Summer brings a welcome break from winter’s colds and flu and springtime pollen, but it too has its perils. We share the outdoors in summertime with all manner of insects, arachnids, snakes (most are harmless, but if they’re not…), and sea and lake dwellers. With preparation and a little luck, we can all enjoy being outside. We share the earth with these creatures, and for the most part, they do us no real harm. In this article, I will talk about insects and arachnids. The next article will deal with snakes and jelly fish and other water-dwelling creatures that bite and sting. (more…)

I believe that nothing gives parents more pain than watching their child face pain, especially medical pain. Even relatively small things—shots, bleeding cuts, stitches—give parents (and of course children) a hard time. When more daunting things are happening—surgery, serious illness, serious injury, or hospitalization—most parents are going to be suffering a lot. The child’s pain actually hurts you, his fear frightens you. Your children are the most important things in your life, and they are in peril. No wonder you are hurting. I don’t know many parents who wouldn’t gladly undergo twice the pain their child was facing if it would spare their child.

So it is a cruel irony that the most important gift you can give a hurting or fearful child is your strength and confidence, your absolute certainty that everything will be all right, that they can handle it, that the situation is under control, that you will make sure that they are all right, that you will be with them whenever possible, that the medical personnel have only their best interests at stake, and that they are wonderful and have your complete confidence. No matter what you’re feeling.

Projecting this existential stance is a tall order when you are somewhere on the spectrums of frightened, angry, ambivalent, conflicted, guilty, sick yourself, or whatever. It’s not easy even when you are confident that you are doing the right thing for the right reasons with the right people, simply because it’s upsetting when your child is upset. (more…)

There are coughs and there are coughs. Some are annoyances, some signify important health problems, some interfere with sleep. But few coughing illnesses can compare with whooping cough, a disease that had become uncommon but that is now making a comeback.

It is exhausting to have a cough for a few days. But whooping cough has been called the 100 day cough. Can you handle one that lasts for months, or watch your child in an awesome display of desperation and air hunger as he tries to fit a breath of air into the paroxysm of coughing? Over and over, day after day, the whoop, the exhaustion. It’s a scary disease and can be a deadly disease, especially for the very young.

Whooping cough is back.

Back in the olden days—the 1930s and 40s—thousands of American babies died each year from whooping cough (whose medical name is pertussis, caused by a bacteria called Bordetella pertussis). With the advent of immunization, whooping cough became very uncommon. In 1976 there were only 1000 cases reported in our country. But the number of cases has steadily increased, and in 2005 there were 25,000 cases in the USA. Even now whooping cough leads to many hospitalizations and even deaths from asphyxiation, stroke, seizures, pneumonia, collapsed lungs, broken ribs.

The signs of whooping cough
In the past weeks, several cases of pertussis have been reported in the Triangle area. In older babies and children it starts with what seems to be a regular cold with an unremarkable cough. After a week or two the cough gets much worse. There are coughing spells or “paroxysms” that are often ended with a “whoop” as the child tries to pull air into his lungs at last. This stage can last for 6 weeks of longer. Then there is a convalescent stage when improvement starts. This stage can last weeks to months. (more…)

What happens when we get an ear infection?

Ear infections occur in the middle ear—the part of the ear that has the little bones that conduct the sound from the ear drum to the inner ear. The middle ear is a small, completely enclosed chamber with a tube (the Eustachian tube) that is able to open and that connects to the back of the throat behind the nose. When things are going well, the chamber is filled with air and the tube can open and allow the pressure inside the middle ear to be equal to outside air pressure. The tube also opens and closes to allow the middle ear to keep itself clean and empty.

But there are several ways that problems can occur. The nearby nose and throat are full of bacteria that have been trapped there as they try to enter our bodies. These bacteria live in uneasy harmony with us, but they are always ready to infect us if they can find a way to do so. Some of these bacteria will find their way up the tube to the middle ear, but in a healthy person with a fully functioning response system and Eustachian tubes, the bacteria will be repulsed or killed.

So ear infections happen when an environment is created that allows the bacteria to get into an area where it will be safe, where it can grow and expand and “raise a family”. That area is often the middle ear. Most commonly this occurs when we have gotten a cold. The cold virus weakens our ability to fight off bacterial infection in many ways. And the virus irritates the linings of our nose and throat. The irritation can make the Eustachian tubes function poorly. Tonsils and adenoids get large in an effort to fight off the virus, and so they too can block the function of the Eustachian tubes. (more…)

Q. What is cradle cap, how can it be avoided and how do you treat it?

Cradle cap is a form of seborrheic dermatitis, a skin condition that causes yellow crusty scales to appear on the skin. In babies, it usually occurs on the scalp and behind the ears. Sometimes it can also involve the eyebrow and eyelid areas. Rarely, it can be an extensive rash on much of the body. When it just involves the head, it is usually mild, not life threatening, not scarring, and will usually resolve by about 1 year of age. The causes and cures of cradle cap are not well studied and not well understood, and for this reason, there are a multitude of conflicting recommendations and cautions about its management.

The causes:
There seems to be a certain fungus that either causes the cradle cap, or likes to grow in it. It has the rather silly sounding name Malassezia furfur. And cradle cap and seborrhea tend to run in families, so there is probably an inherited predisposition to get it. Since it is “outgrown” at about a year of age, there may be a component of immune insufficiency that resolves as the immune system of the skin matures. (more…)

Q. What is the best way to treat a diaper rash?

Diaper rash is usually caused by irritation and/or yeast. Changing the diaper soon after soiling or wetting, gentle cleansing with a well-tolerated cleanser, and application of barrier creams, such as Desitin or A&D ointment, and/or anti-yeast creams such as Nystatin, can be helpful. Soaking in a warm bath or exposing the area to the air can also be helpful and soothing to irritated skin.

But as with everything in medicine, there are occasions where a diaper rash may be more concerning. Sometimes the irritated skin can get infected and will need other treatment. Sometimes the rash may be the sign of an illness that may or may not be important. If the rash does not improve with the above care, it would be a good idea to see the baby’s pediatrician. If a child is having a rousing case of diarrhea, you can be sure you are going to be dealing with diaper rash despite your best efforts as long as the diarrhea persists. Prolonged diarrhea (10 to 14 days), bloody diarrhea, diarrhea associated with fever, or diarrhea that has resulted in dehydration should suggest a trip to the pediatrician.

Q. What tips do you have for parents with newly potty-trained children regarding occasional nighttime bed-wetting?

The short answer is: Don’t do anything and don’t worry about it. Down-play it and deal with it. “That happens sometimes. Don’t worry about it. Let’s clean it up.” Sometimes it is helpful to cut down on late evening fluid intake. Some people find it helpful to get the child up to urinate before they go to bed.

The longer answer involves thinking about other factors:

How occasional is ‘occasional’? Many children become day trained long before being night trained. Don’t martyr yourself on a pile of laundry. Put him back in pull-ups (very matter-of-fact-ly, not as a punishment) and wait till he is usually dry at night to try again. Low-key, small rewards for dry nights may add some incentive in borderline cases.

How long has he been toilet trained and how long has he been dry at night? Recurrence (as opposed to persistence) of nighttime wetting can signal urinary tract infections or can be a response to significant stress. If these are concerns, see your child’s pediatrician.