Category Archives: Common infections

Why didn’t the doctor prescribe an antibiotic?

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Robert Berman, M.D.
What are antibiotics?

Antibiotics are chemicals designed specifically to kill or prevent the growth of some specific types of infections. A wide variety of things can cause infection, such as bacteria, parasites, viruses, and fungi, so we need a variety of antibiotics. Many germs, such as E. coli, can be killed by a variety of antibiotics. Some infections, such as HIV, the virus which causes AIDS, cannot be wiped out completely by any antibiotic we have so far. No antibiotics can treat the common cold, which is unfortunate since the common cold is so common!

Do all infections need antibiotics?

In order to correctly treat an infection with antibiotics, we first need to have a good idea which agent is causing the infection. Otherwise we won’t be able to select the right antibiotic. And as we saw above, some infections, like a cold, simply don’t improve no matter what antibiotic we give. Second, we need to be sure that taking the antibiotic won’t cause more problems than it solves. Some antibiotics have only been tested in adults, or are known to cause problems when given to children. And any antibiotic has the potential of causing unwanted side effects in some people.

What kinds of side effects?

Some antibiotics kill the bacteria which live in our large intestines. This can cause diarrhea and may affect other drugs also being taken. Some antibiotics cause nausea. For any antibiotic, an allergic rash can develop in a small percentage of patients. Also, the more we take any particular antibiotic, the more resistant infections can become to that antibiotic over time. These are all good reasons to be cautious about giving antibiotics unless we believe they will help.

What kinds of infections are not likely to be improved by giving antibiotics?
  • Symptoms of infection in the nose, such as congestion, runny nose, and cough, which last less than two weeks, are probably caused by one of the many viruses which we don’t have useful antibiotics against. Our bodies can usually take care of those infections within two weeks, so if symptoms last longer than that, we may consider another cause, such as allergies or bacterial infection. In that case, antibiotics and other medicines may help treat the problem.
  • Children frequently contract viral infections which cause fever, nausea, vomiting, diarrhea, decreased appetite, and crankiness. The fever from a virus should last three days or less. If the fever lasts longer than this, a bacterial infection may have occurred, and antibiotics may be appropriate. As always, you should call us if you have any doubt about your child’s condition. See our fever page for more on this topic.

Why do children get so many colds?

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Robert Berman, M.D.
What is a cold?
A cold is the way you feel when a virus has infected your upper respiratory system, which includes your mouth, nose, and throat. This can cause runny nose, nasal congestion, a ticklish or painful throat, cough, a feeling of pressure in the ears, fever, headache, and a general feeling of ill health. These symptoms are caused by the battle between the virus and your body’s immune system.
Is that like bronchitis?
The word “bronchitis” basically means “cough illness.” Inflammation of the large airways of the lungs results in coughing. Colds frequently include bronchitis, both from the virus itself attacking the lungs, and from mucus which enters the lungs from the nose and must be coughed back up. In adults, particularly in smokers, sometimes bronchitis is due to a bacterial infection which will require antibiotics, but that is not the case in children. The presence of cough, in children who are usually healthy, does not mean that the cold will “turn into” pneumonia.
How long does a cold last?
The worst of a cold may be over in a few days, or it may last 2-3 weeks.
Why do children get so many colds?
Many different kinds of virus can cause a cold. The human body must learn to fight each one of these viruses all over again. Adults have already been exposed to most of these viruses, and the second time you are infected with the same virus, your immune system may defeat it more quickly. But a child’s immune system is still learning how to fight each of these viruses for the first time. This means that children are more likely to develop the symptoms which we call a “cold,” and they may have those symptoms for a longer period of time than an adult exposed to that same virus. Also, children spend time around other children who have colds, and this makes it more likely that the cold will be passed on to them.
How many colds do children get in a year?
More than their parents and older brothers and sisters. The following graph shows that the average number of colds per year in infants is more than 6, with most adults getting only 2 or 3. (source: Lancet, Jan 4, 2003, p. 51)

