Buzz Your Way Out of Pain

As adults, we know that going to the doctor’s office can be a pain-in-the-you know what, even under the best of circumstances. But we tend to rationalize our way to our physician’s office anyway, knowing that it is in our best interest to go. Then once we arrive, we will take the visit with a grain of salt.  However, imagine if the patient is a kid.

We’ve all seen the scenario, right? Have you ever seen a child jump for joy, when they are told they are going to see their pediatrician? Of course, not. Don’t be ridiculous. Now, add to that, the child needs a shot. As parents, we have all had to come up with some type of bribe, mixed with a little extortion, for the child to allow the doctor exposure to that bicep or thigh or some other part of their anatomy.  Then after the deed is done, we have fed them candy time and time again, to alleviate that shrieking and hyperventilation, accompanied by many tears. What’s a parent to do, right?

Well, there is a Pediatric Emergency Room Physician named Amy Baxter, who believes she might have the solution we have all been waiting for. Not only is she a doctor, she is a parent as well. What other motivation do you need to start thinking about a solution. Dr. Baxter has invented a device that she has named “Buzzy.” Once you hear about the technology behind this invention, you will wonder and ask the question, “why didn’t someone invent this device a long time ago?”

So, what is this device known as “Buzzy?” It is a palm-sized unit that the caregiver presses against the skin to reduce pain. This device uses a very high frequency, low amplitude vibration along with a freeze-solid ice pack. The combination of the high frequency motion and intense cold activate nerves that run parallel with the pain nerve, and consequently jams the pain signal to the brain.

You might be asking the question, “Why haven’t we heard of this device before?” There are several reasons you might not have heard of this device. The first reason is that this device is relatively new. Secondly, something you might not know exist but there are barriers to innovation in the healthcare world. I will touch on some of them in this blog so that you will have a better understanding and appreciation of the skepticism of the medical community when it come to new / innovative devices.

Most practitioners continue to trust and practice what they learned in academia even though there is continuing education and lifelong learning. There is also the fact that it takes time for new science to permeate to practice. Not to mention that doctors and hospital systems inherently averse to taking risk largely attributed to the legal climate that exist in healthcare today. They find security in continuity to do what they know is right, what is ethical and what is sound practice. Fear of change perhaps? It makes you wonder.

At this point, you may ask the question, so why should we fall “in love” with this product? The main reason would be that the response from the patients has been overwhelmingly positive, i.e., “thumbs up.” In the interview with Dr. Baxter, she mentioned that parents are thanking her all of the time for introducing them to the devise. But don’t just take her word for it. Allow me to share with you what the research has shown.

There was a study in Italy which concluded that “Buzzy” demonstrated significant pain reduction in adolescents with severe cognitive impairment. What is the implication (importance?) of this study? It establishes the fact that this is not the result of psychological distraction. There were two studies conducted on adults in Turkey which concluded that it reduced pain from injections and blood draw about 10% more than in kids. This supports the physiological component of pain relief underlying its effectiveness. Matt, does this make sense or should I leave it off? However, the study that captivated my attention occurred at Children’s Healthcare of Philadelphia. This study concluded that “Buzzy” relieved pain from IV access as effectively as the leading topical anesthetic (Emla Cream or LMX4), but it worked 10 times faster. They were able to perform blood draws and IV starts in 3.5 minutes compared to 40 minutes with LMX4.

There are other studies which are promising and suggest that this technology may also be useful in other areas outside the injection / blood draw arena. Those areas are orthopedics, physical therapy, diabetes, chronic pain and sports medicine. Keep your eyes and ears open for more information on this product as it becomes available to us at yourkidshealth.net and hopefully you will get to meet “Buzzy” if the situation calls for him.

 

Back to School Sunscreen?

While the hot season advances, our kids love to spend time outside, even while at school.

It is actually very common for school students to spend more time outdoors during the first weeks os school to attend various activities, including PE classes or even simple recess.

In many schools, students are not allowed to use sunscreen or wear a hat outdoors. This actually could increase their potential for sunburns. However, in many cases, parents have the option to resort to a form to be signed by a physician, in order to allow their kids to use sunscreen at school. We strongly recommend taking the necessary steps forward to make this happen!

