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.

http://www.mhawisconsin.org/

http://www.mhawisconsin.org/factsheets.aspx

http://www.mhawisconsin.org/Data/Sites/1/media/fact-sheets/teendepression[1].pdf

http://www.comh.ca/publications/resources/dwd/DWD_PrintVersion.pdf

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!

Laundry room safety

We all spend a lot of time baby proofing our houses, but one easy place to forget is the laundry room, or in my house “that corner of the basement.” Here are a couple of tips in case that area of your home was overlooked.

  • Keep detergents and other cleaning products in their original packages.
  • Store detergents or cleaning products in a cabinet with safety locks or an area that is out of reach. (Remember your kids can climb, so it may be safer to lock everything up.)
  • Never let your children touch single use laundry packets (or dishwasher packets). They can dissolve quickly when in contact with saliva or wet hands.
  • Use child-proof locks on front-loading washers and dryers.
  • Keep irons and their cords out of reach.
  • Make sure any laundry chutes and doors are child-proof.

A lot of houses don’t have laundry chutes, but I had one growing up and I remember really wanting to slide down into our hamper. Luckily I was too big to fit at the time. Don’t forget if your child does get into cleaning products or anything else you should call poison control. They are nice people and a great resource. The phone number is 1-800-222-1222. Don’t be embarrassed to call, we have had to call at my house (for me).

Drink Up

Now that the summer is finally in full swing, I think it is important to make sure that our children are getting enough fluids with the warmer weather approaching. We all lose body water throughout the day via various routes such as tears, urine and sweating. Water also evaporates off of our skin and vaporizes when we breathe. Most of our body fluid and salts can be replaced with the water and salts in our regular diet. However, during prolonged exercise during warm weather, we can lose even more, setting us up for dehydration.

Here are some signs of dehydration:

  • dry or sticky mouth
  • few or no tears when crying
  • eyes that look sunken into the head
  • soft spot (Fontanelle) on top of baby’s head that looks sunken
  • lack of urine or wet diapers for 6 to 8 hours in an infant (less than 1-year-old)
  • lack of urine for 12 hours in an older child
  • dry, cool skin
  • lethargy or irritability
  • fatigue or dizziness in an older child

The best way to prevent dehydration is to make sure kids get plenty of fluids when they are physically active, especially in hot weather.   They should consume more fluids than they are losing. If your child participates in strenuous exercise, they need to begin drinking extra fluid even before the activity starts. They should also continue drinking at intervals (about every 20 minutes) during the activity and after it ends. Keep in mind, too, that sugary drinks and soda are not good at keeping you hydrated. Water is best. Limit low-calorie sports drinks to episodes of extreme exercising.

Thirst is NOT a good sign of early dehydration. By the time a child feels thirsty, he or she may already be dehydrated. In addition, thirst can be quenched even before the necessary body fluids have been replaced.

Below is a weight-based chart regarding how much fluid your child should consume on a daily basis. This does not take into consideration exercise or hot weather. Parents always are amazed at how much fluid we all should be consuming.

Weight in Pounds                                Fluids per day

  •  10 pounds             16 ounces (2 cups)
  • 20 pounds             30 ounces (3-3/4 cups)
  • 30 pounds             40 ounces (5 cups)
  • 40 pounds             48 ounces (6 cups)
  • 50 pounds             52 ounces (6 ½ cups)
  • 60 pounds             55 ounces (7 cups)
  • 80 pounds             60 ounces (7 ½ cups)
  • 100 pounds          70 ounces (8 ¼ cups)
  • 120 pounds          75 ounces (9 cups)
  • 140 pounds          80 ounces (10 cups)
  • 150 pounds          85 ounces (10 ¼ cups)