Enterovirus D68 – What’s going on

If you have been watching the news on TV or reading it on-line you cannot escape having heard about enterovirus D68. The past 10 days the news stations have been talking about this virus and sharing all of the scary facts about it. But that is what the media does with a story. They let us know what is out there and often give us only the scary details and not the full story. Hopefully I can give you a little more information I also have the time and space to do that which the news people cannot.

Enterovirus D68 belongs to a group of viruses called enterovirus. This family includes over 70 different viruses. To those of you with kids in school or daycare there are a few more well-known enteroviruses that you may be familiar with - polio and coxsackie- otherwise known as the hand, foot and mouth virus. This enterovirus D68 is just one more in the family. It was first discovered in the 1960s and we haven’t seen a lot of it over the years but when we do see it, it can cause some significant illness.

Symptoms of enterovirus D68 can mimic the common cold. A child will start with cough and congestion and may also get fever. For many people who contract the virus these are the only symptoms that they will have. Others will get pretty sick from it and develop a harsh cough, wheezing and breathing problems. These are the kids they have been talking about on the news. Again, I will emphasize that not everyone ends up with these more significant symptoms.

How can you help your child? First of all, what do we always say at Bayshore Pediatrics- the best way to help your child is to make sure they are resting and drinking lots of fluids. If they are younger nasal saline and suction can be helpful. Nasal saline also helps older children as does a humidifier (cool mist of course) in their room. We are not able to distinguish between this more mild form of the illness and the common cold.

It is important to watch for worsening or changing symptoms, that can happen quickly. We want to see them if they are having difficulty breathing or wheezing or have a new fever. We also would want to see them immediately if they have any of the following symptoms:

  •                 Turning gray or blue around the mouth
  •                 Pulling in by the ribs while breathing
  •                 Difficulty speaking because they can’t breath
  •                 Not drinking much and little urination

While watching the news makes it seem like all children should be seen, if their symptoms are mild and more like a cold they do not have to come in. We do not have a medicine that will make it go away and treatment is supportive only. At the same time, if you are worried or you think they do not look right we absolutely want to see them.

How can you prevent this virus? This virus is spread like most other respiratory viruses you need someone who has the virus to cough or sneeze on you. So if your child is sick keep them home from school AND activities. Good hand washing is also important. Also, although this is really hard with kids, remind them to try not to touch their face frequently, especially their eyes, nose, and mouth .

I always try to remember that the media is helpful in spreading news about what is going on. I also want to help our patients see our take on the news and hopefully help provide you with some more information. This is a serious virus and many kids are getting really sick from it. Many of those are just getting cold like symptoms. A smaller percentage are going to the hospital and needing supportive care. So please don’t immediately get worried if your child starts with cold like symptoms. Watch them closely and if you are worried or they showing concerning symptoms call us or come in and be seen.

The Lemonade Stand Dilemma

My kids recently begged me to have a lemonade stand. It was one of our rare warm days, the sun was out, and they wanted to make some money, The problem is, I am not a huge fan of lemonade stands. I worry that it is a way for child predators to find out where children live, find out their names, and make them a target. We live in a nice, safe area but so did Elizabeth Smart.  On the other hand, having kids work to earn money is a great thing. It teaches them that making money takes time, that it can be really boring, and they have to deal with rejection. In addition, I grew up doing lemonade stands, and it was also a lot of fun. It is sad that something so sweet and innocent has to be tarnished by the reality of the world we live in.

So, what did I do? I let the kids have their stand in front of our house. However, they first had to listen to a lecture about stranger danger. In addition, they could only man the stand when I was in the yard with them (just how I like to spend my summer days). The stand went well. Primarily only neighbors came by, and they had a lot of fun trying to sell the lemonade. I am not sure I made the point about making money takes a lot of time, since some nice lady gave them $20 for their lemonade! Overall, it was a great experience for them.

The moral I learned from this story is that fear shouldn’t rule how we let our children experience life. We give them as many tools we can to deal with the unexpected, but you also have to let them experience new things. Part of being a parent is learning to let go a little.

Hand, Foot, and Mouth

We have been seeing a lot of Hand, Foot, and Mouth Disease at Bayshore Pediatrics lately. A lot of parents hear that diagnosis and get very nervous. Although this illness can cause some serious discomfort, it is not a serious problem. In fact, most cases can be easily treated at home. It is a common infection in children that is usually caused by the coxsackie virus or other viruses. It can cause mouth sores and a rash on the hands, feet, or buttocks. Your child may have a sore throat, drooling, or pain when swallowing. Fevers are common, but should not last more than 3 or 4 days. Kids are no longer contagious 24 hours after the fever is gone. It can be easily spread from one person to another and usually appears about 1-3 days after exposure, so it is important to wash hands and not share food or drink with anyone who may have it. The illness usually lasts about 7-10 days. Because it is a virus, there is no medicine that can stop it or make it go away faster, but there are things you can do at home to help your child feel better. The most important thing is to make sure your child is comfortable. Some things to aid in that are:

  • Offer plenty of fluids.
  • Alternate Tylenol and ibuprofen every 3-4 hours to help with pain and fevers.
  • If your child is old enough to swish liquid in his/her mouth and spit it out, you can try “Magic Mouthwash”

o  To make it, mix 25mL diphenhydramine liquid (such as Benadryl) with

25mL antacid liquid (such as Mylanta).

  • Swish and spit 5mL of the mix every 6 hours.
  • Give your child cold liquids, ice, or frozen juice bars may help soothe mouth pain. Avoid giving your child spicy or acidic foods.
  • A cool-mist humidifier in your child’s room can help your child breathe more easily. Be sure to clean the humidifier often using directions from the company that made it.