Even only 15 minutes under the hot sun can actually cause severe sunburn in children. This is the reason why parents should always be cautious and make sure that their children stay protected with the proper application of sunscreen. Many schools and educational institutions also organized field trips and other extracurricular activities during summer, to take advantage of the good weather.

A little sunburn? It’s probably no big deal!

Sunburns can be painful and annoying, but there’s more to the story than just a little bit of wear and tear affecting your kid’s skin. Though it doesn’t sound like a big deal, sunburns can actually be very dangerous because they expose your child to the risk of skin cancer. The UV rays of the sun can damage the layers of the skin, exposing sensitive tissue to dangerous radiations.

Children have a particularly sensitive skin and therefore, it is very important to make sure to protect it. Applying sunscreen a little bit before going outside under the sun should be instilled in them as a habit, just in the same way you teach your children the day need to brush their teeth before bedtime!

Thankfully, sunscreen is sold in many shapes and forms. There are many brands that sell high-quality sunscreen in compact bottles, which can be easily carried in a pocket without too much hassle for your child. Some companies even target kids specifically with fun designs and cool packaging that makes sunscreen more appealing to them!

In conclusion, sunburns should not be taken lightly. Wearing sunscreen is a very simple remedy to ensure a safer summer for your kid and dramatically reduce the risk of skin cancer and other issues!

Controlling Your Sugar Cravings

 

If your kids are like most kids, controlling their cravings for sweets is a never-ending battle. Whether they are playing at home, at school or hanging out with friends, it is a struggle that many children experience. Can I get a witness?

At this point, some of you might be asking the question, “Is that really a problem?” Well, yes, it can be. Did you know that too much sugar consumption can lead to an unbalanced blood sugar level? An unbalanced blood sugar level can significantly increase the risk of developing conditions later in life such as diabetes, heart disease and metabolic syndrome. Conversely, maintaining a balanced blood glucose level can be a life-sustaining practice and possibly a life-saving practice. I’m not referring only to children with diabetes, but also to healthy children as well. 

Let’s be real – hidden sugar is omnipresent in the Standard American Diet (SAD). I think we can agree that most people don’t have a clue as to how much sugar we consume. How familiar does this sound to you: “I just had to have that cinnamon roll. I couldn’t resist it.” And you didn’t!  We may even be unaware of how much we crave sweets until the craving hits us. So why does the craving hits us at all? 

Let me introduce to you what we will call “The Sugar Crave Cycle.”

The Sugar Crave Cycle

Normal blood glucose levels remains even with a healthy diet. It can only take one indulgence in sugar and begins when:

  • Your child drinks that high carbohydrate drink or eats that sweet food (i.e., donut).
  • Their bloodstream becomes saturated with glucose (sugar).
  • Their body responds with a surge of insulin.
  • This surge of insulin causes the blood glucose levels to fall below the optimal level.
  • Since the brain depends on glucose for energy, it perceives a threat to its survival. The brain sends a signal to the adrenal glands to release cortisol. 
  • Cortisol, a steroid hormone, is released in response to stress and/or a low blood glucose level. Cortisol functions to increase blood glucose levels by increasing cravings for more sugar.
  • Your child reacts to these cravings and demands more sweets. After you give in, the cycle starts over again.

You may feel guilt about giving in to your child’s demands, and quite possibly the child is feeling guilty, too. Even though we know the sweets are bad for them, we give in anyway. Then, we start saying to ourselves, “I am a bad parent (or grandparent). I am weak and have no discipline”.

Let me tell you parents – there is nothing more counter-productive than negative self-talk.   What if I was to tell you, it is not all your fault? It’s not just an idea you’re battling—“I shouldn’t eat this”. It’s much more powerful. This is pure autonomic nervous system (ANS) business. You can’t override it, you can’t tell it what to do. It tells you what to do. In contrast to a computer, which you can override sometimes, the ANS cannot be overridden.

However, the situation isn’t hopeless. I believe that knowing why the sugar crave cycle happens (and knowing it is a false alarm) can be a deterrent to giving in. In fact, it can be a powerful deterrent. Intellectually, you know they don’t need that high sugar item. We also know that if you allow your child to indulge, you will place that child right back on the sugar craving cycle. We can say “no”.  

[Doesn’t that remind you of the anti-drug campaign?]