What can I do to make it go away faster?
Nothing, unfortunately. There are no antibiotics which will make a cold less severe or shorter. If fever is causing discomfort, that can be treated. In general, resting and drinking fluids is all that can help with the symptoms.
What can I do to make my child more comfortable until it goes away?
Removal of mucus is the single most helpful thing. Mucus plugs the nose, causing facial pain and making breathing uncomfortable. Mucus falls into the lungs, causing coughing. Mucus falls into the stomach, causing nausea. Older children who can blow their nose should be encouraged to do so, rather than sniffing the mucus back inside. Hot steam such as a shower can make blowing of the nose more successful. For younger children, a soft rubber nasal suction bulb can be used to clean mucus from the nose. Nasal saline solution may be helpful to remove thicker mucus.
What about the coughing?
Cough is a natural body defense to clear undesirable material from the lungs, so the best thing is to prevent mucus from entering the lungs at all, as described directly above. Apart from that, propping the head of the child’s bed helps the mucus to drain into the stomach instead of building up in the throat. Over-the-counter cough remedies do not contain strong cough suppressants and are not very effective. For children with terribly bad coughing, we may (occasionally) recommend a prescription-strength cough remedy, but we will not do so without examining the child to make sure that the illness is nothing more serious than a cold. Do not expect to fully eliminate coughing, which is a necessary part of the body’s defense against illness.
How can I tell if it’s something worse than a cold?
Warning signs of serious infection of the lungs include persistent fever (more than 4 days) and especially difficulty breathing. This means that the child is breathing quickly and cannot catch his breath, not simply that the sound of the breathing is noisy. Noisy breathing due to nasal congestion is very common in harmless colds. Wheezing is a high pitched sound during breathing which may indicate a problem deeper in the lungs than simple viral bronchitis. If you notice wheezing, persistent fever, or rapid breathing in your child, inform us immediately.
Can my child go to daycare or school with a cold?
Colds are so common in children that it’s not considered good to keep them home, unless they have fever. Children with fever should not return to school or daycare until they are fever-free for at least 24 hours.

What is RSV?

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Suzanne Berman, M.D.

I would give up a year’s salary if I had a safe and effective vaccine against RSV!

What is RSV?

RSV (respiratory syncytial virus) is a very common winter cold virus. Adults and children who get it tend to have a cough, stuffy nose, and sore throat – indistinguishable from most other winter colds. However, they can pass it to infants and young toddlers, and the result can be severe. It is very contagious and is spread by coughing and sneezing. Young infants usually get it from their parents, older brothers or sisters, or older playmates at daycare – who may seem to have just a cold or sometimes have no symptoms at all.

What is bronchiolitis?

Babies with RSV usually just get very bad colds, with horribly runny noses. In fact, babies can make so much nasal mucus that they can choke or gag on it. Unfortunately, they can also get “bronchiolitis” – inflammation of the small airways deep in a baby’s lungs. Bronchiolitis causes severe coughing, fast shallow breathing, and wheezing. Occasionally it can be so severe that babies end up in the hospital.

What can I do for my child’s RSV infection?

Begin by doing exactly what you would do for any bad cold in a baby:

  • Encourage lots of liquids. Fluids help keep a child well hydrated, which keeps the mucus loose. The baby may not feel like drinking as much as usual, so offer feedings twice as frequently as usual. Breast milk, formula, juice, or water are fine for older infants (more than 6 months). Younger infants should get only breast milk or formula unless otherwise instructed.
  • Keep the nose cleaned out with nasal saline drops and a suction bulb. RSV infections in babies cause an incredible amount of mucus. Nasal saline drops moisten hard, dry mucus; the bulb helps suck out the mucus in a baby too young to blow his or her nose. You may have to do this several times an hour for a while – think how much you have to blow your nose when you’re sick. See our information sheet on how to use a nasal bulb suction.
  • Run a cool mist humidifier in the baby’s room. Just like nose drops loosen the mucus in the nose, the humid air will loosen the mucus in the baby’s lungs, allowing her to cough up the mucus.
  • Elevate the head of the baby’s crib with blocks or books. This will help the baby’s mucus drain out the nose, not drip down the throat where it causes coughing and choking.
  • Don’t let anyone smoke in the house or in the car with the baby. Don’t let anyone hold the baby after smoking unless they have washed their hands and changed their clothes. Smoke always makes wheezing worse.
What can I do for my baby’s bronchiolitis?

