DON'T BE "RASH!"

VIRAL RASHES

Right now, I'm seeing a lot of Viral Rashes in the office.  Every child, no matter the age, can get a rash from catching a virus.  Viruses are endemic in our society:  they are everywhere and there is no way to escape them!  Some studies estimate that 99% of the population in America have antibodies in their blood from exposure to Epstein-Barr Virus alone.  (EB Virus causes Mononucleosis and chronic fatigue syndrome).    Back in the "old" days before we had great microscopes to I.D. what caused the various childhood rashes, they were given numbers.  They are all still around today, but we have just been able to identify their cause and now are known by their true names!  

One such rash is called a "Coxsackie" Virus.  And, it tends to show up more during the warmer months of the year.  

It causes a moderate to high fever 102-104*, gives blisters or ulcers in the mouth making it very difficult to swallow, and may also cause a rash that consists of tiny red spots (about the size of this "O") on the hands, feet, and buttocks.  There are several different versions of this Virus:

• Hand, Foot, and Mouth disease:  tiny red spots on the palms of hands, soles of feet, and sometimes the buttocks; blisters or ulcers in the mouth, throat, gums, palate, and inside cheeks; fever and sometimes diarrhea.
• Herpangina:  lots of tiny little blisters all over the throat and palate; low to moderate fever (101-103).  Usually no rash with this one.
• Hemorrhagic Conjunctivitis:  an infection of the eye ("pink eye") that can range from very mild to severe with bleeding in the whites of the eyes.

How do we get Coxsackie Virus?  Well, not to gross you out, but it is a virus that is carried in the intestines and is spread through human contact and feces (poop); meaning, if someone has the virus and goes to the bathroom and doesn't wash their hands afterward, then they can have the virus on their hands and everything they touch afterwards spreads the virus.  

All you have to do is touch a contaminated surface or hand, and then eat something without washing your hands first, and you have just contracted the virus into your own stomach and intestines.  

In fact, this is a very common way of "catching" a virus.  GOOD HAND WASHING is so important!  But you can also see how it is virtually impossible to keep little ones from contracting the virus!  Hygiene and hand washing is not on their priority list!  

Most Coxsackie Virus infections last anywhere from 3 days to 10 days.  Babies who are infected will be cranky and may refuse to eat foods, but continue to drink.  They seem to want you to hold them a lot, but also act like they don't want to be touched!  ("Hold me, but don't touch me!  I feel bad!)  You will notice that they are not as playful and may want to just lie around, and possibly nap a little more.  

TOOL:  When you see spots, blisters, or ulcers in your child's mouth, just be sure to give him acetaminophen (Tylenol) for pain/fever or ibuprofen (Advil/Motrin in children over 6 months of age for swelling, redness, pain, fever, or headache) along with soft, easy to swallow foods and plenty of liquids.  His mouth will be sore and swallowing and chewing may become difficult.  

CAUTION:  some children's sore throat can become bad enough that they stop drinking liquids...even their saliva!  If this happens, even though you are giving Ibuprofen to help take away the inflammation and soreness, then you should watch their URINE OUTPUT very carefully!   If they don't pee within 8-12 hours of their last bottle or glass of liquids, then they have become dehydrated.  Take them immediately to the hospital for IV fluids.   

After 8-12 hours of no urine production in children, the kidneys begin to shut down and then things can get very bad.  So watch for wet diapers and the amount of pee your child produces.  This is also important when kids have vomiting and diarrhea.  It is a big sign of dehydration.  

The Good News is: that most of the time, Coxsackie virus is "self-limited" meaning it ends all by itself within a few days time.  But because it is a Virus, there is no cure.  There is no medicine to give that will make it go away faster!  So it is up to the child's Immune System to attack, fight, and kill the virus.  

Paren't job is to use the TOOLS AT HAND to support your child until he can fight it off:  plenty of fluids and rest, cuddles, acetaminophen (Tylenol) for pain/fever or ibuprofen (Advil/Motrin) in children over 6 months of age for swelling, redness, fever, and pain.  And, if you are using all your tools and still feel your child isn't doing well, never hesitate to see your Pediatrician for examination and support!  

Formula and new Warnings about starting solids....

FORMULA & Starting SOLIDS

A recent study of thousands of babies and toddlers in England revealed a startling fact:  babies who were formula-fed and began eating rice cereal by age 4 months, were SIX TIMES MORE LIKELY TO BECOME OVERWEIGHT OR OBESE BY AGE 3 years!  Wow!

For those mothers who may not be able to breast feed, then giving infant formula is your only choice.  Some mothers do not make enough breast milk, despite drinking plenty of liquid and attempting to breast-feed every two hours.  Formulas are designed as closely to breast milk as possible, but they are all a little different, so you may have to try a few before you find one that settles well on the baby’s stomach and doesn’t result in gas or colic.