Parents, there is no reason to beat yourselves up. Did you know that imbalances in the chemicals in the brain (responsible for managing your moods) are to blame for at least 70-80% of the cravings.

So, what is a parent to do? We know we can just say “no.” But now, we also know that it doesn’t take just good old-fashion willpower. It also takes good health-sense.

Several decades ago, a rock band by the name of The Beatles wrote a song entitled, “With A Little Help From My Friends.” These three ‘friends’ will help you overcome those unhealthy sugar cravings.

Our first friend is named Gymnema Sylvestre. This product has been used in India and Asia for thousands of years to balance blood sugar levels and reduce the sugar craving. In fact, this product works so well, in Hindu its name (gurmar) means “destroyer of sugar”. Naturally, it derives from a plant leaf. Research has shown that, in its supplemental form, it contains an acid which has a molecular structure that is similar to sugar. It is strongly believed that these molecular structure attaches to the same taste receptors that glucose (sugar) uses. This attachment occurs not only in the mouth but also in the intestines. Consequently, sugar absorption in the intestines also decreases. Talk about a little help from our friends… this is enormous! 

But there is more to this product. It has also demonstrated an ability to increase the amount of insulin in the body by aiding the regrowth of pancreatic beta cells. These are the cells that produce insulin. What a huge bonus! For those who may be interested in trying the supplement, the recommended dosage is 400 milligrams per day.

Our second friend is an alkaloid extracted from plants by the name of Berberine. This product was utilized before the discovery of insulin and was recognized for its anti-diabetes effect. Berberine works by stimulating the uptake of glucose into your cells. This results in lower blood glucose levels. And, if this wasn’t enough, it also possesses extra beneficial effects. Those benefits include an increase in insulin sensitivity and a decrease in glucose production in the liver. Some experts say Berberine is as effective as Metformin but without the unwanted side effects (nausea, vomiting, diarrhea, and upset stomach) associated with that drug. The recommended dosage for this supplement is 1000 milligrams per day.

Thirdly, we can get by with a little help from our friend Chromium. Many of us know that chromium is an essential trace mineral. However, few of us know that it plays a role in maintaining a healthy blood sugar level. Chromium is essential in the transportation of blood glucose out of the bloodstream and into the cells throughout your body. Once within the cells, the glucose converts proteins, carbohydrates and fats into energy. There are studies that have proven that a chromium-deficient diet can lead to an increase in blood sugar levels.

Like our two other friends, there is a bonus involved for chromium. Studies have revealed that chromium can help manage diabetes by assisting people with weight loss. If you are interested in this supplement, it comes in two forms: chromium dinicocysteinate and chromium picolinate. The recommended dosage for chromium is 400 milligrams per day.

In conclusion, I don’t want you to be misguided. No supplement can overcome a diet filled with pastries, ice cream and pasta. These supplements may suppress that craving, but nothing can take the place of a nutrient-heavy diet and moderate exercise. And your health-care professionals at yourkidshealth.net always recommend that you consult your doctor before starting any of the supplements featured in this blog.

References:

Ware, Megan. “Chromium: health benefits, sourses, and potential risks” Medical News Today. Updated May 22, 2017. Last accessed June 13, 2017.

“Chromium—Topic Overview” WebMD. Published NA. Last accessed June 13, 2017.

“Gymnema” Published NA. Last accessed June 13, 2017.

Passero, Kevin. “Gymnema Sylvestre: Reduce Sugar Cravings and Balance Blood Sugar!” GREEN HEALING WELLNESS. Published May 9, 2016. Last accessed June 13, 2017.

Can Sugar in a Child’s Diet Trigger Gastroesophageal Reflux Disease?

One of the things, I truly love about becoming a nurse and working in the healthcare profession, is that it is constantly evolving and researching ways to improve the health of people like you and me.  We that are your healthcare professionals are constantly challenging conventional wisdom and thinking, as well as, reevaluating traditional treatment modalities.

This type of thinking can result in some fantastic discoveries, which can alter how diseases are treated and managed. A recent example to this is the research that has taken place with gastroesophageal reflux disease, also known as, GERD. For years (approximately 80 to be exact) the healthcare community have been lead to believe that this digestive disorder was caused by stomach acids backing up into the esophagus. This can result in burning, irritation and even damage to your esophagus. However, a new study published in the Journal of the American Medical Association (JAMA) appears to be questioning this line of thinking. The research from this study seems to suggest that the damage caused by GERD is not the result of stomach acid entering the esophagus. The study proposes that the damage caused by GERD is a result of an inflammatory response prompted by cytokines, which are inflammatory messenger proteins.