If your child’s RSV infection progresses to bronchiolitis, you will want us to check him in the office. In addition to doing the above things, you will want to watch your baby’s breathing very closely:

  • How fast is your baby breathing? You can count the number of times your child breathes in a minute. Normally, healthy infants breathe about 30-35 times a minute. Infants with bronchiolitis breathe 45-80 times a minute. If your baby breathes more than 60 times a minute, he probably needs to be put in the hospital (babies breathing this fast usually can’t eat or drink.)
  • How hard is your baby breathing? Watch your baby’s chest rise and fall. If it rises and falls gently, your baby is in good shape. If the baby is pumping his belly in and out quickly, and his ribs are spreading and contracting wildly, that is a sign that the baby is getting worse.
  • Is the baby wheezing? This is different than simply noisy or congested breathing. True wheezing occurs when the baby exhales. Ask us to demonstrate for you the difference between noisy breathing and wheezing.
  • Is the baby getting enough to eat and drink? If the baby has been taking a bottle, keeping it down, and wetting his/her diaper every 4-6 hours, that is a good sign that his breathing isn’t severe enough to keep him from eating. However, if the baby can’t or won’t eat because of breathing or coughing, he needs to be seen.
  • If you think your baby’s breathing is getting worse, have him or her checked out right away. It is very common to have ill babies come back to the office three or four days in a row for rechecks, to keep them out of the hospital.
Are there any medications that help RSV?

Unfortunately, there is no single medication that works well for RSV. The following are some medications that have been used to treat RSV infections:

  • Breathing treatments. Albuterol is an inhaled medication that relaxes tight airways. Although albuterol has been used for years in babies with RSV, recent studies are challenging this practice. The latest information shows that albuterol rarely helps otherwise healthy babies with RSV. Rarely, we might recommend albuterol breathing treatments for your baby. If someone else suggests albuterol for your baby but we haven’t recommended it, please let us give you more information on your baby’s specific case.
  • Antibiotics. RSV is a virus, and antibiotics never help viruses. However, babies with RSV are at higher risk to get bacterial infections (like ear infections), for which we will recommend antibiotics.
  • Over the counter medications. Most over-the-counter cough and cold remedies won’t help in these young babies. In fact, we don’t recommend cough suppressants in RSV because the baby needs to cough up the mucus to get better. Acetaminophen (Tylenol®) may be used for fever above 101, if the baby appears uncomfortable.
  • Oxygen. Babies who are not getting enough oxygen because of their illness can get inhaled oxygen in the hospital.
  • IV fluids. Babies who are getting dehydrated because of their illness can get IV fluids in the hospital.
  • Other medications. For many years, doctors prescribed other medications such as steroids and antivirals (like ribavirin) for RSV. We know now to avoid them, since studies have shown they don’t help, and can have undesirable side effects.
How long does an RSV infection last?

Most bad colds last 7-10 days. RSV can hang on longer; in some bad cases, cough and congestion can last two weeks or more. A recent study done in South Africa showed that 10% of babies with bronchiolitis were still having some symptoms a month after infection! After a week, though, a baby should be getting a little better every day. If not, we should see your baby in the office to make sure there are no complications, like pneumonia or an ear infection.

If you get RSV once, can you get it again?

Unfortunately, yes. RSV is similar to influenza – you can get it more than once. The good news is that the first infection is the worst, and subsequent infections are milder.

What is Synagis?

Synagis is a injection given monthly during the winter to prevent RSV infection in infants who are at high risk for RSV. It’s not a vaccine, so it doesn’t give permanent immunity. It works well, but the cost is so high (sometimes $6000 for the series of injections) that insurance companies will only approve the shots for babies with special problems, like prematurity, heart defects, bad lungs, etc. We will let you know if your baby is a candidate for Synagis.

What is rotavirus, and what can I do for it?

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Suzanne Berman, M.D.
What is rotavirus?

Rotavirus is a common illness that causes vomiting and diarrhea in young children in the spring months. Occasionally, it can be so severe that it is a major cause of death in children in developing countries who do not have access to medical care.

What are the symptoms of rotavirus infection?

Usually children have fever and vomiting for 2-3 days and severe diarrhea for 4-5 days. (Loose stools can persist for a couple of weeks.) The diarrhea is usually very watery, without blood or mucus, but is often very foul-smelling. Sometimes the stools are explosive; sometimes children have more than 20-30 stools a day early in the illness.

How is rotavirus spread? Where did my child get it?

Rotavirus is most common in children between 4 months and 2 years of age. In central Tennessee, rotavirus is most common between Easter and the early summer, although children can get it any time of year. It is transmitted by coming into contact with infected stool. The virus can live on surfaces for many hours and has been found on toys, water fountains, toilet handles, and telephones.It takes 1-3 days to come down with symptoms after being exposed. Infants and toddlers tend to spread it to each other in daycare and church nursery settings. Almost all children have had it at least once by age 3, although many of these cases are very mild. About 40% of adults who are around a child with it will become infected and can spread it, usually without showing signs of being infected.

