tag:blogger.com,1999:blog-20165174130756008032024-02-18T23:15:37.096-05:00Hilliard KidsA blog about kids health by a Central Ohio pediatrician.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.comBlogger179125tag:blogger.com,1999:blog-2016517413075600803.post-71254635284625032032023-08-29T15:38:00.000-04:002023-08-29T15:38:08.501-04:00Croup - updated protocol August 2023<p> <b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Definition.</span></b></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Croup is a <b>viral</b>
illness, usually caused by parainfluenza virus or respiratory syncytial virus.
Croup is characterized by a <b>distinctive cough</b> that sounds tight,
metallic, and like a barking seal. It occurs year-round<b>, </b>but it much
more common during the <b>fall and winter </b>seasons. The virus infects and
inflames the upper respiratory tract, especially the voice box. Severe croup is
associated with a<b> </b>problem called <b>stridor</b>, which is a harsh,
raspy, vibrating sound made when the child breathes in. <o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Expected Course.</span></b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Croup begins a few days
to a week after exposure to the virus. Croup is quite contagious, much like
other upper respiratory viral illnesses. Mild symptoms of a cold, sore throat,
or <b style="mso-bidi-font-weight: normal;">laryngitis</b> (hoarseness and losing
your voice) without the barky cough of croup occur in many persons with the
parainfluenza virus. Therefore, many children with croup were not exposed to
someone else with the same symptoms. Most cases of croup occur in children less
than 5 years of age, with the peak ages for infection being 6 months to 3 years
of age.<b> </b>We do see teenagers with croup symptoms, even stridor. Note:
during certain strains of COVID, we saw cases of COVID that presented with
croup symptoms.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Croup symptoms can <b>begin
suddenly</b>.<b> </b>Some children have no symptoms of illness prior to
awakening with the cough of croup in the middle of the night. Other children
have mild cold symptoms and perhaps a hoarse voice prior to the cough
appearing. The cough of croup<b> </b>is <b>worse at night and with more
activity</b>. Croup typically lasts about <b>3-5 days</b>. A mild case may last
a night or two and some cases linger on for well over a week.<b> </b>It is not
unusual for the cough of croup to <b>come and go </b>throughout the illness. Cough
spasms can occur where the cough is nearly non-stop for some time. During the
day, many children will have long stretches without coughing.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Other symptoms
associated with croup include fever, fussiness, and a decreased appetite. A few
children will have vomiting, usually around the time of the coughing spasms.
Some children with croup, as with other respiratory illnesses, will develop a
bacterial ear infection.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Although some children
have croup once, it is not unusual to have croup more than once. Some otherwise
healthy children seem particularly prone to croup and will have it frequently.
These children typically require the same treatment as other children with
croup. Occasionally persons with asthma will present with barky coughs, we will
hear wheezing in their chests, and they will respond to albuterol
(bronchodilator) treatments. This is called spasmodic croup. Most children with
frequent barky coughs do not have spasmodic croup.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Prevention.</span></b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Because croup is spread
so easily through casual contact with the virus, it is difficult to prevent.
The virus can be spread from being close-by when someone with it sneezes or
coughs. It can also be picked-up from toys, cups, door-handles, and other
objects recently in contact with someone with the virus. Older children should
be strongly encouraged to cover their mouth and nose during coughing and
sneezing (teaching children to cough into the crease of their elbow can help,
as your hands are more likely to spread the germs). Frequent hand washing or
using hand sanitizer is important.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Children should be kept
home from school or daycare on those days in which they have a fever or
frequent cough.<b> </b>Check with your child's daycare or school for their
specific policy on returning there with symptoms of croup, as these may vary.<b>
<o:p></o:p></b></span></p>
<p align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment.<o:p></o:p></span></b></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Croup will run its
course without special treatment. Because it is caused by viruses, <i style="mso-bidi-font-style: normal;">antibiotics will not help with croup</i>. However,
certain treatments can be helpful.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-- Dry air makes the cough of croup worse and increased moisture
in the air helps decrease the swelling and inflammation around the voice box.