The researchers took a group of 12 men who were on proton pump inhibitors to use as their sample group. Proton Pump inhibitors, otherwise known as PPI’s, is a medication that reduces the amount of acids produced in the stomach.  When you have less acids produced in the stomach you diminish the harmful effects (the burning, the irritation, and the damage). 

The men were asked to stop taking their PPI’s for 2 weeks. The researchers expected to see a resumption in the symptoms.  What the researchers did find, however, is that in 11 of the 12 men, there was changes in the esophagus. The change in the lining of the esophagus was not indicative of burns (which is what the researchers expected).  What they discovered is that the esophagus was stimulated by the stomach acid, to produce cytokines. This led to the beginning of a cascade of inflammatory processes which led back to the disease.

Their research concluded that it is not the stomach acid that is causing the problem but rather it is the cytokine messengers. They believe that the development of GERD is cytokine-mediated and not the result of chemical injury.

So now, you might be asking the question, “why is this finding and change in thinking so important?” Well, the answer is that it tells the medical community that we might be placing our focus in the wrong area.  When you consider that this is a disease that affects millions of people, this could be huge.  Perhaps, we need to place our focus on cytokine blockers and inflammation since this appears to be the catalyst to the development of this disease.

Why should we reduce cytokines?

The problem with cytokines is that when activated, they drives chronic, low-grade inflammation process. This type of inflammation is linked to certain diseases such as Diabetes,

Cancer ‘and Heart Disease.  In regards to the link between cytokines and GE Reflux Disease, we certainly need to see more research, to justify changing our treatment modalities but it does sound promising.

So, the question you might ask at this point is, what if additional research does prove that cytokines are the cause of the damaging effects of GERD?  What would be the next step? The next step would probably be to find ways to lower their presence in your body. And that would not be hard to do, considering there are cytokine blockers currently in use to treat some of our most formidable inflammatory diseases, such as, Arthritis, Inflammatory Bowel Disease (Crohn’s) and Psoriasis. Some clinical trial leaning in that direction might prove them to be effective against GERD. To the medical community and sufferers of this disease, this is exciting news! 

So, what could you do in the meantime? Well, your healthcare professionals at yourkidshealth.net have several suggestions to offer. One way you can help your child is by lowering their intake of sugar.  It is sugar that triggers the release of cytokines.  You can also increase your intake of anti-inflammatory omega-3 fatty acids. If taking omega-3 supplements aggravates your child’s reflux (which has been known to happen in some cases) you can always eat foods rich in omega-3. Meals containing salmon, mackerel, trout, albacore tuna, and sardines two or three times a week would be adequate. And, of course, with GERD you want to avoid highly acid foods (oranges, lemons, tomatoes, etc.) and spicy foods.

Reference

Dunbar KB, et al. JAMA. 2016;315(19):2104-112.

Inflammatory Bowel Disease

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Inflammatory bowel disease (IBD) is a term used to describe two forms of chronic inflammation of the intestine. These two diseases are known as Ulcerative Colitis and Crohn’s Disease. While these two conditions may have some characteristics in common, there are some differences.With Ulcerative colitis the inflammation affects the mucosa (the inner lining) and the submucosa ( the lining underneath it) and is limited to the large intestine and the rectum. This lining becomes inflamed (swollen and red) and develops open, painful wounds, commonly called ulcers. The affected area is often the most severe in the rectal area, which can result in frequent diarrhea. It is not uncommon to see mucus and blood often appear in the feces (stool / poop) if there is damage to the lining of the intestine.

With Crohn’s disease, the inflammatory process can involve any part of the gastrointestinal tract from the mouth to the anus, however, it most commonly affects the last part of the small intestine (called the terminal ileum) and parts of the large intestine. Another characteristic of Crohn’s disease is that the inflammatory process tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel.

