talk to your physician.

Humidify the air

A cool mist vaporizer or humidifier can help your child breathe easier.

Change the water every day.

Clean the machine per the manufacturer recommendations to prevent it being a source of germs.

Things to avoid

Never use menthol products around infants. They have been shown to increase mucus production and worsen symptoms, especially in children under 2 years.

Don’t demand antibiotics. It cannot be cured with antibiotics. No viral illness can.

Decongestants thicken mucus and can lead to more difficulty breathing, sleep disturbances and irritability.

Hospital treatments

Historically we have tried medical treatments when infants present with bronchiolitis. These include breathing treatments with bronchodilators, steroids, and more.

A single treatment with a bronchodilator can be used to see if there’s response to decrease wheezing, but should not be continued if there’s no benefit.

Steroids have not been shown to help unless there’s a history of asthma.

Oxygen is a standard treatment that can help if the oxygen level is low or to ease the work of breathing.

Intravenous (iv) fluids are often required if hydration from feedings is not successful.

Suctioning is a primary treatment in the hospital setting, much like at home.

When should kids be seen?

Infants and children should be seen relatively quickly if the following criteria are met:

  • Infants under 2 months of age should be assessed by a physician. They often require hospitalization because of the risk of apnea. Apnea is when they stop breathing and is a risk of very young infants with bronchiolitis.
  • Respiratory rate over 60 breaths/minute consistently. It’s common to breathe faster with a fever, so if you can bring it down and their breathing is less labored, that’s okay. They also temporarily breathe faster after eating or crying. Again, if it slows within a few minutes, that’s okay.
  • Dehydration. Signs of dehydration include no tears, thick/pasty or no saliva, or fewer than 3 wet diapers in 24 hours.
  • The color of the child’s lips or skin looks blue.
  • The infant looks uncomfortable or is inconsolable.
  • Infants under 3 months (or an under-vaccinated child) with a temperature over 100.4F.

If your child simply isn’t getting better after several days or if earache develops, make an appointment during regular office hours.

Pharmacogenetic Testing: Personalized Medicine

Pharmacogenetic testing involves testing a person’s genetics to find out how a certain drug would work in that person. Learn the pros and cons of this testing.

I’ve recently seen increasing numbers of parents who want testing to decide which medication to use for their child’s condition before trying any medicines. Many admit that they don’t know much about it and want to learn more. Pharmacogenetic testing involves testing a person’s genetics to find out how a certain drug would work in that person. While that sounds like it would be fantastic to know, it has many limitations. We’ll talk about the pros and cons below.

Traditional dosing of medicines

Before they can be approved to be used, drugs are tested in large groups of people.

Dosing schedules are determined based on safety and efficacy of the medicine, but this is in a group. It relies on information gathered from a mass of people, and majority rules. This means that whatever works for most people is what becomes the recommendations.

Although this works for most people, any individual can have a variation that is not seen with the large numbers in a group. We all know people that can’t tolerate certain medicines. In the past we use family patterns to help predict tolerability. If a family member (or especially if multiple family members) report that certain medicines require lower or higher doses to be tolerated and effective, then we use that in our decision making for prescribing medicines. Of course it isn’t a perfect way to do things, but it can help.

What is pharmacogenetic testing?

Pharmacogenomics is the study of how genes affect a person’s response to drugs. It’s a growing field that involves using what we know about the person’s genetic make up and how they will metabolize a medication. This can allow the prescriber to use certain medicines and not others, or begin with overall higher or lower doses than standard recommendations suggest.

It is personalized to a person’s genetic makeup, so it’s often called personalized medicine or precision medicine.

Many medicines work well for most people, but there are people who will metabolize certain things slowly, allowing the medicine to build up to toxic levels when dosed per standard amounts. Other people may require higher doses due to a very rapid metabolism. Some people should avoid certain medications all together. Knowing these dose adjustments and risks before even starting a medicine could be very beneficial!

