Hand, Foot and Mouth…..and Butt??

I’ve been on call this weekend, and gotten quite a few calls about fevers and rashes that sound like Hand, Foot and Mouth Disease. This illness is very common during the Spring and Summer months, is highly contagious, and very common among young children. For those of you that are wondering, is this the same thing as Foot and Mouth Disease? NO, totally different!!!

Hand, Foot and Mouth is a Coxsackievirus that causes bumps, blisters, and/or ulcers 

  on the hands, the feet,

in and around the mouth, 

and Yes, on the buttocks and backs of the legs.The bumps that appeared on the backside and back of the legs of a toddler is what prompted one of the calls from a Mom this weekend. Actually, the only symptoms that this child had were fever and red throat when he was seen in the office. Over the past 24 hours, the bumps on the buttocks and back of the legs appeared. So far, there is no hand or foot rash involved. All cases of Hand, Foot and Mouth present differently, not everyone gets the typical rash. Some kids will only have a fever and sores in the mouth, and possibly go undiagnosed.

This virus is spread via direct contact with nose and throat secretions, saliva, fluid from blisters, or the stools. Most people will get Hand, Foot and Mouth as a child, and then more than likely never get it again. The incubation period is about 3-7 days.  Most parents will not get the virus because they were exposed as children. Although, I do know of one mom that got it, and got it pretty bad. Ouch!!

Hand, Food, and Mouth starts with a fever, and usually the fever is pretty high, up to 103′s. The fever starts prior to the arrival of the rash. During the febrile stage the child typically doesn’t want to eat. They aren’t eating because the sores in the mouth are painful. The goal of treatment during this stage is to keep the child hydrated. I highly recommend giving cold drinks, freeze pops, popsicles, pudding, yogurt, milkshakes, smoothies, etc. DO NOT give the child anything that is hot, spicy, or acidic. Orange juice, soda and pizza would be a NO NO!

There is no medicine to treat Hand, Foot and Mouth. The only thing Mom and Dad can do is keep their little one comfortable. Giving Tylenol or Motrin for the fever and for the pain caused by the ulcers is the best way to handle this difficult time. As with any other virus, antibiotics will not help! I’ve said it before and I’ll say it again – Antibiotics are for bacterial infections, they will NOT get rid of viruses. Viruses are not bacteria. Keeping your child comfortable and treating the fever are your top priorities. If you need to know more about fevers in children, please check out my blog on Fevers: To Treat or Not To Treat??

Hand, Foot and Mouth usually last about 5-7 days. Keeping the child home from daycare, school, and away from other children will help prevent the spread of disease. Unfortunately, the fever typically precedes the rash and may not be that high in the beginning, so others may be exposed accidently. I was guilty of this when Joshua was in pre-school. I thought he was cutting molars, and gave him Motrin because his temperature was 100-101F. After a few days, his temp when up to 102.9. I had him evaluated by his pediatrician, and that is when we discovered the ulcers in his mouth. So, the fever and not eating wasn’t teething after all, and I had exposed the whole preschool. Oops, I felt bad, but there wasn’t anything I could do except warn the teachers and other parents, and tell then what to watch for.

Hand, Foot, and Mouth is one of those childhood illnesses that everyone gets. As parents, it’s all part of the journey. Every parent has had to deal with Hand, Foot and Mouth. Some kids will only get a mild case, and their parents won’t ever know what that fever was because the rash was only in the mouth and never observed by a practitioner for diagnosis. Those children (and parents) that experience those mild, undiagnosed cases are the lucky ones! Hand, Foot and Mouth hurts, and if you child doesn’t have to suffer through it, be thankful!!

So, if you have a child that experiences a high fever anytime soon, keep in mind it could be this painful Coxsackievirus that should be called Hand, Foot, Mouth and Butt! 

Just another part of the journey for all of us parents to suffer through. As I always say, regardless of the difficulties, I hope you enjoy the journey!