Therefore, the most effective treatment for croup is humidified air. Run a <b>cool
mist vaporizer </b>(recommended over the warm mist vaporizers because some
children burn themselves on the warm mist and studies show that either cool
mist or steam vaporizers help equally) or a <b>humidifier</b> in the child's
room. If the child is having their sleep disrupted by the cough and the
vaporizer is not helping, run a <b>hot shower</b> in the bathroom with the door
and windows closed. Sit on the floor with your child (toys or books or
screentime can keep young children occupied). After 10-15 minutes, many
children have their cough settle down and they can return to sleep. If they
continue to cough and it is cool or cold outside, try bundling them up and
taking them outside. The <b>cool night air</b> often helps the cough if the
steamy shower did not. This also usually takes 10-15 minutes to work. <o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-- <b>Tylenol® </b><span style="mso-bidi-font-weight: bold;">or<b>
Motrin®</b></span> (acetaminophen or ibuprofen) can be given for fever or pain
(sore throat).<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-- Although the cough of croup does <b style="mso-bidi-font-weight: normal;">not</b> usually respond well to cough medicines (the medications will
not change the cough of croup significantly), it is okay to try an
over-the-counter cold and cough medicine for children 4 years old and above. If
it does help, it is fine to continue the medicine throughout the illness.
However, if it does not help after a dose or two, stop.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-- Coughing spasms can be due to the sticky mucous of croup.
Drinking <b>clear fluids</b> (water, apple juice, lemonade, etc.) can help
relax the vocal cords and loosen the mucous. <b><span style="mso-spacerun: yes;"> </span></b><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-- The laryngitis (losing your voice and sounding hoarse) gets
better over a few days with resting your voice. Little kids do not rest their
voice on request, even with encouragement. Their laryngitis will gradually get
better without special treatment.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-- <b>IF THE CHILD HAS STRIDOR</b> <b>OR OTHER SEVERE BREATHING
DIFFICULTY</b>: <o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Some children with
croup will develop the harsh, raspy, vibrating sound of <b>stridor </b>when
they breathe in. This is caused by a narrowing of the airway in your voice box.
Stridor gets worse with crying, coughing, and other activity. <b>It needs
treatment right away</b>. Stridor often frightens both children and parents. Do
your best to remain calm. Stridor is often worse in the night.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>If you hear stridor,
the breathing becomes more difficult, or the breathing becomes tighter:<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; tab-stops: 1.0in; text-autospace: none; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Sit in the bathroom with your child with the door and windows
closed. Run a <b style="mso-bidi-font-weight: normal;">steamy shower</b>. It may
take 10-20 minutes to help. If better, put back in bed with the vaporizer
running in their room. This steamy shower treatment can be repeated as often as
needed.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; tab-stops: 1.0in; text-autospace: none; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If that has not helped, bundle up your child and take them <b style="mso-bidi-font-weight: normal;">outside into the cold/cool night air</b>
(it is not as effective, but standing right in front of the open freezer door
also can help) for 10-20 minutes. If that helps, put back in bed with the
vaporizer running in their room. This cool night air treatment can be repeated
as often as needed.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; tab-stops: 1.0in; text-autospace: none; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If not better and after office hours, your child needs to be seen
right away at Nationwide Children’s Hospital Emergency Department or Urgent
Care. If during walk-in hours at 8 a.m., we want to see your child at that
time. During routine office hours, call for an appointment.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.8in 3.6in 5.4in; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-tab-count: 1;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-tab-count: 1;"> </span><b>CALL 911 (THE RESCUE SQUAD) IF YOUR
CHILD TURNS BLUE OR DUSKY, PASSES OUT, OR STOPS BREATHING.<o:p></o:p></b></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-tab-count: 3;"> </span><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>A few notes on "steroids"</span></b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">:
Some children seen in the office with more severe croup will need to be treated
with steroids. These help the naturally occurring steroids in our body <b>fight
the inflammation</b> in the respiratory tract caused by the croup virus. It has
been shown that these steroids decrease the chances that the croup will worsen.