Certain proteins affect how drugs work. Pharmacogenetic testing looks at differences in genes for these proteins. These proteins include liver enzymes that chemically change drugs. These changes can make the drugs more or less active. Even small differences in the genes for these liver enzymes can have a significant impact on a drug’s safety or effectiveness.

What are some uses in general pediatrics?

I’m limiting this discussion to uses that a general physician would use this type of testing. There are other uses for chronic diseases that are managed by specialists and beyond my scope.

Please realize that these are the commonly requested uses, not recommended uses.

ADHD

The most common time that I’m asked about this type of testing is for kids with ADHD.

Many parents are afraid of side effects of stimulants and have heard of other children who needed many adjustments of medication, both type of drug and dosing.

Starting a new stimulant medication can be frustrating, especially if it takes weeks or months to find what works. Parents would like to avoid that and start with the best.

Unfortunately the tests currently available do not predict which medicine will be most effective. They test how it will be metabolized.

Many people who show best tolerability for a certain drug may find that drug ineffective in managing their symptoms. This is due to many factors, but in the end still leaves us with the need to do a trial of various medicines to find the best one.

Failure to find a beneficial medicine based on these trials may lead to reassessment to be sure the diagnosis is correct. Proper diagnosis is not tested with the pharmocogenetic tests.

Anxiety and depression

Anxiety and depression medications are another type of medicine that has many options, and some respond to one better than another.

The traditional way to start is to look at family history (which is also a study of genetics, although included in the cost of your visit and doesn’t include a lab). Unfortunately, many people do not know of family member’s specific health details, especially what medicines they were on and what their reactions were.

When we pick a medicine, we start with low doses, and increase as tolerated and needed. If the first medication doesn’t work or isn’t tolerated, it is stopped and another is tried. This can prolong the time it takes to feel better, which is significant, and likely the reason people want a quick answer with a lab test.

Unfortunately, much like the ADHD testing mentioned above, the tests don’t predict which medicine will manage symptoms best. They only predict how they will be metabolized.

Should you get tested?

I am excited for the future of personalized medicine.

We may no longer need to try multiple medicines to be able to see which are better tolerated. Starting near the target dose, rather than starting at a low dose and titrating up, which prolongs the time it takes to get to an effective dose, would be welcomed in many people.

Unfortunately, I think psychopharmalogical testing is not yet for prime time.

The FDA agrees. They’ve sent out warnings that these tests should not be used to help choose a medicine.

Just because your body will metabolize a medicine more slowly or rapidly doesn’t predict if it will be effective to treat your symptoms.

It is still very costly and insurance companies resist paying for it. With high deductible plans, many people must pay the cost. With the new FDA warning, it is unlikely that insurance companies will cover the cost of these tests anytime soon.

It is being widely used in cancer and HIV patients and has helped to prevent significant side effects that often lead to hospitalization. From an insurance company standpoint, they’re saving money by covering the test for these purposes. From a patient standpoint, they have added security that they will respond well to the treatment.

For more:

Pharmacogenomics and Personalized Medicine By: Jill U. Adams, Ph.D. (Freelance science writer in Albany, NY) © 2008 Nature Education Citation: Adams, J. (2008) Pharmacogenomics and personalized medicine. Nature Education1(1):194

ADHD Medicines: Starting out and titrating

Can pharmacogenetic testing save time and money when choosing a new medicine? Personalized medicine is exciting, but is it ready for prime time?

Addendum: 10/3/19

The New AAP ADHD Guidelines were released this week.

Pediatrics October 2019, VOLUME 144 / ISSUE 4 From the American Academy of Pediatrics Clinical Practice Guideline

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Mark L. Wolraich, Joseph F. Hagan Jr, Carla Allan, Eugenia Chan, Dale Davison, Marian Earls, Steven W. Evans, Susan K. Flinn, Tanya Froehlich, Jennifer Frost, Joseph R. Holbrook, Christoph Ulrich Lehmann, Herschel Robert Lessin, Kymika Okechukwu, Karen L. Pierce, Jonathan D. Winner, William Zurhellen, SUBCOMMITTEE ON CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVE DISORDER                      

The authors specifically state that this testing is NOT recommended.