Is that sore throat Strep? How to know…

It’s spring time, which means it’s the season for Strep Throat! Not that strep has to be in season, but spring is the most common time for strep. I’ve gotten a call today from a parent asking me if I would call in an antibiotic because her daughter has a sore throat and stomach ache. This child may very well have strep throat, but of course, I said “No.” The only way to determine if a child has strep throat is to have them evaluated, and 99.9% of the time a throat culture is needed for confirmation. I’m grateful the mom was understanding and planned on going to an urgent care facility after I spoke to her.

Symptoms of strep are sore throat, fever, headache, stomach ache, nausea, vomiting, rash, muscle aches, and petechiae on the palate.

Petechiae on the palate is usually diagnostic of strep.

Does the child always have a fever- No. Does the child always have a sore throat – No. Some kids will have no symptoms, but have a rash that presents with little red spots that are raised and feel like sandpaper. This sandpaper like rash is one of the symptoms that will cause me to forgo the culture. When children have lots of petechiae on the palate, and an extremely red throat, and usually really swollen tonsils, I don’t feel the need for a throat culture. When the throat looks this bad, it is strep and hurts to do a culture. When the throat has swollen tonsils with white spots, this is frequently, but not always strep, and a culture is needed.

I’m going to ask a favor of you – please help us! Children do not like throat cultures, but it is very important to obtain for proper diagnosis. When the parent is helpful, the culture is much easier for the child. I have had children beg their mom or dad “Don’t make me do it!!” This is when it is important as a parent to show some strength and be firm. Yes, the throat culture is necessary, please back me up!! Most kids really dislike having a throat culture done. I can’t say that I blame them, but it is a necessary evil. I often say that you would think we could figure out a better way to diagnose strep with all of the technology that we have nowadays. But, the bacteria that causes strep throat is hanging out on those tonsils.

Joshua has had strep throat twice. The last time he threw up so much I would have assumed it was a stomach virus if we hadn’t done a throat culture. The poor kid threw up for almost 8 hours, how miserable when you already have a sore throat. The first time he had strep he also had pneumonia. The poor guy had a high fever, was achy all over and was absolutely miserable! He didn’t even want to move. When he gets sick with strep, he really gets sick!

If you are worried that your child may have strep throat, please have them evaluated. Please do not ask your medical provider to just call in an antibiotic. Do not give your child an antibiotic that you have left over from a previous illness. If I child is on an antibiotic the throat culture will be negative even if they had strep throat. Also, you shouldn’t have antibiotics left over from other illnesses. When antibiotics are prescribed, they are usually meant be be given until the medication is all gone to properly treat the infection.

So, if it’s not strep, what could it be? It could be a URI, it could be allergies, it could also be mononucleosis. How do you know the difference, it’s not always easy to differentiate. It is very common for most upper respiratory infections (URI or cold) to present with a fever and sore throat. How do we know it is a virus and not strep?? Proper assessment, evaluation and culture. How do you know if it’s mono? Mono is confirmed by a blood test. Most sore throats (including mono) will go away without any treatment.

Sometimes a child can have more that one illness at a time. I spoke to a mom today that was wondering why her daughter wasn’t getting better after being on an antibiotic for strep throat (confirmed by culture) after 4 days on an antibiotic. The child started feeling worse 2 days ago. At the same time, she started with coughing and congestion. It sounds like she has a URI now, on top of strep throat, how miserable!!

Strep throat can sometimes go away without treatment, but could cause complications if not treated appropriately. Some of the complications of strep throat could be quite serious, such as rheumatic fever, scarlet fever, and glomerulonephritis. This is why it is very important for proper diagnosis and treatment.

If your child has strep, 10 days of Amoxicillin is the best treatment. Strep throat is contagious for 24 hours after starting the antibiotic. Sometime it takes a few days for the sore throat to feel better. Treat your child with Tylenol or Motrin for fever and pain relief. You can find the links to Tyelnol and Motrin dosing in the sidebar on this page.

So, the next time your pride and joy has a sore throat, make an appointment with your doctor or nurse practitioner, and ask for a throat culture. Hopefully, I have helped you understand why we need to gag your child when we suspect strep.