Remember NOT to give a baby any goat's milk, even if pasteurized.  It lacks many essential ingredients that babies need to develop healthy brains and grow in a healthy manner.  There is only one powdered goat's milk formula I have found that equates to cow's milk or soy formula and it is imported from Australia by way of England and is very expensive.  It is called "Nanny Care" and should only be used as an absolute last resort if no other formula (and there are many to try) is found to be tolerated by the baby.

Even if you are feeding with formula, you should try to stick to giving the baby 2 ounces every 2 hours at first to help him gain weight after birth.  Then, as he grows, your baby may take more formula with each feeding and spread the feedings out a little more.  He will let you know when He is hungry!

Generally speaking, a baby’s stomach can’t hold more than about 2 ounces at birth.  If they drink more than that, they will probably spit up the extra formula that they may have consumed, but their little tummy just wasn’t big enough to hold.

As long as your baby continues to gain weight and grow, you shouldn't worry about the spitting up...unless you're overfeeding him.  We will cover spitting up a little later.

By age 4 months, most babies can hold down 3-6 ounces of formula every 3-4 hours.   By age 6 months, they will take anywhere from 6-8 ounces at a time.

It is STRONGLY RECOMMENDED that you WAIT to start Cereal or Solids until 6 months of age.   Grandmothers and the WIC program (Women, Infants, and Children food program) may still offer you rice cereal and solids at 4 months....but WAIT!

The study I mentioned above also made the following recommendations when starting solids to help keep your baby from becoming overweight or obese:

• Avoid white rice cereal.  Instead, give a whole grain oatmeal or some other whole grain cereal
• Once baby is doing well on cereal, start VEGGIES NEXT!  keep them on veggies for several weeks.
• If baby refuses certain veggies at first, KEEP TRYING up to 10 times over several weeks to give the baby a chance to develop a "palate" or "taste buds" for the taste.  Some veggies refused at first, might be enjoyed if tried a little later.  Don't give up!  
• After veggies for a couple of months, start meats.
• Save fruits for last so baby doesn't get a "sweet tooth" too soon!  

Following these guidelines will help reduce the risk of having an overweight or obese baby.  It is possible that some children’s intestines are not mature enough to get all the nutrition out of solid foods until this age.  Starting solids earlier than 6 months may give them extra calories, but not the extra nutrition!  So baby is getting fatter but NOT HEALTHIER!  I know this is not what you want!

Your baby can have all the breast milk or formula he wants until 6 months of age.  Do your best to wait as long as you can to start solids!

BREASTFEEDING

Breast milk is the VERY BEST FOOD your baby can have during his first months of life.  Companies have tried hard to create milk formulas that are as nutritious as breast milk, but even the best formulas are not as good as breast milk for your baby.  PLEASE CHOOSE TO BREAST FEED if at all possible.

Only breast milk has PROTECTION against certain illnesses and diseases built in to it.  It will help keep your new little baby safer from sickness during her first few months of life.  Formula cannot offer this.

Breast fed babies are healthier and have less stomach problems (such as colic, constipation, and gas.)

At first, your breasts make a very rich milky substance called “colostrum.”  This is very healthy for the baby to drink but is not as thick and rich as breast milk.  It may take you several days for your breast milk to “come in.”  When this occurs, you will notice a greater sense of fullness in your breasts and they may also begin to leak a little through your clothes when it is time to breast feed your baby, or if your baby cries.  This is normal.  It is also a good reason to have your baby on a feeding schedule.

Babies are not good at breast-feeding at first.  So, you must be PATIENT with them and teach them how to be good at breastfeeding.  Be sure the baby’s mouth is as wide open as possible so she can take as much of your nipple into her mouth as she can when nursing.

Babies who pinch their lips together tightly over the nipple will not suck or feed efficiently and will get a lot less milk.  In addition, it will cause pain to the mother’s breasts.  So help your baby open her mouth as wide as possible.

If your nipples are very sore, or if the baby doesn’t seem to be latching on correctly, one simple tool you can use is called a “nipple shield.”  These can usually be found at Pharmacies or Baby stores.  Place the plastic shield over your nipple and then let the baby nurse through the shield.  This can really help a lot if pain is an issue.  Once your nipples become more used to the nursing, you may stop using the shield.

Keep the baby’s head more upright so that her bottom is much lower in your lap than her head.  Babies who feed lying flat (horizontally) tend to have more ear infections.  So allow your baby’s head to be higher than her bottom when she feeds.

Be sure to drink PLENTY of water or fluids every day so you will make plenty of breast milk.

Emptying your breasts also stimulates them to make even more milk!