They also seem to help decrease the worst of the symptoms of croup. They are
given as either a shot (injection) of Decadron® (dexamethasone) or a few days
course of a liquid called Orapred®, Prelone®, or Pediapred® (prednisolone) or a
one-time oral dose of dexamethasone.<span style="mso-spacerun: yes;">
</span>Most cases of croup seen in our office do not need these steroids. But,
for those children that do, it is important to remember a few things:<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>-- Either the shot or the liquid take a
few hours to begin working in your child's system.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>-- The shot keeps working for few days
after just the one dose.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>-- Continue having your child take the
liquid medicine as instructed, even if they seem much better before they are
done.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>-- Let your doctor know if your child has
never had chicken pox but has been directly exposed to it in the last month
(this is <o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>because the steroids could cause a worse
case of chicken pox).<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>-- Although there are no longer-term side
effects from the steroids given for croup, some children get headaches,
grouchiness, moodiness, an increase in appetite, or stomachaches while they are
taking them or for a few days after the shot.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>-- If the liquid forms of the medicine do
not taste good to your child, the liquid can be mixed with something to drink
(such as a small amount of juice or chocolate milk) to make it taste better.
Many pharmacists recommend flavoring this medication.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-align: justify; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Cough and Cold Medicines</span></b><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">:
If you choose to try a cough and cold medicine, here is one you may find
helpful. Please realize more coughs of croup will <b>not </b>be better with
these medicines. All of these have a cough suppressant (dextromethorphan,
usually called "DM"). <o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-tab-count: 1;"> </span>Other cough medications are discussed on
the Coughs, Colds, Allergies, and Sinus Infections protocol.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Delsym® Children’s 12 Hour Cough Liquid 4-5
yrs.: 2.5 ml.; 6-11 yrs.: 5 ml.; 12 years and above: 10 ml. <span style="mso-bidi-font-weight: bold;">Every <b>12</b> hours<b>.</b></span><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-tab-count: 3;"> </span><span style="mso-tab-count: 1;"> </span>--
Dr. Tim Teller, M.D. -- Hilliard Pediatrics, Inc. – 8/2023<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; tab-stops: 1.0in 1.8in 3.6in 5.4in; text-autospace: none; text-indent: -.25in;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: "Calibri",sans-serif; font-size: 10.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></p>Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-25096119409212473212023-08-29T13:18:00.001-04:002023-08-29T13:18:17.460-04:00Allergic Rhinitis ("Hay Fever") - an update!<p><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Introduction</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;">.</span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;"> </span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Allergies are a common health problem. At least
1 out of 5 people have allergic rhinitis sometime in their life. Allergies run
in families (are genetic) and often occur in children with asthma, eczema, and
food allergies. Allergies take some time to develop. Although you might be
“born to have allergies” because of a history of them in your family, they
often take 2 years or more to develop. For the rest of this information sheet,
when I say “allergies” I am referring to what is technically called <b>allergic rhinitis</b> and <b>allergic conjunctivitis. </b>See below.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;"> </span></p><p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Symptoms of Allergies</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;">.</span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> Allergies cause a number of different
symptoms. Allergies never directly cause a fever. Not everyone with allergies
have the same symptoms, but there a number of common signs to look for:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">--
runny nose --
itchy nose --
congested nose</span></p><p class="MsoNormal"><span style="font-family: Arial, sans-serif; font-size: 9pt;">--
clear nasal mucous</span><span style="font-family: Arial, sans-serif; font-size: 9pt;"> </span><span style="font-family: Arial, sans-serif; font-size: 9pt;">--
itchy eyes</span><span style="font-family: Arial, sans-serif; font-size: 9pt;"> </span><span style="font-family: Arial, sans-serif; font-size: 9pt;">--
watery eyes</span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> </span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Common Allergy Seasons</span></b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> Some allergies have a regular season,
based on when the plant is releasing pollen into the air. These dates are based
on Central Ohio seasons. Specific pollen counts are available online.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Ragweed</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: From early to mid
August until late October (it takes 2 good over-night frosts to stop the
ragweed from pollinating).<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Trees</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: From March thru May.
