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Illnesses - Ma-Pz

MONONUCLEOSIS (MONO)
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General Information:

Mononucleosis is a viral infection that causes a severe sore throat, swollen lymph nodes in the neck, armpits, and groin, fever for 7-14 days, and an enlarged spleen in about half of the cases. While mononucleosis can occur at any age, it is most common in its severe form in 15- to 25-year-olds because of intimate contact that spreads the virus through saliva by coughing, sneezing, and kissing.

Most children and teenagers with mononucleosis have mild symptoms that resolve in about one week. Even those with severe complications usually feel completely well by 2 to 4 weeks. Complications are rare but include dehydration, breathing problems from severely enlarged tonsils, and a ruptured spleen if a sick teenager is struck too hard in the abdomen.

Treatment:

1. Antibiotics do not cure mononucleosis since it is a viral infection.
   
2. Give your child fever and pain medicines with acetaminophen or ibuprophen.
   
3. Give throat lozenges or spray with throat sprays to reduce pain.
   
4. Your child does not need to be at bed rest; activity does not lengthen the time your child is feeling poorly.
   
5. If your child has an enlarged spleen, he should avoid contact sports for 4 weeks since a ruptured spleen can cause severe bleeding.
   
6. Your child is mainly contagious when she has fever, but should avoid kissing, sharing drink or food, and other close contact for about 4 weeks.

Call Your Doctor If:

1. Your child has difficulty breathing.
2. Abdominal pain occurs especially high on the left.
3. Your child suddenly becomes very pale.
4. She is not drinking enough.
5. He cannot sleep at night.
6. She develops new symptoms such as ear pain, sinus problems, or other new problems.

NEWBORN SKIN
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General Information:

Newborns have very sensitive skin and have many different unique skin rashes. Your baby may have a very red color to the skin due to his high red blood cell count. If your baby becomes cold he may become pale or mottled-blue in appearance. After about one week your baby's skin will become dry and flaky.

Newborn Rashes:

1. Acne of the Newborn- About 30% of newborns will develop small red bumps or neonatal acne. This rash begins at about 2-3 weeks and lasts for several months. It is not necessary to treat with anything since nothing helps and this will improve on its own.
   
2. Rash Related to Drooling- Most babies have a rash on their chin or cheeks caused by drool containing food and a little stomach acid (from spitting up) coming into contact with your baby's sensitive skin. Place an absorbent diaper under your baby's face at nap time and wash her face with water after feedings.
   
3. Erythema Toxicum- More than 50% of babies develop this rash after one or two days. The rash appears as multiple red bumps with a white swelling in the middle that look like insect bites. They tend to be numerous and are harmless, resolving after 2 weeks.
   
4. Birth Trauma- During a difficult delivery a baby can show signs of skin trauma. Your baby may have bruises, scrapes, forceps marks, a malformed head, swelling of the scalp, and scratches or puncture wounds where a scalp monitor may have been placed. All of these resolve over days to weeks without problems in almost all cases.
   
5. Milia- Almost half of newborns have little white bumps that occur on the face and especially the nose. They are blocked-off pores that will open up spontaneously in the next few weeks.
   
6. Mongolian Spots-These are bluish gray birthmarks found in most American Indian, Oriental, Hispanic, and African-American babies. They are mainly found in the lower back and buttocks, but can occur on any area of the body. They usually fade by 2 to 3 years of life although some remnant can remain until adulthood.
   
7. Stork Bites- More than half of newborns have rashes that are pink, flat rashes called capillary hemangiomas occurring over the bridge of the nose, the eyelids, and the back of the neck. Almost all of these clear by 2 years of age and they are completely harmless.

Newborn Skin Care

Bathe your baby with mild soap and water every other day using sponge baths before the cord has fallen off. You do not need to wash inside the vaginal area. After your baby has a wet diaper simple use warm water to clean her bottom. Mild soap can be used for dirty diapers. Do not use baby wipes until one-month-old.