As challenging as it can be, I hope you are enjoying the journey!

Don’t eat that egg…You’re allergic to Ragweed…Huh??

Why in the world would I be telling you not to eat eggs if your allergic to Ragweed?? Concomitant Food Allergies.

Did you know there are certain foods that can make your environmental allergies worse? There are also foods that can worsen food allergies and food intolerance. These are called Concomitant or Synergistic Allergies. When certain environmental allergens are blooming (like ragweed for instance), eating these foods (such as eggs or milk) can make the allergy symptoms worse. Avoiding these foods during the blooming season is very helpful.

I wrote a post last week with basic allergy information, symptoms and treatment options, Springtime & Sneezes…You might have allergies if…. This post will help you recognize and treat your allergy symptoms.

You may not know what you are allergic to, and that is why allergy testing can be helpful!! Treating allergies isn’t easy, and knowing which allergens affect you can make developing a treatment plan easier. I remember calling my friend Kathy, RN/Allergy Specialist and asking her about Joshua’s allergies. She is my saving grace when it comes to Joshua and his allergies. (If you haven’t picked up on it yet, Joshua is definitely one of those kids that needs the entire village!) I have mentioned that Joshua has allergies, but has a negative RAST test. RAST testing is done via blood draw with lab testing to identify specific allergens.

There are many different panels that can be ordered depending on what part of the country you live in. Joshua was unable to do skin testing because he reacted to the control test that contained only saline. How his RAST test was negative alludes me… But, I say kids don’t read and follow the books. Also, we can’t test for every substance under the sun, it’s just not possible. Every April since this boy was 2 months old he has had a clear runny nose, that, my friends, is allergies!! No doubt about it. Some doctors will tell you that infants can’t have allergies. I beg to differ, I live with that clear runny nose, morning cough and sneezing each April, and have for 10 years now. Joshua eats a lot of apples, this high fiber food is actually necessary to help Joshua with another of his problems, but we can talk about why kids need fiber another day. So in April, when all the trees are blooming, Joshua avoids apples.

Keep in mind that allergy symptoms can be cough, congestion, clearing your throat, sniffles, runny nose, sore/scratchy throat, itchy/watery eyes, headache, skin rash, dry skin, eczema and asthma.

So, I wanted to share a list of specific foods that compound allergy symptoms. The following charts are provided by Online Allergy Center, and list what foods make specific allergies worse.

As you or your children sneeze and cough your way though this allergy season, I hope this information helps you Enjoy the Journey and beauty of Spring a little bit more!

Proven Concomitant Foods:

Rhus Allergy (poison ivy, oak, sumac)…	Pork, Black pepper
Ragweed…	Egg, Milk, Mint
Iva ciliata…	Wheat
Sage…	Potato, Tomato, Tobacco (chewing or snuff)
Pigweed…	Pork, Black pepper
Grass…	Legumes: Beans, Peas, Soybean, Cottonseed (cooking fats)
Cedar…	Beef, Yeasts (baker’s, brewer’s or malt)
Elm…	Milk, Mint
Cottonwood…	Lettuce
Oak…	Egg, Apple
Pecan…	Corn, Banana
Mesquite…	Cane sugar, Orange
Dust…	Oysters (seafood)
Molds…	Monilia, T.O.E., Cheese, Mushrooms, Truffles
Cystic breast disease…	Caffeine foods (thoephylline): Coffee, Tea, Cokes, Chocolate

Questionable Concomitant Foods (to be proven):

Dust…	Nuts
Influenza Vaccine…	Onion
Iva ciliata…	Tea
Chenopods…	Egg

Proven Synergistic Foods:

Corn…	Banana
Beef…	Baker’s yeast, Brewer’s yeast
Cane Sugar…	Orange
Milk…	Mint
Egg…	Apple
Pork…	Black Pepper

Questionable Synergistic Foods (to be proven):

Wheat…	Tea
Pork…	Chicken
Milk…	Chocolate

Springtime & Sneezes…You might have allergies if…

AAAACCHHOOOO! Excuse me! We’re having a little problem with allergies already this spring, how about you?!? It’s Springtime and allergies are in full flare! I love Spring, it is my favorite season! The grass is so green, the flowers are so pretty and brilliant, the birdies are singing, the air is warming up, what’s not to like? Well, ok, yes, the pollen and allergens that travel up our nose as we begin to venture back outside.