Unfortunately, people can get rotavirus several times during their lifetime.

How do you test for rotavirus?

A rapid test for rotavirus can be run on a child’s stool sample. Many times, however, we suspect rotavirus just based on the child’s symptoms and appearance. In this case, we may not even test the child’s stool sample. Also, regardless of whether your child has rotavirus, or a rotavirus-like illness, it doesn’t usually change what we do.

What can I do for my child’s rotavirus?
  • Give liquids by mouth. For infants, breast milk or formula is the best choice. Most children can keep some breast milk or formula down, even if there is some vomiting. If your child vomits up liquid, try offering it in smaller amounts. The amounts may be very small — sometimes parents have to give a few tablespoons every 15 minutes. This is tedious, but it will do the trick most of the time!
  • Unless your child is dehydrated, there is no need to give Pedialyte. Pedialyte is used to rehydrate dehydrated children as a last resort instead of giving them an IV. It does not prevent dehydration any better than another liquid. Also, it is pretty expensive. Once your child is rehydrated, there is no need to keep using it, even if your child continues to have vomiting and diarrhea.
  • Don’t give very sweet or concentrated liquids, like fruit juice or soft drinks. These tend to make diarrhea worse. Stick to breast milk or formula for infants; offer older children water, half-strength lemonade, or Popsicles.
  • If a child is extremely dehydrated and parents are unsuccessful giving liquids by mouth at home, we will give intravenous (IV) fluids in the hospital. We try to avoid hospitalization because rotavirus can be spread to other children in the hospital, and because of the expense. Fortunately, 98% of children with rotavirus can be treated successfully at home.
  • Let your child eat as soon as she or she wants to eat. It is now known that early eating (within 24 hours after symptoms start) actually helps children get better faster. Eating the right kinds of foods stimulates the intestinal tissue to repair itself. Good foods for rotavirus infection are starchy and high in carbohydrates. These include:
    • crackers
    • bread or toast
    • noodles
    • rice or rice cereal (for infants)
    • baked potato (without butter)

    Some people mistakenly think that a child should get only Pedialyte (or other liquids) until he or she is diarrhea-free. This can prolong diarrhea and actually make the child worse. Remember, encourage your child to eat.

  • Keep track of your child’s intake and output. This will help you assess his or her progress and will give you some information to share with us. See our intake and output flow sheet for a sample.
  • Try lactobacillus. There is new information that suggests that lactobacillus, a “good bacteria” found in the intestine, can help children get over rotavirus a little bit faster. Lactobacillus is naturally found in yogurt and can be purchased over the counter at pharmacies. Let us know if you are interested in trying this.
  • Try a diarrhea formula. Sometimes children become sensitive to lactose in milk during rotavirus infection. If your child is formula-fed, there are some special infant formulas that are lactose-free and can reduce the amount of diarrhea the child has. After your child gets better, you can switch back to his or her usual formula. (Note: breastfed infants do not usually become sensitized to their mother’s lactose and thus do not require switching to formula.)
  • Don’t give other medications. The American Academy of Pediatrics recommends that diarrhea medications not be given to children with rotavirus. Experts agree that these medications, either prescription or over-the-counter, are generally not helpful in rotavirus infection: “Neither antibiotics, antisecretory drugs (e.g., bismuth subslicylate [Pepto-Bismol]), antimotility drugs (e.g., diphenoxylate, atropine, loperamide [Imodium]), absorbents (e.g., kaolin [Kaopectate]), nor antiemetics (e.g., phenothiazines) play a role in [treating] rotavirus.” (Mandell, Principles and Practice of Infectious Diseases, 5th edition.)In fact, some of these medications can be harmful for infants and toddlers, which is the age group most likely to get severe rotavirus infection. Therefore, we rarely recommend using these medications.
What do I need to watch for?

Watch for signs of dehydration. (Read more about dehydration.) If you think your child is getting dehydrated, and your attempts to keep fluids in your child at home aren’t working, please let us know right away. Dehydration is much more common when a child has vomiting and diarrhea. Children with diarrhea alone, even if it is severe, usually don’t get dehydrated as long as they can keep enough down by mouth.

How can I prevent the rest of my family from getting rotavirus?