Etiology or Causes of IBD

Although there has been plenty of research the exact cause of IBD is uncertain. However, researchers believe that many factors might be involved, including the environment, diet, and genetics. There is evidence that has shown that in people with IBD, a defect in their genes affects how the immune system works and responds to an offending substance like a virus or bacteria and even some proteins in food. There is also evidence that suggests smoking can increase the likelihood of developing Crohn’s disease.

Signs/Symptoms

The most common symptoms of both Ulcerative Colitis and Crohn’s disease are diarrhea and abdominal pain. Diarrhea can range from mild to severe (as many as 20 or more trips to the bathroom a day). If the diarrhea is extreme, it can lead to dehydration, rapid heartbeat, and a drop in blood pressure. And continued loss of small amounts of blood in the stool can lead to anemia.kidinsunglasses

At times, those with IBD may also be constipated. With Crohn’s disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (known as proctitis).

The loss of fluid and nutrients from diarrhea and chronic inflammation of the bowel can also cause fever, fatigue, weight loss, and malnutrition. Pain is usually from the abdominal cramping, which is caused by irritation of the nerves and muscles that control intestinal contractions.

And IBD can cause other health problems that occur outside the digestive system. Although experts don’t understand why, some people with IBD can show signs of inflammation elsewhere in the body, including the joints, eyes, skin, and liver. Skin tags that look like hemorrhoids or abscesses may also develop around the anus.

Inflammatory bowel disease also might delay puberty or cause growth problems for some kids and teens because it can interfere with them getting nutrients from food.

Diagnosing IBD

Diagnosing IBD can be hard because there may be no symptoms and if there are symptoms, they often resemble those of other conditions. Diagnosing IBD starts with a history and physical. Laboratory test to check for anemia and malnutrition are ordered. Your child’s stool will be tested for the presence of blood if blood is not obviously apparent. Upper endoscopy (a tube with a camera to visualize the lining of the esophagus, the stomach and the first part of the small intestine) and colonoscopy (to visualize the lining of the rectal and the large intestine), along with biopsies of the aforementioned areas is common. The endoscopic test allows the doctor to examine for inflammation, bleeding, or ulcers on the wall of the GI tract. Abdominal sonograms and CT scan might be ordered to evaluate for abscesses (infection pockets) and fistulas (unnatural passageways between the intestines and adjacent structures such as the bladder, vagina, and anus).

Treatment

The main treatment modality for Crohn’s and Ulcerative Colitis is medication. And fortunately, there has been progress seen in treating these diseases. There are two classes of medications being prescribed. First of all, there are anti-inflammatory drugs prescribed to decrease the inflammation. Secondly, doctors are prescribing immunosuppressing drugs to prevent the immune system from attacking the body’s own tissues and causing further inflammation.girlsonswing

Surgery is the second option, if symptoms don’t respond to either of these medicines. However, the surgical procedure for ulcerative colitis is not the same as for Crohn’s disease.

In the case of Crohn’s disease, the doctors will try to avoid surgery, because of the recurring nature of the disease. There are also complications that can occur if surgery is performed such as short bowel syndrome (which can lead to growth failure and a reduction in the intestines ability to absorb nutrients).

In cases of ulcerative colitis, removal of the colon (large intestine) is sometimes performed to completely get rid of the diseased bowel. This may also require the performing of a procedure in which the surgeon forms a pouch from the small intestine to collect stool in the pelvis. This enables the stool to pass through the anus.

Nutritional Support

Nutritional support is an important aspect in the treatment of IBD. There are 3 goals you would want for your child; 1) Correction of nutritional deficits and replacing the ongoing losses 2) providing sufficient amount of protein and energy for healing, 3) and thirdly, providing an adequate amount of nutrients to support normal growth. A well-balanced, high-protein, high calorie diet is recommended for your child if symptoms do not prohibit taking foods in orally. Also, supplementing your diet with multivitamins, iron and folic acid is very helpful. Sometimes, that nutritional support may include parental nutrition (nutrition given intravenously) and supplementation with special enteral formula (an elemental formula which consists of simple / small proteins).

Prognosis

First of all, IBD is a chronic disease which can consist of long periods of dormancy followed by exacerbation (an acute increase in symptoms). However, overall the prognosis is good. Colorectal cancer is a long-term complication of IBD. Surveillance colonoscopy with multiple biopsies is the gold standard for early detection and should begin approximately 10 years after diagnosis. This should continue every 1-2 years.