Can you recognize the symptoms??? Some patients tell me they don’t have allergies,  they just have a cough.

•  Well, if that cough is nagging you mostly at night and when you wake in the morning, you might have allergies.
• If you wake up and have to clear your throat or blow your nose, you might have allergies.
• If your child is coughing when they first wake up, it sounds a little wet, or a little hoarse, but then goes away in 30-45 minutes or so, they might have allergies.
• If you sneeze, you might have allergies.  
• If you have a sore, scratchy throat, but no fever, you might have allergies. (It is always a good idea to have a sore throat check out with your doctor or NP, if it’s strep, it has to be treated.)
• If you have a clear runny nose that doesn’t get worse and doesn’t go away, you might have allergies.
• If you have itchy, watery eyes, you might have allergies. 
• If your child has asthma and is wheezing, it may be worsened by allergies.

 There are many people that don’t think they have allergies, but they might…. . Keep in mind that if you notice these symptoms year round, your allergies may be indoor and outdoor. The best way to determine if you have allergies is to see you primary care provide or an allergist. My allergy doc and his RN/Allergy Specialist wife, are a great resource for me! They are two of the most knowledgeable people I know. They are the best!! If you are local, email me and I will give you their contact info. They would be happy to help!

There are millions of particles floating around in our environment.  Most people will have a little trouble in the Spring, even if they don’t suffer from bad allergies. I find that even if you aren’t allergic to pollen, it can still be very irritating to your sinuses.  We have all seen the yellow cars that are so hard to keep clean in the Springtime. Imagine breathing in that yellow dust every time you are outside, the pollen can sit in your nasal passages and sinuses just like it sits on the cars.

So, what can you do about your allergies so that you can enjoy the great outdoors???

• If you don’t typically suffer from allergy problems, a netty pot can be a great way to help clean out those sinuses. I have friends that swear by their nasal rinses! You will want to microwave or boil the water before using the netti pot…of course, you should allow it to cool to room temperature before doing the rinse. (Thanks, Kathy!)
• Taking an antihistamine such as Claritin or Zyrtec can be helpful, if you find that this does not resolve your symptoms, I recommend seeing your medical provider for an alternative.  
• Nasal sprays such as Flonase or Nasonex can be quite helpful. They help to reduce the swelling and secretions caused by allergens.
• Eye drops such as Zatidor or Pataday can be helpful as well. Check with your health care provider to be sure this is the appropriate treatment for your family.
• Wash your hair every night!! As we go though the day, all kinds of allergens sit on our hair. If we don’t wash them off, they are on the pillow. Laying on a pillow full of allergens all night is just as bad or even worse than being outside.
• Keep your windows closed! The first thing I want to do when the weather warms up is open the windows. My husband runs behind me closing them all up again because he and Joshua have bad allergies. Keeping the windows closed keeps the allergens out!
• Get rid of carpet and heavy drapes that hold dust and allergens. Hard floors and blinds are much easier to keep clean.
• Buy hypoallergenic pillow and mattress covers. I am not even going to mention all the allergens (dust mites,etc) that can be trapped in pillows. Speaking of which, I think I need some new ones. :-/
• When you are cleaning the house, wet dust and wet mop. Sweeping and dry dusting just moves the dust around. Investing in a vacuum with a good HEPA filter to trap the allergens can be helpful also. Many vacuums just blow the dust right back out.
• Immunotherapy: Allergy shots provide small exposure to specific allergens to help the immune system build up antibodies against the allergen. Immunotherapy works!
• Don’t forget that Hydration can be helpful! If you learn nothing else from me, you will learn the importance of hydration (see The Importance of Hydration for more info on adequate hydration)
• Treating allergies can be tricky, don’t try to do it all by yourself.