Shampoo her hair once or twice a week with a nonstinging baby shampoo. Do not use oils or greasy substances on the skin since they can block the pores and cause a rash. Clean the umbilical cord several times a day with alcohol to keep it dry and reduce the number of bacteria. Cut the nails while the baby is asleep. Round off the fingernails to reduce scratches, but cut the toenails straight across to prevent ingrown toenails.

NOSEBLEEDS
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General Information:

Nosebleeds in children are common and seldom cause serious problems. The main purpose of the lining of your child's nose and sinuses is to warm inspired air before it reaches his lungs. His nose does this by having lots of warm blood flowing through it.  However, almost any kind of trauma to his nose can start his nose bleeding.  Causes of nosebleeds include scratches, bad colds with lots of blowing, or inju#monory to his nose.

Although the amount of blood loss often seems impressive, even with multiple episodes of bleeding children seldom become anemic.  Some children are particularly prone to bleeding because they have blood vessels in their nose that run very close to the surface.  Rarely, nosebleeds can be evidence of tumors, leukemia, abnormal blood vessels, or other serious problems.  These can almost always be detected by a physical exam. The typical nosebleed is mild, easy to stop, occurs from only one nostril, and has a logical cause such as a respiratory infection or injury. If her nosebleeds are difficult to stop, occurring much more frequently, occurring in both her nostrils, or without apparent cause, it may be necessary to evaluate her further.

Treatment:

During your child's nosebleeds do the following:

Have him sit up (rather than lie down) since this decreases his blood pressure in his nose and so decreases his bleeding. Pinch close his nostrils with firm pressure for at least 5 minutes.  Time this by your clock. If his nose is still bleeding, apply pressure to his nose for 10 more minutes. Place icy cold water in a cloth over the bridge of his nose at the same time.

Once the bleeding has stopped, try to minimize movement or trauma to his nose. Place Vaseline or an antibiotic ointment (if his nose is irritated) in both his nostrils to decrease cracking and bleeding and to treat a possible mild, mucosal infection. Re-bleeding is common in the next few days and should be treated in the same way.

Call Your Doctor If:

1. She has repeated, large bleeds.
2. He has extensive bleeding from both his nostrils.
3. Her nosebleeds are occurring with increasing frequency.
4. He is pale, passes out, or is fatigued; all of these might indicate anemia.
5. She has a prolonged sensation of pressure in her sinuses.
6. He has any swelling in his mid-face area.

PENIS IRRITATION
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Penis irritation, also called balanitis,  is usually a mild inflammation of the penis in little  boys. It occurs more often in an uncircumcised boy, especially under his foreskin where moisture, a small discharge, and bacteria are often found. Frequent cleaning will usually keep balanitis from developing. Occasionally, insect bites in your child's genital area will cause irritation and swelling.

Treatment:

1. Gentle cleaning of the discharge from around your son's foreskin.
   
2. Soaking in soapy water 2 or 3 times a day.
   
3. Antibiotic ointments are seldom necessary.  If you use one, do not use for more than 3 days.
   
4. You may give oral Benadryl to your son for itching especially if an insect bite is involved.
   
5. Bring your son to the office if the inflammation is not improving or if he is not urinating.

Call Your Doctor If:

1. Your son's irritated penis does not improve with soaking three times a day for three days.
2. His rash is spreading beyond the penis.
3. He begins running fever of greater than 100 degrees.
4. You suspect that someone has been touching him inappropriately.

PINWORMS
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General Information:

Pinworms are relatively harmless parasites that are common in warm climates in the southern United States and Mexico. The only symptoms that they cause are perianal (rectal) itching and vaginal itching in girls, both occur especially at night.  Pinworms do not cause vomiting, diarrhea, weight loss, or any other major symptom.