Children are contagious for a few weeks after coming down with symptoms. Therefore, you’ll want to be sure to do the following:

  • Vaccinate your baby! There are two vaccines now available that help protect against this nasty disease.
  • Wash hands frequently. Teach your children how to wash their hands well with soap several times a day. Unfortunately, a “quick rinse” under the faucet without scrubbing with soap does nothing to kill the virus.
  • Wash surfaces well. Clean bathrooms, countertops, etc. with a bleach solution and water.
  • Consider using disposable gloves to change infected diapers While not a substitute for handwashing, it will prevent stool particles from getting in hard-to-wash areas (like under fingernails.)
  • Breast feed your infant. Breast milk protects against rotavirus infection. Also, breastfed infants who get rotavirus have milder disease.

What is influenza?

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Suzanne Berman, M.D.
What is influenza?
Influenza (“the flu”) is a viral illness that typically hits Tennessee in the late fall and winter. Symptoms include:

  • fever (often very high, up to 106.5 degrees)
  • fatigue and exhaustion (can last 2-3 weeks)
  • headache and muscle aches
  • red, watery eyes
  • cough (usually dry)
  • runny nose
  • sore throat

Although people may refer to bad colds or other viruses as “a touch of the flu,” true influenza is much more severe. In fact, it doesn’t usually just touch you — it feels more like a hammer!

I’ve heard of influenza A and B. What does that refer to?

The two major influenza strains referred to as A and B.Influenza A (about 90% of all cases) is the cause of the major pandemics (worldwide epidemics) of influenza that have occurred.

Influenza B (about 10% of cases) is less common and less severe than Type A, but is often associated with specific outbreaks, such as in nursing homes or daycares.

How is influenza diagnosed?

Rapid tests are now available for diagnosing influenza in our office. We can use a cotton swab to get a mucus sample from one nostril; results can be back in as soon as 5 minutes.In cases of community epidemics, or when it is known that a family member is positive for influenza, we will sometimes not test a child if he or she is showing classic influenza symptoms.

Can influenza cause serious problems?

Fortunately, most healthy kids recover from influenza without complications. However, influenza can cause lots of problems:

  • About 1% of people who get the flu end up in the hospital.
  • In the winter, as many as 30% of all children in the hospital are there for complications of influenza. In children, this is usually related to dehydration; less commonly, influenza pneumonia can occur.
  • During the 2003-2004 flu epidemic in the US, about 150 children died from influenza. Half of these children were previously healthy youngsters.
  • Even a relatively mild case of influenza can cause lots of time in missed school, missed work, and lots of money spent on doctor’s visits, medicine, etc.
How can I keep my family from getting influenza?
  • Good handwashing. Ordinary soap is sufficient. Alcohol-based hand gels are useful if soap and water are not handy.
  • Breastfeeding your baby. Women who breastfeed reduce the risk of respiratory infections in their children.
  • Annual flu shots. Studies are finding that the more people that are vaccinated, the healthier the community at large. Some points to remember:
    • Flu shots do not give you the flu.
    • Even if your child gets a strain of influenza not covered by the flu shot, his or her symptoms will be much milder.
    • We recommend influenza shots in all children over 6 months old, especially those who are at risk: daycare attenders, children with asthma or other lung conditions, children prone to febrile seizures, etc.
    • If you are pregnant or nursing, you can still get the flu shot.

What medications help influenza?

  • Tylenol and ibuprofen work well for fever and achiness.
  • Prescription antiviral medicines. Because influenza is a virus, antibiotics are not helpful against it. However, there are some medications which can shorten the course of influenza a little and make people less contagious if they are started within 48 hours of showing symptoms. The two most common medications pediatricians use are amantadine (Symmetrel) and oseltamivir (Tamiflu). Both are approved for children over age 1 year. Unfortunately, many strains of influenza are now resistant to these medications, and they can cause nausea and vomiting in many children.
  • Do not use aspirin in children or teenagers who have influenza. There is a small chance of getting Reye’s syndrome (liver failure and coma), a rare but sometimes fatal disease.

What are the risks and benefits of getting myringotomy or ventilation tubes (“ear tubes”)?

