What's going Around - Summertime

What's Going Around?
Most Common Summertime Illnesses

Most people recognize winter as cold and flu season, spring as allergy season, and fall as back-to-school strep throat and cold season. What about summer? Is this the season when illnesses take a vacation too and leave our kids alone for a few months? That would be nice! There are, unfortunately, several very common illnesses passed around in the summertime that flood our pediatric office with sick children and worried parents.

Here is a discussion on the most common summertime illnesses, how to treat them, how to avoid them, when to worry, and when not to worry. They include the summer “flu” (fever with or without headache and sore throat), diarrhea, viral meningitis, contact rashes (poison ivy), red eyes, swimmer's ear and sunburn.

The Summer Flu Virus - mysterious fevers and aches
Probably the most common illness we see during the summer is fever with no other symptoms except general aches and pains. Whereas most parents expect some fever when their child is going through a bad cold or the wintertime flu, many parents are naturally worried when their children come down with high fevers and aches with no other symptoms.

Don't worry! This mysterious fever is probably the summer flu virus. It will run its course in a few days without the need for any antibiotics.

Main symptoms of the summer flu virus include:

• Fever - may be as high as 104 degrees, and may last for up to five days.
• Headaches - this is a common sign, especially when the fever is higher.
• Sore throat
• Body aches
• Vomiting

Treating the symptoms

• Fever reducers such as Tylenol or ibuprofen if the fever is high or your child is miserable. Lower fevers (below 102) in happy children do not need to be medicated. Click here for a complete discussion on treating fevers.
• Pain relievers such as Tylenol or ibuprofen, aside from treating the fever, will also help with the headache, sore throat, and body aches. You may find that ibuprofen works better for the general aches and pains from this virus.
• Click here for more info on treating sore throats.
• Click here for detailed instructions on how to treat vomiting.
• Drink lots of fluids.
• Click here for dosing charts for Tylenol and ibuprofen.
• Antibiotics won't work because it is a virus, not a bacteria.

When NOT to worry - don't call the doctor
A general guideline for this illness is that if your child is feeling and acting well when the fever is down, then you can probably rest assured that there is nothing to worry about. Even if your child looks terrible when the fever is high, the key is how he looks when the fever and aches are under control. Expect it to run its course in two to five days. If your child is doing fairly well, you don't need to see your doctor. If the fever runs more than three days, a doctor's visit is advised just to make sure.

Worried about strep throat? It is often difficult to tell if you have strep throat (treatable with antibiotics) or have a severe sore throat as part of this virus. Click here to read how to tell the difference.

When to worry - CALL YOUR DOCTOR
If your child is acting lethargic and looks terrible even when the fever is down, you should take your child to the doctor that day. If your child is vomiting (more than just a few times) and/or has severe neck pain (where the back of the neck, not the throat in front, is painful and so stiff your child won't look down), this could mean he has meningitis. You should see or page your doctor right away. See our longer discussion below on meningitis if your child has the vomiting and neck pain symptoms.

Viral Meningitis
This occurs when a normal cold or sore throat virus spreads into the lining of the brain or spinal cord, causing an infection there. It is extremely rare, as most such viruses run their course through our bodies without spreading to the brain. Viral meningitis is not treatable with antibiotics. Bacterial meningitis, on the other hand, is treatable. It is viral meningitis, however, that seems most prevalent during this summer season. Bacterial meningitis does not occur during any particular season.

Here are the five main symptoms of meningitis:

• Fever - will usually be high, over 103.
• Severe head ache - this is not a typical headache. It is extremely painful.
• Vomiting - the irritation in the brain triggers persistent vomiting (more than just a few times).
• Neck pain and stiffness - this does NOT apply to sore throat pain in the front of the neck. It refers to severe pain in back of the neck. Looking down at your stomach (stretching the back of your neck) will cause severe pain. Some kids will refuse to even look down at all. They will keep their neck rigidly stiff.
• Photophobia - this means that light hurts your eyes. Meningitis will cause someone to refuse to look into light, especially the bright sunlight.

How to tell if your child may have meningitis.

• If your child has all five symptoms, don't even call or page your doctor. GO STRAIGHT TO AN EMERGENCY ROOM.
• The key to meningitis is the neck pain and stiffness. So if your child has severe neck pain and stiffness, and one or more of the other four symptoms, call your doctor to be seen right away, or page the doctor after hours.

  On the other hand, if your child does NOT have neck pain or stiffness, and DOES have the other symptoms, then it is less likely to be meningitis.

• In fact, the first three symptoms above, without neck pain or stiffness, is probably the flu virus described first in this article.