Head Injury / Trauma

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The number one cause of death and acquired disability in the pediatric population is accidental trauma. It is estimated that head injury alone may account for the majority of these incidents.

Causes of Head Injury

Most pediatric head injuries are caused by a motor vehicle accident (MVA), fall, assault, sporting injury, or child abuse.

Signs/Symptoms

When a child experiences head trauma you can expect one or more of the following symptoms:

  • Tearing or bruising of the skin around the head (scalp injury)
  • Cracking/damage to the bone structure of the head (skull fracture)
  • Damage to the brain that changes the way it works (concussion)
  • Damage of brain tissue
  • Memory loss
  • Vomiting (emesis)
  • Sleepy, difficult to wake (loss of consciousness)
  • Bleeding inside the brain (intracranial hemorrhage)
  • Bleeding between the skull and the brain (subarachnoid hemorrhage)
  • Bleeding from the fluid filled areas of the brain (intraventricular hemorrhage)
  • Injury that penetrates the skull
  • Seizures

The damage may be centered in one area (focal) or spread out over a large area of the brain (diffuse). It is not uncommon to see changes/complications throughout the entire body after Traumatic Brain Injury.

What to do if you suspect your child has suffered head injury/trauma:

All parents/caregivers suspecting brain injury should seek out medical attention AS SOON AS POSSIBLE. Children suffering from head trauma can deteriorate quickly and it is often difficult to judge the level of injury by observation alone. This is why it is best to put your child in the hands of a trusted professional.

Diagnosis/Tests

In the event of suspected head injury your doctor may order a long list of tests, both to get an idea of your child’s overall health and help judge the extent of the damage. Commonly ordered blood tests may include:

  • Complete blood counts (CBC)
  • Blood chemistry
  • Blood clotting ability/factors (coagulation profile)
  • Blood type and cross match (Identifying the patient’s blood type)
  • Arterial blood gas.

A blood or urine drug test (toxicology) may also be ordered as certain medications and chemicals can cause a child to suffer from symptoms similar to head injury.

Along with blood tests, your doctor may order imaging (radiographic) studies to have a look at the actual tissues themselves. These often include:

  • Computed Tomography (CT) also known as a “Cat Scan” offers the doctor a quick look into the brain or other organs to determine if there has been tissue damage.
  • Magnetic Resonance Imaging (MRI) offers a more detailed image of the internal structures however, it typically takes longer to obtain.
  • Ultrasonography (Ultrasound, US) uses sound waves to generate an image of the structures inside the body and is very useful in diagnosing damage in newborns and infants whose skull plates (fontanels) have yet to close.

Managing Head Injury

After a head injury, it is the goal of your doctor to treat the life-threatening symptoms first then control any other symptoms that may arise. To do this your doctor may bring a specialist onboard such as a neurologist, neurosurgeon or epileptologist. A neurologist focuses on general study of the brain. A neurosurgeon is an expert on brain surgery. An epileptologist is a doctor whose focus is seizures.

These specialists can help your doctor better plan ways to manage any complications such as: seizures, internal bleeding, breathing /heart difficulty, inability to regulate temperature, pain control and issues requiring surgery.

kidsinthegrass

Cellulitis

Cellulitis simply means an infection of the skin. Your skin is your first barrier against germs and bacteria. When your skin is damaged (whether it be by cut, scrape, sore, etc.) bacteria has a chance to move in. Most bacteria thrive in a warm, wet environment so wounds are the ideal place to set up camp.

If left untreated, this infection can spread to other parts of the body and result in severe injury or death. It is also possible to develop cellulitis without an obvious break in the skin if a person has a weak immune system or other condition, such as diabetes, eczema or fungal infection, that compromises their ability to heal.

Causes of Cellulitis

The most common cause of cellulitis is bacteria like streptococcus (strep) or staphylococcus (staph). You may be wondering where these bacteria come from. They are actually all around us living, growing and thriving. Some of them we even consider “normal flora” which means they are commonly found on our own skin. Knowing this, it is remarkable that every cut we suffer doesn’t turn into cellulitis. It occurs more often in people with frequent exposure to meats, fish, chicken and soil as these items are a great breeding ground for bacteria.