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Suzanne Berman, M.D.
What do ear tubes do?
If fluid and debris cannot escape the middle ear through the natural Eustachian tubes, putting a tube through the ear drum lets the fluid drain out another way. (Read more about what causes ear infections here.)
When should a child get ear tubes?
Based on recommendations from both pediatricians and pediatric ear, nose, and throat specialists, we recommend considering ear tubes if a child has three separate ear infections in a six-month period, or four infections within one year. We also recommend tubes if there is a buildup of fluid in the middle ear (infected or not) for more than 3-4 months, because fluid buildup can cause hearing loss over the long term. There are other reasons why we will suggest tubes, such as certain kinds of speech problems, children with immune problems, and children with certain kinds of ear and face defects (like cleft lip or cleft palate.)
What is the surgery like?
An ENT (ear, nose, and throat) surgeon makes a small incision in the ear drum and inserts a tiny plastic tube into the hole to keep it open. A child usually does not need deep anesthesia for the surgery, which usually takes only a few minutes. About one million children have tubes put in every year without problems. In fact, it’s the most common surgery children have. If you have more specific questions about the procedure, ask the ENT surgeon where we refer you.
Will tubes cure ear infections completely?
Unfortunately, no. Ear tubes do mean the end of ear infections for many children, but other children still get ear infections after tubes. Also, tubes are designed to fall out between 6 and 12 months after they are put in. The tubes may work very well after they are put in, but the ear infections may return after the tubes fall out. (In this case, a second set of tubes may be needed.) In spite of all this, it is fair to say that, for most children, tubes dramatically cut down on ear infections.
What about preventive antibiotics instead of tubes?
For a long time, many pediatricians suggested prophylactic (preventive) daily antibiotics instead of ear tubes, which were seen as a last resort only if the preventive antibiotics failed. Some physicians will still occasionally recommend this. We don’t recommend this any longer, however, for the following reasons:

  • The types of antibiotics we use for prevention usually don’t work as expected.
  • The surgery is so simple and quick that there’s really no need to avoid it.
  • Antibiotics, especially when used every day for months, have side effects, including diarrhea and yeast infections.
  • We are trying to use antibiotics sparingly, now that there are so many resistant bacteria.

What causes ear infections?

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Robert Berman, M.D.
Suzanne Berman, M.D.
Why do children get ear infections?
The middle ear normally secretes a small amount of fluid. When a child is healthy, this fluid easily drains through the Eustachian tubes to the back of the nose. However, when a child gets a cold, allergies, or sinus inflammation, the middle ear makes a lot more fluid (just like the nose runs more than usual.) Unfortunately, the Eustachian tubes become swollen and puffy, making it hard for the extra fluid to drain out. The warm, moist fluid builds up in the middle ear, providing an inviting habitat for bacteria to grow. Children do grow out of ear infections eventually — older children and adults have bigger Eustachian tubes that drain better.
What puts a child at risk for ear infections?
In addition to having a cold and being young, the following are also known to be risk factors for ear infections:

 

  • Cigarette smoke exposure.

 

  • Pacifier use. In a 2000 study in Finland, children who used pacifiers over the age of 6 months got 30% more ear infections than children who didn’t use pacifiers.
  • Bottle use, especially when lying down.

How are ear infections treated?
Most ear infections will go away without any treatment at all. Studies have shown that four days after symptoms began, 80% of ear infections ended without any antibiotic treatment, compared to 95% of infections which received antibiotics. This means that when antibiotics are given for ear infections, only about one child in seven gets any clear benefit. Since we can’t guess beforehand which children will benefit, pediatricians in the United States usually prescribe antibiotics as soon as an ear infection is detected. We will prescribe 10 days of an oral antibiotic (usually a twice-a-day medication.) It is very important to finish all 10 days of the prescription; otherwise, a partially-treated infection can come back worse than before. Antibiotic ear drops may be used to treat mild ear infections, but these are only used if a child has ventilation tubes.

What can I do to help my child’s ear pain?
Antibiotics may take 24-36 hours before they start to have a noticeable impact on the infection and your child’s ear pain. Even after the ear infection starts to clear up, children still sometimes have some residual ear pain. We recommend the following home treatments to keep your child comfortable:

 

  • Ibuprofen. This over-the-counter medication, used every 6 hours, can take the edge off your child’s ear pain. Check our dosing sheet for how much to give.

 

  • Warm compresses. Towels or cloths warmed in the dryer, then placed against your child’s face and ear, can sometimes be soothing. Even a stuffed animal, warmed against a heating pad, then given to your child to cuddle can be a comforting measure.
  • Analgesic ear drops. These precription drops can be put directly in the ear, as long as your child doesn’t have ventilation tubes in place.

Hasn’t my child had too many ear infections?
Even one ear infection is one too many! Unfortunately, ear infections are pretty common:

  • 44% have at least one ear infection by age 6 months
  • 86% have at least one ear infection by age 1
  • 90% have at least one ear infection by age 3, and 50% of these have had three separate infections by age 3.