The available scientific literature does not provide sufficient evidence to recommend genetic testing for ADHD medication management. @pediatricskc

Top 10 Quest for Health KC posts of 2018

Have you read all of the most popular 2018 posts from Quest for Health KC?

At the end of the year I like to take a look at which posts were popular to help identify what I should write about in the next year. It also gives me the opportunity to share with readers all the best posts they might have missed along the way.

10. Help! I’m sick and I have a baby at home!

Parenting is a tough job, even when you’re not sick. When you have an infant and you’re sick, not only do you have extra sleep needs, but you have to try to keep your baby healthy despite being around your germs. What can you do when you’re sick with a baby at home?

9. Top 10 reasons a child or teen is tired.

We all know the jokes about that teens sleep past noon, but the truth is they need to catch up on sleep deprivation. Learn the top 10 reasons a child or teen is tired.

8. Summer Penile Syndrome

During the summer months one of the most uncomfortable reasons I see boys is that their penis and/or scrotum is swollen significantly. Learn what Summer Penile Syndrome is and what to do about it.

7. Dark Under Eye Circles

When kids have circles under their eyes, parents worry that something’s wrong. Sometimes there’s a treatable reason, sometimes not. Learn all the most common causes of under eye circles and what to do about them.

6. The flu shot doesn’t work

I’m pro-vaccine, so this title might surprise you. I hear the argument that the flu shot doesn’t work so often that it deserves to be addressed.

5. Flu Season Fears: What should you do?

Every flu season as we start to hear reports of kids dying from influenza the fear surfaces. This was written during one of the worst outbreaks in recent history. Be protected against each flu’s season fear with a flu vaccine and healthy habits!

4. Antibiotic Allergy or Just a Rash?

We see rashes all the time when kids are on antibiotics, but thankfully most do not mean a child is allergic. Learn when to suspect antibiotic allergy versus just a rash.

3. Lip Licker’s Dermatitis

When saliva gets on our skin, it breaks it down. Licking the lips leads to increased cracking and bleeding. Some kids have a wide ring of dry skin around their mouth from lip licker’s dermatitis. Learn what you can do to help them heal their smile.

2. What happens if a vaccine booster is delayed?

There are many reasons that people fall behind on their vaccines. Some are intentional, some due to circumstance. Regardless of the cause, what happens if a vaccine booster is delayed?

1. Bumps, ridges, and soft spots on a baby’s head. When should you worry?

I wrote this because I hear concern about bumps, ridges, and soft spots on baby’s (and older kid’s) heads quite often. Learn when you should worry and when it’s okay.

What was your favorite?

I’m surprised at the popularity of a few of these and sad that some of my personal favorites didn’t make the list.

I wish more people would read what fever is so they worry less about a number. Learning the evolution of illness might also help parents understand why exam findings are different on different days. I hear far too often that an ear infection was missed, but it’s more likely that they developed since the first exam.

I’ve also written a little on insurance and the business of medicine, but it doesn’t surprise me that those are not as popular. Sadly, we all need to understand the intricacies of billing and insurance as well as how the business of medicine works. As more and more private practice physicians sell out to large corporations, we’ll all feel the negative impacts.

Nip it in the bud?

When kids start to get sick, don’t you wish you could nip it in the bud before it gets worse?

If your kids have ever been sick, you know it can go from an annoyance to a fairly scary ordeal pretty quickly. When should you bring your kids to the doctor so we can prevent their symptoms from getting worse? We all want to know when we can nip it in the bud!

Can we prevent progression and spread of illness?

Mom: We’re here because my little one has a cold. It always settles in her ears, so I want to get on top of things and nip it in the bud this time.