Signs/Symptoms

Cellulitis can develop on any part of the body, however, in children it is most often seen on the face or around the anus.

Cellulitis usually presents as a warm/hot, red, swollen area that is tender to the touch. The redness may spread over time and the child may develop fever and chills. Swelling can be seen, not just in the immediate area, but in tissues around the site and result in severe pain/stiffness.

What to do if you suspect your child has cellulitis:

It is important to see your doctor right away if the infection is located on the face or the groin. Infections of the face can lead to serious complications including permanent blindness and damage to the brain. All forms of cellulitis can lead to an infection of the blood called sepsis which can be difficult to reverse and lead to other permanent injury or death.

If your child presents you with what appears to be an insect bite or sting but develops fever and chills, seek medical attention from a trained professional.

Lastly, even if you have already seen your doctor and been treated but are noticing worsening symptoms such as the infected area is growing instead of shrinking, it is becoming more painful, it has developed red streaks, or it has begun to discharge fluid, an immediate follow-up visit is warranted.

If you are experiencing any of the above and are unable to get in to see your pediatrician, do not hesitate. Remember, you can always take your child to an urgent care/ER and be seen and evaluated. Early diagnosis is important for proper treatment to prevent further complications.

Diagnosis/Tests

Determining the cause of your child’s condition will involve a physical exam where your Doctor looks at the site and asks you several questions about it. If fluid or drainage is visible, your doctor may take a sample to help identify what is growing in the wound. This is called a “culture” and will help her/him decide which antibiotic is best to treat the wound.

Managing Cellulitis

Don’t be surprised if treatment is begun before the results return. This is often done because of the severity of the diagnosis. Today physicians are apt to use what they call “broad spectrum” antibiotics. As the name implies, these antibiotics work on multiple different types of bacteria and are often the best treatment for the most common cellulitis associated infection. If a culture is done and it is determined that another antibiotic would better treat your child’s infection, you can expect the antibiotic to be changed.

The type of treatment is also dependent on how severe the infection is. For a mild infection, your doctor may feel comfortable treating your child with medications taken by mouth and sending you home.

In the case of more severe infection, expect to be admitted to a hospital for IV (in the vein) antibiotics and monitoring by trained professionals. A course of IV antibiotic can last from several days to several weeks so be prepared. It can also be extended if the infection does not respond well to the initial treatment or if other complications arise.

Whether your doctor chooses to treat your child by oral or IV antibiotics it is very important to remember to give the antibiotic EXACTLY AS IT IS PRESCRIBED. Do not stop the antibiotic early even if the wound looks much better than it did or resolves completely. Not finishing your antibiotic can cause the infection to return STRONGER than before and be RESISTANT to that antibiotic and antibiotics similar to it.

Pancreatitis

The pancreas is a large organ or gland that sits behind the stomach. It is responsible for producing and secreting digestive enzymes that help break down food. These enzymes are secreted into the duodenum, which is the upper section of the small intestine. This is where the breakdown of food takes place. The pancreas is also responsible for producing two hormones named insulin and glucagon. These hormones are responsible for regulating blood sugar levels. With pancreatitis, the gland becomes inflamed. This inflammation takes place when the digestive enzymes are activated in the pancreas instead of the small intestine.

Causes

There are many causes for pancreatitis. The two main causes, which account for up to 90% of cases, are gallstones and alcohol abuse. Of course this wouldn’t be a problem with small children; however, in today’s society, teenage alcohol abuse is on the rise. With gallstones, there is a stone blocking the pancreatic duct. This disables the pancreas from excreting the digestive enzymes into the small intestine. Consequently, these digestive juices will begin causing damage to the pancreas itself.

Some other causes of pancreatitis includes: some medications, family history, infection bacteria, viruses, fungi, and some parasites, injury resulting from abdominal trauma, exposure to certain chemicals, high fat levels in the blood, high calcium levels in the blood, mumps, and hypothermia autoimmune disease.

Signs/Symptoms

The most prominent symptom associated with this disease is severe pain in the left upper quadrant of the abdomen that can radiate to the back. The pain can become so intense, that it will sometimes make it difficult for your child to sit upright or stand. The abdomen may be tender to touch. Other symptoms that accompany this disease are nausea with intractable vomiting, anorexia, jaundice (yellowing of the skin or the white portion of the eyeball), fever, and dehydration. Blood pressure could be elevated due to pain OR decreased due to dehydration.