Remember that the fluffy stuff you see floating down from the trees is <b>not</b> the pollen itself, even if that is
when the pollen is being released by the trees.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Grasses</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: From April thru early
July.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Dust mites</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: From Fall until
Spring, when we have our homes closed up and we are running the furnace. Dust
mites live on fabrics such as clothes, bedding, carpets, and furniture.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Molds</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: There are two
categories of molds that cause allergic reactions. One type is worse when it is
damp and will worsen when it rains or moisture is trapped under fallen leaves
(in the Fall). This type of mold is what often is in damp basements. Another
type of mold likes dry conditions and can act up even when it has not rained
recently. Molds often cause symptoms around Christmas time from live trees that
are brought into the house. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;"> </span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Allergies that do not
have a Season</span></b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Pets</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: Exposures to pets
happen at all times of the year. We expect the symptoms to be whenever someone
is around the pet. Although any pet with fur (hair) can cause an allergy, cats
are the most likely to cause allergies, followed by dogs. The hair, skin, and
saliva cause the symptoms. A cat that sleeps on your bed or favorite chair will
leave behind enough hair and dander that you will have allergy symptoms even
when the pet is now somewhere else in the house.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Dust
mites and Molds</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">:
If they are in your house and you are sensitive enough to them, you may have
allergy symptoms to dust mites and molds year round. They will be expected to
be worse when the house is closed up when the air conditioner or furnace is
running.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> </span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Treatment for Allergies</span></b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;"> </span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">The most effective treatment for allergies is <b>avoiding the thing your child that causes
your child’s allergies. </b>In real life, this is not very practical. Your
child wants to play outside, go to grandma’s house where the cat causes them to
sneeze, and roll in the fallen leaves. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> The second most effective treatment is <b>immunotherapy</b>, also called <b>allergy shots.</b> Allergy shots work by
desensitizing you to those things that cause your allergy symptoms. You are
given shots on a regular schedule (usually weekly to start and then spaced out
to 2-4 weeks) of tiny amounts of the proteins that trigger your allergies. Over
time, you become less and less allergic. Depending on your symptoms, sometimes
the shots are given for a few years and sometimes much longer.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> The most common treatment for allergies is
medication. They can help many children and adults with allergies, but they do
not “cure” the allergies. Almost all of the medications are available
over-the-counter without a prescription, while a few of them require a doctor’s
prescription. The medications that help with sneezing, itchy eyes or nose, and
runny nose are <b>antihistamines. </b>These
include Claritin® (loratadine), Zyrtec® (cetirizine), and Allegra®
(fexofenadine). For the stuffy nose and congestion, many children will try <b>decongestants</b>, such as pseudoephedrine
and phenylephrine. There is a prescription strength medicine that can help for
chronic congestion called Singulair® (montelukast). For eye itching that does
not respond to antihistamines by mouth, we recommend allergy eye drops. These
include Zaditor® (ketotifen) and Patanol® and Pataday® (olopatadine). For nasal
allergy symptoms (runny nose, congestion, sneezing, itchy nose) that do not
improve with the above medicines, we recommend a nasal steroid spray. These
include Rhinocort® (budesonide), Flonase® (fluticasone), Nasacort
(triamcinolone), and Flonase Sensimist® (fluticasone). These steroid sprays are
available over-the-counter. Astepro® Allergy Nose Spray is an anti-histamine
nasal spray that is available without a prescription. <o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> </span></b></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Specific ideas for
avoiding what causes your allergy symptoms</span></b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Grass</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: During the grass
pollen season, playing in the fresh-cut grass will cause the most symptoms. If
after playing outside in the grass, someone’s symptoms are bad, try having them
take a shower and changing clothes to get the pollen off their hair, skin, and
clothes.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Molds</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: Bringing live plants
and trees from outside to inside your home will dramatically raise the mold
count in your home. Changing from a live to an artificial Christmas tree will
help. Also, avoid raking leaves when the leaves have gotten damp (it is better
to wait when they are dry). The dampness makes the mold count greatly increase.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Dust mites</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: Dust mites live on
carpets, rugs, bed clothes, clothing, couches, and chairs that have a fabric
covering. They are often worst when the house is closed up and the furnace