Me: Her ears look great today, so keep doing what you’re doing. I’m glad you’ve started giving extra fluids, using saline in her nose, and letting her stay home from preschool to rest.

Mom: But we have family coming into town. They have a new baby, so I don’t want the baby to get sick. Can’t we just have an antibiotic now to help everyone?

Me: There’s no sign of a bacterial infection. She has what’s most likely a cold from a virus. Antibiotics don’t help.

Mom: But can’t we just try? She always gets an ear infection.

Me: It doesn’t work that way. Antibiotics don’t prevent ear infections. They don’t even treat the large majority of ear infections, since they’re viral. 

Mom: But we’ll be around a baby.

Me: An antibiotic would give a false sense of security. Your daughter would still be contagious from the virus. Viruses can be very serious in newborns. Your daughter shouldn’t be around the new baby until she’s well. 

Mom: But …

This circular conversation can continue indefinately.

I hear requests like this all the time. Unfortunately, illness doesn’t work that way. We don’t give antibiotics to prevent ear infections. They don’t stop the spread of most infections because most are from viruses.

If your doctor gave you antibiotics for your last cold “just in case” and you felt better, it’s likely you would have felt better anyway. That’s what happens with colds.

I realize when your baby has had several ear infections it seems tempting to give a treatment to prevent this cold from turning into another ear infection. But it doesn’t work that way. 

But she always gets and ear infection...

Antibiotics don’t:

  • Prevent the spread of viral illnesses. 
  • Keep an illness from changing from a virus to a bacteria.
  • Make all sinus infections go away.
  • Treat all ear infections.
  • Make people feel better immediately.
  • Come without risk.
Antibiotics usually aren't needed for sinus pressure, which is typically from a virus or allergies.

You take risks every time you use an antibiotic.

We need to use antibiotics wisely. Antibiotics are generally safe and most of us tolerate them well. But sometimes they lead to side effects, such as rashes and diarrhea. They can also cause true allergic reactions.

Over time bacteria can learn how to avoid being killed by antibiotics, called developing resistance. This can put us all at risk of deadly bacterial infections that have no cure. 

You take risks every time you take an antibiotic. Use them only when necessary.

But we have to get better fast!

  • Your teen has finals.
  • You must get back to work.
  • The baby being up all night fussing is wearing you down.
  • Your family has a big trip coming up.
  • You’re pregnant and you don’t want a sick family member in the home.

Whatever the circumstance, we can’t make someone not contagious anymore. It takes time for the symptoms of a virus to go away. There’s just no short cut. No way to prevent the natural course and progression

Up next…

Next week we’ll talk about what to do when you or your family is sick and how to prevent illness in the first place. (Prevention is always best!)

Nosebleeds

Nosebleeds can look very scary, but they’re common and usually can be managed at home with a few simple measures. Learn what to do and when to worry.

Many of us remember having a lot of nosebleeds as children, yet they bring fear to parents when their kids have them. Why won’t it stop? Why are they getting so many? Is there a bleeding disorder? Does it need to be cauterized or packed? Most of the time a nosebleed is just that. A nosebleed. I had several myself this past week. I was staying in a hotel and I think the air was dry. Yes, they’re annoying, but not horrible.

What, why, and when?

Unfortunately, nosebleeds are common in kids — especially when they are sick or suffering from allergies (due to swollen nose tissues) or the air is dry.

Nosebleeds often happen at night, when the head is at the level of the heart.

They also start with a forceful blow of the nose, sneezing, or other things that cause sudden pressure in the nose. 

The part of the nose that commonly bleeds is the center part separating the nostrils. If you look carefully up the nose toward the center on both sides, you can often see blood vessels close to the surface. After a bleed you can often see the scab.

Trauma to the nose can cause bleeding higher up, but the most common bleed in kids is very close to the tip of the nose. 

For more causes of nosebleeds, check out Dr. Deborah Burton’s post 12 well-known causes of nasty nosebleeds in children.