Children acquire the infection by ingesting the eggs of the pinworm usually while being close to another child who is infected.  At night, the female pinworm bores through the perianal tissue (causing itching) to lay her eggs  near the anus.  Children then scratch the area and often get the eggs under their fingernails.  The infected children can then pass these eggs to playmates by sharing toys, food, or merely by physical contact.

Diagnosis:

The easiest way to diagnose a case of pinworms is to see the female worm in the anal area.  At your bedtime take a flashlight and examine your sleeping child in this area by gently pulling apart the buttocks.  The pinworm is about 1/2 inch long, white, with the thickness of thread. It should be moving.  Be sure not to mistake lint for a pinworm. 

The 2nd best way to prove your child has pinworms is to see the eggs.  You do this by getting two glass slides from your doctor's office.  Then double a piece of clear scotch tape (the frosted will not work) and place one sticky portion on the slide with the other sticky portion facing out.  Then in the morning before your child has fully waked up and washed, touch one glass slide with the tape to one side of your child's perianal area and the other slide to the other side.  Take these slides to your doctor's office to be examined under the microscope for the eggs.

Treatment:

1. If pinworms are seen a medicine will be given to your child and other family members.
   
2. Have your child scrub her hands and fingernails thoroughly before each meal and after using the bathroom.  Keep her fingernails cut short so that fewer eggs will collect there.
   
3. Your child should wear underwear or diapers every night to keep the eggs from getting in  his bed, floor, and other places.
   
4. Each morning for 3 days you should take your child to the bathtub, remove his underwear and wash his perianal area to eliminate the eggs.  Washing the underwear will kill the eggs.
   
5. Vacuum or wet-mop your child's room since eggs may be left scattered on the floor. They are infectious for 1-2 weeks.
   
6. Change and wash bed linen to eliminate eggs in the bed sheets.

PINK EYE
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General Information:

Pink eye or conjunctivitis is a general term for any inflammation of the lining of your child's eye. Most of these are viral infections and pass after a few days, but bacteria, allergies, irritants, or injuries can also cause pink eye in your child.

A baby may have a repeated, mild pink eye if his tear ducts do not drain well. The poor drainage allows bacteria to grow, causing irritation, swelling, and the discharge of pus. Your baby will probably outgrow this problem by about 1 year of age. An older child may also have some drainage from his eyes when he has cold symptoms.

The main worry with pink eye is whether your child has a viral or bacterial infection since trauma or chemicals in her eyes have an obvious cause. If she has a large amount of swelling and drainage from her eyes, then she probably has a bacterial pink eye. If she has minimal swelling and only a little discharge every few hours, then she probably has a virus. Do not be fooled by her increased discharge in the morning with her lids stuck together. This pus has simply accumulated over her 8-10 hours of sleep.

Viral infections should improve dramatically over a few days. If your child has only a little swelling and discharge from his eyes, but his symptoms have persisted for 7-10 days, then he probably has a bacterial pink eye.

Treatment

    

1. Wash away the pus from her eyes every once in a while with a warm wash cloth.
2. Wash your hands frequently when caring for your child with pink eye and teach him to wash his hands also. 
   
3. If your doctor believes her pink eye might be bacterial, then antibiotic drops might be given.
   
4. Occasionally, antibiotic drops may be prescribed (even though the infection is probably viral) to allow your child to go back to his nursery or school earlier.
   
5. Do not use her antibiotic drops for longer than 5 days since they can become irritating and cause a chemical pink eye in your child.
   
6. Do not use Visine or similar over-the-counter products in his eyes.

Call Your Doctor If:

1. She has rapid swelling or an increased production of pus in her eyes.
2. He has dramatic discoloration under his eyes especially if it is associated with fever.
3. She has severe pain or visual disturbances.