circulates them through the house. Since the bedroom can be a likely place to
get exposed to dust mites, placing dust mite covers on the mattress and bed
pillows can be very helpful. Wash the sheets and blankets at least once a week
in warm to hot water to remove the dust mites. Remove carpets from living areas
and clean rugs and carpets frequently to remove dust mites. An air filter
(“HEPA filter”) also can help remove the dust mites.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Pets with fur</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">: If you have a cat or
dog that causes your child’s symptoms, do not let the pet in their bedroom
(especially their bed), try to avoid having the pet lick your child, vacuum
frequently to remove the pet hair, and consider having your dog live outside
rather than inside.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Ragweed, other weeds,
and trees</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">:
keeping the windows closed and running the air conditioner helps decrease how
much of the air-borne pollen your child will be exposed to. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;"> </span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">What to do for your
children’s allergy symptoms.<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">If
you see seasonal and year-round <b>allergy
symptoms</b> and your child is at least 2 years of age: try one of the
over-the-counter antihistamines. These medicines can safely be given every day
or as needed. Consider adding a nose spray if the antihistamines do not help or
if they antihistamines cause side effects (especially drowsiness).<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">If
your child’s <b>symptoms do not improve</b>
with the over-the-counter medications, contact our office during regular office
hours. Your child may benefit from an appointment to discuss other options.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">When
it is time to <b>see an allergist</b> for
allergic rhinitis: 1. If maximizing what we can with medications does not help
your child’s allergy symptoms. 2. If the allergies now cause your child to
wheeze. 3. If you want to know if your child is allergic to a pet (especially
if you plan on getting rid of one). <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">If
your child’s allergies <b>improve with the
medication</b> and they need the medicine during certain seasons, just keep
using the medication as needed. If it seems to stop working, we can discuss
other possibilities.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Note
that ongoing research into diphenhydramine (Benadryl®) shows that, although it
may help with allergy symptoms, the side effects (especially drowsiness) are
enough to not routinely recommend it for allergies at this time. We would
recommend Claritin®, Zyrtec®, or Allegra® instead.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">If
one of the Claritin®, Zyrtec®, or Allegra® is not working well, try another
one. It is not unusual for one of these to work better than another in some
people.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">If
the antihistamines are not working well on their own, add a nasal spray.
Astepro® works best for sneezing and runny nose (as it is an antihistamine),
while the inhaled steroid nose sprays (Flonase®, Nasacort®, etc.) work best
against congestion.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">The
least volume of spray and the least scent of any nose spray for allergies is
Flonase® Sensimist.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;"> </span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Medication Dosing.<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Claritin® Syrup</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> 2-5 years of age: 5 ml.
once a day. 6 years of age and above: 10 ml. once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Claritin® Reditabs
24-Hour </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">6
years of age and above: 1 dissolvable tablet once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Claritin® Reditabs
12-Hour </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">6
years of age and above: 1 dissolvable tablet twice a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Claritin® Children’s
Chewables</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">
<b>5 mg.</b> 2-5 years of age: 1 once a
day. 6 years of age and above: 2 chewables once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Claritin® 10mg Tablets</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> 6 years of age and
above: 1 tablet once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Zyrtec® 10mg Tablets</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> 6 years of age and
above: 1 tablet once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Zyrtec® 5mg Chewable
Tablets </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">2-5
years of age: 1 tablet once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Zyrtec® 10mg Chewable
Tablets</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">
6 years of age and above: 1 tablet once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Zyrtec® Children’s
Allergy Syrup </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">2-5
years of age: 2.5 ml. once a day. 6 years of age and above: 5 ml. once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Allegra® Oral Suspension
</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">2-11
years old: 5 ml. twice a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Allegra® ODT Orally
Disintegrating Tabs</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">
6-11 years old: 1 tablet twice a day. It dissolves on the tongue.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Allegra® 60mg Tablets</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> 12 years of age and
above: 1 tablet twice a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Allegra® 180mg Tablets</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;"> 12 years of age and