Click here for a complete discussion on meningitis.

Diarrhea
During summertime we see many cases of diarrhea in our office. It can range from mild to severe and can last just a few days up to several weeks.

Don't worry! Diarrhea is usually caused by a virus (not treatable with antibiotics). It almost never warrants a trip to the ER or an urgent page to the doctor. It usually doesn't even need to be evaluated in your doctor's office.

Click here for a detailed discussion and to learn about how to treat it, when to worry, and how long you can expect it to last.

Contact Rashes
Poison ivy is probably the most well known example of this. It basically refers to any rash that breaks out on your skin from any irritating substance that you come into contact with.

This occurs mostly in the summer for two reasons:

1. Plants that can irritate the skin are more prevalent during the summer

    

2. More importantly, our children are more likely to be out playing in bushes, forests, or on camping trips in shorts and T-shirts during the summer.

There are two types of contact rashes:

1. The first type appears as red, raised bumps or patches, and can have a slight crusty surface. It is extremely itchy. They can also run in a line on the skin from the irritant being scratched along the skin. This is often initially confined to one or two small areas on the body, but then may spread over the next few days. It is caused by contact with an irritant such as poison ivy, other plants, cleaners or other chemicals. Click here to see a picture of this type of rash.

   This type of rash is treated with over-the-counter hydrocortisone 1%, calamine lotion, and benadryl liquid for severe itching. Stronger prescription creams can be used if needed.

   You can prevent this type of rash by applying a lotion to the skin prior to adventuring, and then rinsing the skin after returning home, with a special lotion available at sporting goods stores. One such brand is Tech-Nu, but any brand should work.

    

2. The second type of contact rash is more generalized throughout the body. It occurs as fine, red pimples or small spots. It can be caused by a huge variety of irritants such as new clothes, soaps, shampoos, bubble baths, detergents or fabric softeners, suntan or other lotions, bed sheets, grass, swimming pools or anything else that comes into contact with your child's skin. It is often NOT ITCHY, but can be. It can persist for weeks, but is harmless and does not require any treatment, except to figure out the cause, and use hydrocortisone if needed. We see this rash much more often during the summer because of the mixture of sun, sweat, lotion, beaches and water.

Red eyes
There are many different causes of red eyes, but the one we see mostly during the summer is simple chemical irritation of the whites of the eyes. This usually occurs from pool water, but can also be from lakes or oceans. It is a harmless, usually painless redness. There is no discharge, and usually no stinging or itching.

This can persist for weeks, and looks a lot worse than it really is. You can treat it by simply flushing the eyes out with saline eye drops after swimming. It is ok to continue swimming, but doing so may prolong the redness (which, again, is harmless).

If you have any eye discharge, burning, itching, or pain, click here for a complete discussion on pink eye or conjunctivitis.

Swimmer's ear
This is an infection in the skin of the ear canal, similar to an infection anywhere else on the skin such as from a scrape or a bite. It is different from an ear infection, which occurs in the middle ear space behind the eardrum. Swimmer's ear infection occurs external to the ear drum in the ear canal.

When water gets stuck in the ear canal after swimming or bathing, the water can irritate the skin of the ear canal. This irritated skin then gets invaded by bacteria. This infection will fester until it builds up enough to cause pain. This can occur over a few hours, or can take several days.

Lake water is the most likely to cause an infection, followed by ocean water, bath water, then pool water.

Clues that your child has swimmer's ear include:

• Known exposure to water in the ear such as swimming or bathing.
• Ear pain with yawning or swallowing.
• Pus draining from the ear canal.
• Usually there is no fever with swimmer's ear.
• Try the ear movement test -
  • Push on the anterior ear flap - the small flap of ear that covers the ear canal.
  • Pull back and up on the entire ear.
  • Push on the face just in front of the ear.
  • If any of these movements cause severe pain, then that is a big sign of swimmer's ear. Try the test on the other ear. Swimmer's ear is even more likely if the unaffected ear does not hurt with this test.

What to do if you think your child has swimmer's ear - call your doctor's office. He or she might call in a prescription antibiotic ear drop to treat the infection. The doctor may want to see you first however.

Click here for a complete discussion to learn how to PREVENT swimmer's ear.

Sun burn
We won't go into a full discussion here, but just a simple reminder. Use sunscreen regularly, wear hats and sunglasses, and try to avoid playing outside in just a bathing suit between the hours of 10 am to 2 pm (the time when the sun's rays are the strongest).

Click here for more information on sun protection.

Click here to read how to treat sunburns.