If your allergies are troublesome enough that a daily Claritin or Zyrtec isn’t helpful, I strongly recommend seeing an allergist. Most people don’t like shots, but those who get and need allergy shots will tell you it is very worth it. They definitely work! Please keep in mind that untreated allergies can cause increased problems for those with asthma and eczema. I see so many kids with eczema problems that are not on allergy medication, allergy medication may be key in controlling the eczema symptoms. The secretions that come from inflamed nasal and sinus tissue can cause ear infections, sinus infections, and headaches. I have found that most people that suffer from allergies are allergic to grass and dust mites. So inside and outside, there is always exposure. These people should be on allergy medication year round.

There are a many different foods that cause allergies as well, a couple of the most common are peanut and shellfish. Most peanut and shellfish allergies are quite dangerous and can cause severe breathing problems. Drew Elizabeth has a friend in her class, Sophie, with a peanut allergy. All the students and all the parents were made aware immediately for Sophie’s safety. A bad peanut allergy can cause hospitalization and death,it is nothing to play with! Drew came home from school the first week telling us all about peanut allergies and how dangerous they can be. I’m glad they designate a “no nut” table during lunch, all schools should, and many do.  Drew loves peanut butter tastykakes and has taken them for lunch all through preschool. She will tell us to be sure not to put any peanut butter tastykakes in her lunch, because she wants to be able to sit with Sophie at lunch, what a sweet friend! I love that girl!

Many people suffer from food sensitivities vs. food allergies. I suffer from occasional stomach pains, and was convinced it was from some food sensitivity. Food sensitives can present as stomach pain. I went to my friends at the ENT/Allergiest and had my friend Dania, RN test me. After the testing, I found out that I was allergic to dust, grass, cats (I’ve had cats for over 20 years now), dogs (explains alot about my asthma as a kid growing up with dogs), and a couple other plants of some sort. NO food allergies! Dania looked at me laughing and said, “Well, you know you could get allergy shots, you reacted to 6 different allergens.” She knew that wasn’t the information I was looking for, I wanted to know what foods I should be avoiding. We sat there laughing….Watch what you go searching for, you might find completely different information that you aren’t prepared to deal with.  Allergy testing, diagnosis, and treatment can be tricky.  We tested Joshua, who exhibits every allergy symptom I’ve mentioned (minus the asthma and eczema), and he has a negative allergy panel…Go Figure! I’ve talked to Kathy, RN my best allergy source at the office and we both agree that an negative allergy panel is not conclusive; there is no way to test for the millions of substances that are floating around in this world. As I’ve told you before, Joshua is a special case and hard to figure out, he doesn’t usually follow the books… :-/

Well, I hope I’ve given you enough info to help you through the Spring. I talk more about food allergies and concomitant allergies in another post, Don’t eat that egg…You’re allergic to Ragweed.  Concomitant allergies are foods that will make allergies worse. One example is avoiding apples during the season when oak trees are blooming. Another is avoiding milk, egg, and mint if you have a ragweed allergy. So, as you can see, allergy testing can be quite helpful!

I think it’s time end this post and go wash my face and hands… My cat came and sat down next to me about 10 minutes ago, which usually doesn’t bother me, but I was rubbing on him for a few minutes, and apparently touched my face, and now my eyes are all itchy and watering…. Still love my Jersey cat though! He’s a big, beautiful, black tom cat that will be 17 next month. He’s a sweety! Glad I didn’t know I had a cat allergy before I got him. Although, I had a sneaky suspicion when I got my Persian back in college and needed my inhaler every couple hours to breathe comfortably the first few days.  After I got used to her, things got better, I should have known then. I guess I did, but I love cats, and denial is a powerful defense mechanism!

Please let me know if you have more questions about allergies, and I will do my best to help you along your parenting journey!

Yuck, the “throw ups”…Do I need to be worried because my child is vomiting??

Well, tonight’s post wrote itself when friends of mine called to make sure they were doing the right thing for their daughter that had been vomiting all day. I saw kids of all ages today that had nausea, vomiting and diarrhea.  So, it sounds like the best parenting advice right now would be on managing that nasty stomach virus also know as gastroenteritis.