Diagnosis

There are several findings that will lead to a definitive diagnosis of pancreatitis. However, be aware of other disease processes that can mimic pancreatitis such as an inflamed gall bladder, a perforated peptic ulcer (hole in the stomach), an infarcted bowel (dead intestinal tissue due to loss of blood supply and oxygen) and diabetic ketoacidosis. First of all, the signs and symptoms listed previously are significant for pancreatitis. Secondly, lab work, specifically serum amylase and lipase levels, which can be elevated as high as 4-6 times above normal. Thirdly, an abdominal ultrasound is recommended, which will not only show an inflamed pancreas, but also can be beneficial in detecting the cause of pancreatitis. Gallstones and an alcoholic fatty liver may be detected via ultrasound. CT scan can be utilized to make a definitive diagnosis.

Treatment

The treatment for pancreatitis is supportive in nature and includes medications, diet, and possibly surgery. Your doctor will order strong pain medications to alleviate the discomfort associated with this disease. Medication to relieve the nausea is also commonly ordered. Pancreatic enzyme capsules, if ordered, are usually given once your child is allowed to eat and are taken prior to eating. In regards to diet, patients will most likely be placed on NPO status (no food or drink) initially. If the vomiting is intractable (continuous in nature), a nasogastric (NG) tube may be inserted through the nose and down to the stomach and placed to suction. This will keep the stomach empty, thus eliminating the vomiting. Anticipate your child receiving nutrition via the veins at this point. Once your child can begin eating again, a clear, liquid diet will be introduced first and progress to a low fat diet. Pancreatitis can also lead to respiratory problems, so supplemental oxygen might become necessary. If the pancreatitis is caused by gallstones blocking the bile duct or pancreatic duct, surgery might become necessary to remove those stones. Surgery to remove the damaged pancreatic tissue may also occur, but this is done very rarely and is usually reserved as a last resort.

Meningitis

Meningitis is an inflammation of the membrane that covers the brain and spinal cord. The different types include bacteria, viral and fungal. The treatment will depend on what type your child may have. The most common types are viral and bacterial. Viral meningitis may improve without treatment. Bacterial meningitis is very serious and requires immediate treatment with antibiotics. Waiting too long to get treatment could end in death or brain damage. Bacterial meningitis can be fatal within a matter of days. The only way to know which type you have is to undergo a series of test.

Testing for meningitis may include:

  • Blood cultures, Complete Blood Count
  • CT or CAT scan of the head to see if there is any swelling around the sinuses
  • Spinal Tap – involves collected spinal fluid that may identify the exact bacteria that is causing the illness

Infants

IF your infant is running fever and is under 2 months old you need to have your child examined by your child’s doctor. These are the signs and symptoms of meningitis in a newborn/infant.

  • Fever
  • crying constantly
  • the soft spot on the top of the baby’s head is bulging
  • crying harder when picked up or moved
  • not eating well
  • very sleepy and inactive
  • skin rash
  • temperature LOWER than normal

Children and Teenagers

Some signs and symptoms that your child or teenager may have could include:

  • Stiff neck
  • headache (usually severe)
  • vomiting
  • confusion
  • fever
  • extreme pain or inability to bend head forward (like your trying to touch your chin to your chest)
  • skin rash or purple spots anywhere on the body
  • sensitivity to light

Treatments

Viral meningitis will resolve on it’s on usually without any treatment and will usually last about 7-10 days. Over the counter pain medicine may be used to help with body aches and fever. Make sure your child is drinking enough fluids as well. ALWAYS- consult your child’s doctor if you have any concerns about their health!

Bacterial meningitis will require IV (medicine that goes into your veins) antibiotics. Your doctor may use more than one antibiotic until the cultures are complete (which takes 24-72 hours). When the cultures are complete he or she will know which antibiotic to use to treat that particular bacteria. In most cases more than one antibiotic are used due to the severity of bacterial meningitis.

Prevention

  • routine immunizations are up to date including the meningococcal booster
  • have your child wash their hands often
  • do not share food or drinks
  • avoid contact with anyone who has been infected with meningitis

Seek medical attention immediately if your child has symptoms of meningitis.