Once it bleeds, it is likely to bleed again and again until the skin completely heals. Sometimes it is just a few specks of blood when the nose is blown, other times it is full-on bleeding that seems to keep going and going. 

When the nose is bleeding:

  • Sit or stand. Don’t lay down– that increases the pressure in the head, which increases the bleeding.
  • Don’t tilt the head back — that causes blood to go down the back of the throat. You can tilt it forward slightly.
  • Pinch the nostrils at the highest part the nose is soft (just below the hard part) with a tissue or cloth.
  • HOLD IT FOR 10 MINUTES. Do not peek. Do not check. Do not let go.
  • Seriously, don’t let go for 10 minutes. This is the step kids have a hard time with. One minute seems long. Ten is forever. Hold it for 10 minutes anyway.
  • Some people like to put an ice pack over the nose, but if you do this, still try to hold pressure on the nostrils. Put the ice pack on top of the nose, above your fingers that are holding pressure.
  • AFTER 10 minutes, gently remove the tissue or cloth. If it is still bleeding, hold for ANOTHER 10 minutes. Still don’t peek during this time.
  • If after the two 10 minute holds (20 minutes of pressure total) it is still bleeding, it is time to go to the doctor. If you haven’t tried a real 10 minutes of consistent pressure, that is what they will do first, so save yourself the trip and the money and HOLD IT FOR 10 minutes!

After the bleeding stops:

  • Do not blow the nose for 24 hours if possible to allow the skin to heal under the clot.
  • Add humidity to the air with a humidifier or vaporizer.
  • Do not pick the nose.
  • Add a lubricant to the nostrils. Use a cotton tipped applicator or a tissue. My kids loved the “Vaseline sword” — we put vaseline on the tip of a tissue and pulled it into a sword shape. We put the sword in the nose, plugged it from the outside, and pulled the sword down, coating the inside of the nose with the petrolatum jelly.
  • Treat allergies if needed to decrease the swelling in the nose tissues.

Remember that as long as there is a scab in the nose, it will re-bleed if the scab falls off before the skin completely heals underneath. Keep moisture in the air, the nostrils lubricated, and remind kids to not pick!

Most nosebleeds are simple nosebleeds, despite how scary they look!

Red flags (or things to see a doctor about):

  • Frequent nosebleeds that take 20 minutes of pressure to stop.
  • Bruises that are not explained by injury. (In general, any child with bruises all over the shins is normal. Think of areas that don’t often get bumped or hit — if they are bruising for no reason, that is more of a concern.)
  • Red or purple spots on your skin that don’t blanch with pressure. These are petechia and can be seen when there is a clotting problem.
  • Blood in the stool. While the most common cause of this is constipation, if you have multiple sites of bleeding, you should be evaluated by a doctor.
  • If you think your child stuck something up the nose that might have contributed to the bleed.
  • When trauma to the nose or face leads to the nosebleed, it should be checked out.
  • If your child seems pale, unusually tired or dizzy, or has unexplained weight loss or fevers.
  • Gums bleeding. This is commonly due to poor oral hygiene and gingivitis, but can be due to a clotting problem.
  • If your child takes any medications that thin the blood. (This is unusual in kids, more common in adults, but high doses of fish oil might increase bleeding risks.)

What do doctors do about nosebleeds?

  • Usually all that is needed is home treatment and I simply reassure the parent and child with the above information.
  • If there are frequent bleeds, I will sometimes recommend cauterization of the nose. This sounds scary, but it is a relatively easy procedure. One common method is using silver nitrate. It is applied to the areas where the blood vessels are close to the surface of the nose. In many people a single treatment is all that is needed. Some people require repeat treatments.
  • Treat any underlying allergy to control the nasal swelling.
  • If there is a family history of a bleeding disorder or signs of other bleeding (bruises or petechiae, rectal bleeding, gum bleeding, heavy menstrual bleeding) blood work can be done to see if there is a bleeding disorder.
  • When trauma is the cause of a nosebleed, we make sure there is no hematoma or broken bones.