Poor little Maddie has been vomiting all day.  Her brother had vomiting and diarrhea a few days ago, and now it sounds like it’s her turn.  One question her Dad had; could it be something else? Well, maybe…but, probably not.  Dad told me he had been giving Maddie about a 1/2 ounce of Gatorade every 20 minutes or so.  She had been doing fairly well, then started having really bad stomach cramps. It seems that Maddie took a big drink of Mom’s tea, which wasn’t a good idea, but who can blame her, she was probably really thirsty.  Maddie probably had more than her stomach was able to tolerate.  It probably didn’t help that the tea had caffeine in it, which can be irritating to an empty stomach.  Drinking too much or eating or drinking the wrong thing can cause the pain and vomiting to start again. With rest and small amounts of fluids, Maddie will probably get throght this stomach virus just fine.  Slowly staying hydrated, and then eating small amounts of bland foods.  No doubt, she will be back to her happy playful self, and keeping up with that brother of hers.

Most vomiting spells will usually last 8-12 hours, but can come and go for a few days.  If your child vomits for more than 24-48 hours, you might want to consider having them evaluated by their pediatric provider.

Most children will have diarrhea with or after vomiting. This is just another way for the virus to exit the body.  Do not give children medication to stop the diarrhea or vomiting.  If this is necessary, medication should be prescribed and supervised by your provider.

Dehydration is usually the worst complication of gastroenteritis. Keeping your child hydrated after the initial vomiting spell is very important.  If your child is vomiting, don’t give anything by mouth the first couple hours; then give small sips of pedialyte or Gatorade (1/2 oz.) every 15-20 minutes.  For young children, Pedialyte popsicles can be really helpful.

If children tolerate fluids after several hours, try bland foods such as saltine crackers and toast.  Slowly, increase the diet with bland, salty foods over the next few days.  Do not give your child milk products, acidic products, or greasy foods. French fries and chicken nuggets are NOT a good idea.  Yes, too many parents of 3 or 4 years old children will come into my office and say, “Well, she said she would eat chicken nuggets” (or hot dogs, you can fill in with either)…. I want to scream “Are you kidding me?”   Fortunately, I learned to bite my tongue a few years back.  Trust me, it took some practice, I usually say what I think, but have learned that I just can’t do that sometimes.  Those of you that know me are smiling and laughing right now, no doubt.

So, What else could it be??

• Some people are concerned that their child could have appendicitis.  Believe me, that is the first thing I want to make sure a child doesn’t have either.  Appendicitis does need to be ruled out if a child is having severe or ongoing abdominal pain.  Appendix pain is usually in the lower right quadrant of the abdomen, but the pain can radiate elsewhere.  If you are worried your child may have signs of appendicitis, please see your provider.  This is not an easy diagnosis to make, even with physical exam.
• Sometimes children will have vomiting, with a fever, sore throat and headache; beware, this can be strep throat.  Some children with strep throat will vomit.  My poor Joshua is one of these kids.  He has only had strep twice in his life,  first, with pneumonia.  Then, a few years ago he presented as fever, nausea and sore throat.  The poor kid vomiting for over 8 hours, he was pitiful.  If I hadn’t seen the positive strep test myself, I would have really thought it was a stomach virus.  It’s always safest to check if you have any doubt.  Strep throat cannot be confirmed without a throat culture, and MUST be treated with an antibiotic.

Again, I want to stress the importance of HYDRATION! Slow but steady hydration is the key to avoiding dehydration. If your child does not urinate at least once in 12 hours, please have him evaluated for dehydration.  Fever, along with vomiting and diarrhea can increase the risk for dehydration.  For more advice on fevers or hydration, please see my related posts.

Remember, sick kids need a little more patience, understanding, and TLC.

At some time or another, a vomiting child is something we all deal with….kind of like a rite of passage. Every Mom or Dad has a gross vomiting story to tell. Good luck with the vomiting thing when you experience it along your parenting journey.