There are some times you should call the office:

  • If your child is unable to drink.
  • If your child has signs of dehydration such as crying less tears, dry mouth, no urine for 8-10 hours and decreased activity.
  • The rash gets much worse and the joints are swollen, red or painful.
  • If your child is breathing faster or has a hard time taking breaths.
  • New ear or face pain.

It can stink big time to see your child with hand, foot and mouth. The frustration can be endless to see your child so uncomfortable, but have comfort in the fact that it will pass and children are very resilient.

Increasing quality of care

The team at Bayshore Pediatrics is committed to providing quality care for all of the families we serve.  At the beginning of 2014, we began focusing on specific health initiatives to enhance and improve the care we provide.  We would like to share a summary of a few of our efforts so that you can be assured of the care your child receives.

Increase the health and protection of our patients through vaccines

Bayshore believes strongly in the public health protection of children.  January 2014, we evaluated our vaccination success rate for our patients.  As a team, we embarked on a journey to increase our vaccination success rate, specifically for infants 2 years and under.  Some of the new things we have implemented are calling families that are overdue for appointments, highlighting in the medical record when a patient is due for a vaccine, and modifying our communication as a team to make sure we address vaccination needs at any point in your medical care.  Here are the results of our efforts:

Vaccination rate (at 2 years of age):     54% as of 12//2013

Improved Vaccination rate (at 2 years of age):    91% as of 8/2014

Follow up appointment compliance for patients with Attention Deficit Hyperactivity Disorder

Patients that have been diagnosed with Attention Deficit Hyperactivity Disorder better known as ADHD should be seen by their physician more frequently.  These visits are an important way to make sure that the medication the children are taken are providing the desired results.  With the addition of electronic health record, we are now able to determine whether we are seeing the patients at the appropriate time.  After the initial evaluation, we realized that we needed to make efforts to improve the follow-up appointments.  The plan included changing the information provided at the time of prescription refills, having a nurse call and speak with the family for each prescription refill to find out about symptoms and how the medication is working, and limiting the prescription refills if the follow-up appointments are not kept.  We feel that these appointments are incredibly important for the ongoing health and care of your child.  We are excited to see the significant improvements made with the few changes we have made.

Follow up for ADHD every 6 months: 51.5% as of 12//2013

Improved Follow up rate: 96.9% as of 8/2014


Teens, depression and the news

As summer comes to a close and I start seeing all my teenagers for the school physicals, it gives me time to reflect on the past year- how my children are growing so fast, how my patients seem to have aged overnight, and how so much seems to have changed this year in the office.

One of the things that I have been working on this past year is trying to find a way to help our teenagers that seem to be “falling”. I am seeing more and more teenagers that are sad, depressed, anxious or just plain worried. Life is fast paced and they have so many expectations on them. As parents we try to understand all they are going through, but their world is not the world we grew up in. Everything is out there on a screen or in print for them to see. The world moves by quickly and they are expected to keep up.

Last summer it really hit me how many teens are suffering. We saw teenagers from schools in Whitefish Bay and Nicolet commit suicide. I had many patients that made gestures looking for help- and teens are good at hiding their feelings. Also, their signs of depression are not always what an adult might think of as depression. While some may seem sad, others are angry and irritable. Friends may change. Grades may start to fall in school. I think the message is just be alert for changes- any change.

As we have seen this week on the news with the death of Robin Williams, suicide happens.  We will miss the laughter he shared with the world.  This makes us think that even if one seems to “have it all”, depression is something that is non-discriminating.

Action is being taken around our community to try to address the face of teen depression. The local schools have started an organization- RedGen. Through their efforts national speakers are coming to speak to parents and others in the community about this national trend. Take a moment and check out their website -www.REDgen.org. Come to one of their functions- it is a start.

When my teen patients come see me, I am now asking them to fill out an adolescent health questionnaire that is designed to help me identify those at risk for depression a little sooner.The more we can learn as parents, the more we can try to help our children.

I’d like to share a few resources that may be helpful for you or someone who you know.





We can’t fix everything for them, but hopefully we can provide them with some tools, or take them to someone who can give them tools to help them.

It’s Summer Time- Have Fun

Wow- it’s hard to believe it is already July 2nd!  Not that you can tell by the weather, but we have had some really nice days to enjoy outside. As I enter the summer months I am full of camp and school physicals. One of my favorite questions to ask the kids and teenagers is, ” so what do you like to do for fun?” You wouldn’t believe how many have a difficult time answering the question. Yes, I want to know what activities they are involved in, but I also want to hear what they think is fun. My face lights up when they say that they like to play in the creek, go for a bike ride, or sit and read a book. Our lives and our children’s lives are so filled with scheduled activities, that it is refreshing to hear about the not scheduled activities.
Summer is a great time to get out there and explore. Even if your children need to go to camp because you work during the day there is time on the weekend to check out everything around us. Going on hikes or bike rides as a family is great bonding time (oh yeah, don’t forget the helmet). Living in Wisconsin we have so many festivals to attend and see the different tastes and sounds of our community.
Try not to over-schedule though. During the year there is so much going on, take time to see where the day will take you. Allow your children to explore the outside without having to rush off and say you need to get to the next thing. Try something you haven’t done before. There are many triathlons that include kids now- this is so great because it encourages physical activity.
One thing, don’t get caught in the “I’m so bored” and then all they do is turn on the TV or get on the IPad. Let them be bored. Sooner or later they will figure out what to do. They might pick up a book and read for a little. They might explore the outside and discover they like to garden or just watch the worms in the garden. They might learn how to cook on a rainy day.
Give them a chance to be bored and see what they can do!