If your child has had 3 ear infections in a six-month period, it might be time to consider ventilation tubes.

What can I do to help my child stop vomiting?

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Suzanne Berman, M.D.

Vomiting is pretty nasty sometimes, but fortunately it doesn’t usually last more than a day or two in otherwise healthy children.

What causes vomiting?
Vomiting is usually caused by irritation of the stomach. Lots of things can cause this irritation. The most common causes are:

  • Viral illnesses. Just like a virus can infect the nose and throat, it can infect and irritate the stomach. Also, swallowing lots of nasty nasal mucus from a cold can upset the stomach too. If a day or two of vomiting is followed by several days of diarrhea, the most likely cause is a viral illness.
  • Eating or drinking something unusual. This doesn’t necessarily imply food poisoning. The body sometimes rejects a food that is new or different. Also, eating too much of any one thing, even if it was tolerated before, can result in stomach upset.
  • Certain kinds of medications. Any medication can potentially irritate the stomach. Medications taken for a cold or “flu bug” are usually taken on an empty stomach, since the child isn’t eating or drinking much while he’s sick. Medicines on an empty stomach can irritate the stomach even more.

Can vomiting be dangerous?
Vomiting due to stomach irritation is no fun, but if it’s the only symptom, it gets better and isn’t life threatening. Rarely, vomiting is caused by a serious problem in the brain, like a head injury or meningitis. Fortunately, these types of brain problems have other symptoms besides just vomiting:

  • Severe, pounding headache or neck pain.
  • Visual changes: blurry vision, tunnel vision.
  • Change in level of alertness: lethargy, loss of consciousness, etc.

If any of these symptoms appear, or if your child looks very sick or dehydrated, bring him to our office right away. Otherwise you can treat him yourself at home (see below.)
What can I do to help my child stop vomiting?
Do everything you can to ease the irritation on the stomach. Try the following:

  • Offer liquids in small, frequent amounts. Offering too much fluid at once can bloat and distend the stomach, which can make vomiting worse.
  • Offering a little bit at a time prevents your child from putting ”all her eggs in one basket.” Even if your child does great and takes a lot of fluid, vomiting once can put her back where she started. On the other hand, drinking small amounts, allowing time in between to digest, means that at least some of it will be kept down if she vomits.
  • Begin by offering a small amount of liquids: only half an ounce every 15 minutes. If your child can keep down half an ounce two or three times, offer an ounce every 15 minutes. After a few one-ounce servings have been kept down, go to two ounces every half hour. Gradually increase the servings as they are tolerated.
  • Offer clear liquids first, like water, juice, Popsicles, lemonade, etc. These are easier for the stomach to digest. Opaque liquids like milk sit in the stomach longer, making them likelier to be vomited. Avoid caffeine-containing liquids like tea and soda; they can irritate the stomach.
  • Pedialyte and other oral rehydration solutions are very expensive. They are unnecessary unless your child is truly dehydrated, in which case you’ll want us to check him or her anyway.
  • Don’t worry about solid foods. Whether or not a child has an appetite for solid foods, or can keep solids down, is not important. Once your child is better, he or she will “catch up” quickly. Avoid solids until the vomiting has stopped for at least 24 hours.
  • Don’t give medications by mouth until the vomiting has stopped for at least 24 hours. For high fever, give acetaminophen (Tylenol) suppositories in the rectum.

If your child still can’t keep any clear liquids down, even when offering half an ounce every fifteen minutes, or begins to look dehydrated, let us know right away.

What can I do for my child’s diarrhea?

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Suzanne Berman, M.D.
What counts as diarrhea?

Most children have a couple of episodes of mild diarrhea a year. The stools can be more watery, more frequent, or both. Since most healthy young children have periods when they have 3-4 stools a day, we usually don’t worry unless a child has more than 6 loose stools in a day: it’s nearly impossible to have serious consequences like dehydration if the child is having 4-5 loose stools a day, but is otherwise well. In fact, there are some stages in your child’s life when he or she should have this kind of stools. Young infants especially have variety in their stools, depending on whether they are breast or formula fed. but this is very normal.

What causes diarrhea?

Diarrhea in children is almost always caused by a viral illness (like the “stomach flu”). Viral diarrhea often goes hand-in-hand with vomiting and a few days of fever. This kind of diarrhea can last 3-10 days. Diarrhea can also be caused by diet. Any variation from a child’s usual diet can cause loose stools. In young children, it often results from too much juice (more than 6 ounces a day), too much soda, or too much caffeine. “Diet diarrhea” usually comes and goes but can last weeks to months. If you are suspicious that your child’s diet may be causing loose stools, keep a diet diary and bring it to the office for us to review together.