Obtain an electric breast pump.  After your baby nurses every 2 hours, pump all the extra milk from your breasts and store the extra milk in the refrigerator.  Breast milk lasts about 1 week in the refrigerator and 1 month in the freezer.  You can use this extra breast milk to supplement your baby’s regular feedings or to allow others in the family (father or grandparents) to feed and bond with the baby.  But if Mom is feeding the baby, it should be from her breasts if at all possible to avoid "nipple confusion."  Bottle feedings should be done by someone other than Mom if possible.

Another way to stimulate increased breast milk production is to drink 2-3 cups of “Mother’s Milk Tea” which can be found at many grocery stores, Whole Foods, and health food stores.  It is very safe and many mothers have found it to be useful in the early days of breastfeeding to increase the amount of breast milk so the baby can gain weight faster.

Pre-Natal (before birth) Tools

PRE-NATAL TOOLS

The HEALTH of every child begins BEFORE IT IS BORN.  Its peaceful life in the womb and health after birth is often determined by the health of its Mother and her choices to eat right, exercise, rest a lot, and drink plenty of water.

Foods that pregnant women should eat to have a healthy baby are full of Vitamins, Proteins, and Folic Acid.  This, in addition to Pre-natal Vitamins and regular Pre-natal Care by an Obstetrician (Pregnancy Doctor), are ESSENTIAL to having a healthy baby.

Foods that are important to eat are:  meats, vegetables, fruits, and whole grains.  Drink as much water as you can. Take Pre-Natal Vitamins every day!

Foods that should be avoided are: Alcoholic drinks, caffeine drinks (soda, caffeinated tea or coffee), candy, very spicy or very greasy (fried) foods, or very starchy foods (bread, pasta, ice cream, rice, potatoes).  Starches turn into sugar in the body which can lead to high blood sugar or stored as FAT that takes a much longer time to lose after having the baby.

DON’T SMOKE and avoid being around people who are smoking.  Smoking causes babies to be born too small for their age, and to be sicker babies after they are born.

Plundering the Toolbox

I've decided to change the name of this Blog in order to give it more focus for Parents who might choose to use it.  The new title is The Parent's Toolbox.

During my first season as a new Pediatric PA 30 years ago, I was practicing in Jacksonville, Florida.  One Saturday as I perused an estate sale in one of the older, more prolific neighborhoods near the St. John's river, I came across an old fashioned Carpenter's toolbox.

It was made of heavy wood, about 3 feet oblong, and obviously meant to carry many tools.  I've moved a million times since that first job, but that old, wooden Carpenter's toolbox has traveled with me to each new home and practice.  It has held tools, paint, books, toys, and flowers.

I think of that toolbox now as I write to you.  After 30 years of treating children and supporting Parents as they tenaciously rumble through raising their children, I feel I have a few practical, "on the go" and "middle of the night" tools that will help you hold the reigns tightly when a virus or some other illness tries to gallop away with your child.  Sometimes it feels like a runaway train...other days it's simply a long journey in the same direction, one foot in front of the other, one day at a time (and sometimes one breath at a time.)

Of course, these are suggestions that you can use in a practical way, but NEVER should replace having your child seen by your family Pediatrician, Pediatric PA, or NP.  When in doubt, go to the nearest Emergency Department, Urgent Care, or Pediatrics practice if you get that feeling in the pit of your stomach that says, "something's not right" with your child.  Trust your gut.  Hopefully, these suggestions will give you practical tools that you can use to get through the night until you can see your Pediatrician first thing in the morning.

So, put on your Carpenter's apron:  we're going to "build" a healthy child.  Let's go!

Plundering Parenthood

As a board-certified Pediatric PA for nearly 30 years, I've developed a passion for Parents.  It's one of the highlights of my daily practice to engage parents on both health and growth & development issues regarding their precious children!  


This blog is my attempt to share with Parents some of the knowledge I've gained over the years and pass it along to you, and to engage you in conversation about your growing children.


We will discuss growth & development, health issues, and heart issues.  As a Christian, I believe deeply in studying our children's hearts to see what we can discover there about life, our world, and who they are now and might become.  


Our children are filled with so many gifts that they will offer to the world and God has made them like precious jewels.  I believe it is our privilege and duty to "mine the depths" of their souls and discover the treasures hidden there and assist them to bring those to light as they grow.  


Plunder is a word usually associated with the spoils of war.  I use the word "plunder" because sometimes it is a battle to discover what is hidden in the seemingly insurmountable fortress of the hearts and minds of our children....and only if we are victorious in our pursuit will we be able to find the jewels and incredible treasures hidden there.  


And not surprisingly, many times the treasure we find is hidden within ourselves as we journey towards the heart of our child.  


In Isaiah 45:3, God says, "I will show you the hidden riches of secret places..." This is what we will do together...seek out the hidden riches in the secret places of our children's hearts and bodies to help them develop their treasures and stay healthy in the process!  


If you like what you see here, please share it with your friends!  Let's build a community.  I look forward to your comments as we "mine the depths" together! 


Going deeper....
Tess Cox, PA-C, MHSC