PNEUMONIA
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General Information:

Pneumonia is an infection of the lungs causing fever and accumulation of fluid in the air sacs in the lungs. Four out of five infections are caused by viruses which do not respond to antibiotics; fortunately, the viral infections are relatively mild compared to bacterial infections. Bacterial infections cause about one out of five infections, come on rather abruptly, and usually cause the children to have higher fever and appear sicker than with viral infections.

Pneumonia causes increase rate and effort in breathing, sometimes painful breathing, frequent coughing even during the day, and fever.  Bacterial pneumonia is usually not contagious because it is caused by bacteria already in the mouth and nose usually following a cold. Only 10% of children need to be placed in the hospital to treat pneumonia. While most pneumonia is viral and unresponsive to antibiotics, many of these viral infections are treated with antibiotics because it is often difficult to distinguish between bacterial and viral infections on exam or chest X-ray. While viral pneumonias are usually milder than bacterial infections, they can be dangerous and even lethal in very young babies and especially in premature babies or babies who have some type of pre-existing lung or heart condition. Otherwise viral pneumonias usually clear up in 2 to 3 weeks. Pneumonias seldom recur. If your child has pneumonia more than twice, your doctor should check for an underlying problem such as asthma, an aspirated foreign body, or an immune disorder.

Treatment:

1. Give your child antibiotics as prescribed; children will often feel a lot better after a day or two of antibiotics but need to take the full 7 to 10 day course of antibiotics to avoid a relapse.
   
2. Give acetaminophen (Tylenol or Tempra) or ibuprophen (Advil or Motrin) for fever of 102 degrees or greater.
   
3. Cough medicines are usually not very helpful in suppressing coughs and cough is actually part of the healing process designed to bring up excess fluids from the lungs. Your doctor may prescribe a cough suppressant for nighttime if the coughing is keeping your child from sleeping.
   
4. Use humidification in the air so as to help loosen secretions and to soothe a sore throat from the repeated coughing.
   
5. Do not smoke around someone with pneumonia since smoke will make their symptoms worse.

Call Your Doctor If:

1. Breathing becomes more labored.
2. Your child's lips become bluish.
3. Grunting sounds occur when your child pushes the air out.
4. Your child starts to act much sicker than he has been.
5. Your child's fever continues beyond 48 hours of antibiotic treatment.

POISON IVY
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General Information:

About 50% of people or more are sensitive to poison ivy, poison oak, and poison sumac which are plants found throughout the United States.  The oil from the leaves of these plants causes redness and blisters on exposed areas of the body from one day to several days after exposure.

Neither the rash or the weepy lesions are contagious, but the oil on the clothing, including the shoes and hats will continue to cause problems for about one week after exposure unless the oil is cleaned away with soap and water. Many people insist that the skin lesions themselves are contagious. The reason many people believe this is so is because when a person is exposed to poison ivy, the skin rash can break out anytime between one day and several days depending on the thickness of the skin at the exposed sites, the amount of oil, and the sensitivity of the person. It is common for a person to break out in one area of the body one day after exposure, then another place in a day or two, and a third place a few days later. These eruptions are from the original exposure. Once the child has had a bath or shower and the clothing has been washed, the rash cannot be spread. Prevent new exposures by avoiding plants with three large, shiny, green leaves. Wear long paints and socks and long-sleeve shirts to prevent skin contact with the oil. If you suspect that your child may have been exposed to poison ivy wash the area three times within one hour of exposure to prevent the skin eruption.

Treatment:

1. Use cool soaks or a cool bath as often as needed to reduce the itching.
   
2. Use nonpresciption 1% hydrocortisone cream on the rash 3 to 4 times a day.
   
3. Trim your child's fingernails so that she is less likely to scratch herself.
   
4. Give your child Benadryl at night time to reduce itching and allow sleep.

Call Your Doctor If:

1. Your child's face becomes extensively involved.
2. Any large blisters develop or your child's skin becomes more red and tender.
3. Your child's rash becomes open and oozing.
4. Your child's rash is not responding to the 1% hydrocortisone after two days.