What can I do for my child’s diarrhea?

  • Let ‘em poop. First, remember that diarrhea is the body’s natural way to get rid of germs in the intestine. Therefore, letting viral diarrhea run its course is a good plan. Even for many bacterial causes of diarrhea (such as salmonella and E. coli), the best course of action is to let it run its course. The stools may be profuse, even explosive, but they will get better with time.
  • Let ‘em eat, if they want. Unless your child has an excess of sweets (including juice) in the diet, no special modification of his diet is necessary. Sometimes children have belly cramps with diarrhea, and so their appetites aren’t great. That’s okay — they’ll get their appetites back within a week or so. Many physicians used to advocate cutting out all dairy products and certain solid foods. New evidence suggests that this is not necessary: it doesn’t make a difference in how fast the child gets better, and it makes the child hungry (and thus crabby.)
  • Lots of fluids. Encourage lots of fluids to help keep your child hydrated. Your child can have water, milk, weak juice, popsicles, weak Kool-Aid, lemonade, or whatever sounds good. Again, avoid very sweet drinks as they can make diarrhea worse. Also, avoid caffeinated drinks (tea, cola) as much as possible.
  • Don’t use Imodium to stop stools in children under 12. With certain kinds of diarrhea, Imodium can rarely cause dangerous side effects.
  • Don’t use Pepto-Bismol. Pepto-Bismol contains salicylates (similar to aspirin). Like other aspirin containing products, it should not be used in children unless directed by a doctor.

If your child is having vomiting as well as diarrhea, some diet modifications will help until the vomiting resolves. our information sheet on vomiting.

When should I worry about diarrhea?
Most diarrhea can be treated at home. You should have your child checked out if any of the following occur:

  • There is blood or mucus in the stool.
  • Your child is having very severe abdominal pain.
  • The diarrhea lasts more than 10 days without improving at all.
  • Your child seems to be getting dehydrated. (See our information sheet on dehydration to see what to look for.)
  • Your child is less than 6 months old. (Small infants get dehydrated faster than older children.)
  • Your child looks very ill or lethargic.

How can I get rid of this stubborn staph infection?

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Suzanne Berman, MD

Staphylococcal infections (“staph”) can cause painful, angry red boils on the skin. Frequently, these skin infections clear up quickly after the boil is lanced and the child begins taking prescription antibiotics. Unfortunately, these infections recur frequently, sometimes three or four times within just a few months. Families get frustrated with taking multiple rounds of antibiotics. Sometimes parents even begin to worry that their child might have a severe underlying problem that makes their child susceptible to skin infections.

The good news is that immune deficiencies that cause recurrent skin infections are pretty rare. The bad news is that the staph bacteria is very tough to get rid of completely, once it’s on your skin.

What is MRSA?
MRSA (pronounced “mur-sah”) stands for methicillin-resistant staphylococcal aureus. Methicillin is a kind of antibiotic that, as the name implies, is no longer good at killing the staph germ.

MRSA, like any germ, has the potential to cause serious or even life-threatening infectins. Most of the time, though, it isn’t really dangerous, just stubborn — not too hard to cut down temporarily, but nearly impossible to get rid of completely.

How can I get rid of this stubborn staph infection?

In addition to taking the prescription antibiotic, be sure to:

  • Use a topical prescription antibiotic like Bactroban (mupirocin) inside the nostrils twice daily for 1-2 weeks. Children tend to harbor staph in their noses. Apply a small ribbon of antibiotic gel to the inside of both nostrils with a Q-tip.
  • Use a bleach solution in the bath as a body wash. You can use ½ cup of bleach in a full bath of water or 1 tsp per gallon of bathwater. Sit in the tub for 15 minutes at least twice a week. You can also put about a 1/2 tsp of bleach into a 32 ounce plastic “trigger squirt” bottle, fill the rest of the bottle with water, and use it as a “body spray” in the shower. (Be sure to avoid the eyes, nose, and mouth.) If bleach cannot be used, you can use prescription Hibiclens.
  • Keep fingernails short and clean.
  • Change and wash every day:
    • towels
    • washcloths
    • pillowcases
    • bedding
    • underwear
    • pajamas
  • Dry towel and clothes in a hot dryer, as opposed to a clothesline.
  • Don’t let family members share towels or other common household items, like razors.