above: 1 tablet once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Zaditor® Ophthalmic
Solution</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">
3 years of age and above: 1drop twice a day, every 8-12 hours.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Patanol® Ophthalmic
Solution</span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">
3 years of age and above: 1 drop twice a day, every 8-12 hours.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Pataday® Ophthalmic
Solution </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">3
years of age and above: 1 drop once a day, every 24 hours.<b><o:p></o:p></b></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Flonase® Allergy Relief
Nose Spray </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-weight: bold;">2-11 years of age (use Children’s Flonase): 1 spray
per nostril per day. 12 years and above: 2 sprays per nostril.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Flonase Sensimist
Allergy Relief Nose Spray </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-weight: bold;">2-11 years of age (use Children’s
Flonase Sensimist): 1 spray per nostril once a day. 12 years of age and above:
2 sprays per nostril once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Nasacort Allergy
24-Hour® Nose Spray </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-weight: bold;">2-11 years of age: 1 spray per nostril once a day. </span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">12 years of age and
above: 1-2 sprays per nostril once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Rhinocort (budesonide) Allergy
Spray </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">6-11
years: 1 spray per nostril; 12 years of age and above: 1-2 sprays per nostril
once a day.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">Astepro
Allergy Nose Spray </span></b><span style="font-family: "Arial",sans-serif; font-size: 9.0pt;">6-11
years of age: 1 spray per nostril every 12 hours. 12 years of age and above: 2
sprays per nostril every 12 hours.<o:p></o:p></span></p>
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"> --
Dr. Tim Teller, M.D. -- Hilliard Pediatrics, Inc</span>Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-79782794076255937852021-06-12T09:24:00.001-04:002021-06-12T09:24:24.656-04:00Do we recommend the COVID vaccine for our patients?<p> As of today, June 12th, 2021, the COVID vaccine is approved for 12 years of age and above. We strongly recommend it for our patients. From all available evidence it is safe and highly effective. We currently have the Pfizer vaccine (this is subject to change and I highly recommend you check our website for up to date information about our COVID vaccine clinics) and have given it to hundreds of adults and children 12 years of age and above. </p><p>Some benefits of the vaccine: helps prevent the illness, helps prevent the spread of the illness to those in poor health, helps prevent the spread of the illness to those who cannot receive the vaccine, and eliminates having to quarantine after possible exposure if the vaccine-recipient has no symptoms.</p><p>We are happy and proud to have been able to serve the community during this challenging pandemic by vaccinating adults and teens with the COVID vaccine! We look forward to approval of the vaccines for children 11 years of age and below. </p>Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-88754126116989858772021-06-12T09:13:00.005-04:002021-06-12T09:13:57.852-04:00Swimmer's Ear Season!<p><span style="font-size: 14pt;">Swimmer’s ear is a common childhood infection where bacteria
infect the skin or lining of the ear canal. It most commonly seen after
swimming, but it can occur after long showers or getting the ears damp with
baths. Swimmer’s ear is more common when the water is untreated (ocean, lakes,
ponds). Often the outer ear will be tender when tugged or pushed. We want to
see these children with possible swimmer’s ear in the office for an accurate
diagnosis. You can help prevent this infection by using swim ear plugs or
putting over the counter drops (SwimEar® and AuroDry® are two brands) in the
ear canals after swimming (note: these prevention drops should not be used for
a child with ear tubes).</span></p>Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-2022122351060874132020-03-04T14:51:00.000-05:002020-03-04T14:51:13.939-05:00Coronavirus and COVID-19<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
Introduction</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>Coronaviruses are a group of viruses that cause illnesses in humans,
mammals, and birds. In humans, the viruses typically cause respiratory illnesses.
In 2019, a new (“novel”) coronavirus infection was first found in China. It has
been named COVID-19. Since that time, the infection is spreading to other
countries. As of 2/4/2020, the countries with the most widespread numbers of
coronavirus infections are China, Japan, South Korea, Iran, and Italy. However,
many other countries have had some cases and this list is likely to expand as
the infection spreads. Because this is a new viral strain, people are not
immune to it from a prior infection.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;">How The Illness Presents<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>COVID-19 presents with symptoms similar with influenza: fever, cough, and
fatigue. Sore throats and shortness of breath have been less common at the
start of the illness. As with influenza, most of the cases of breathing difficulty
(respiratory distress) are occurring later in the course of the illness – the average
is 8 days after the onset of the illness. It is the respiratory distress that
has caused the deaths associated with the COVID-19. A patient with COVID-19
infection with respiratory distress will be breathing hard and fast, as well as
coughing very frequently.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>Most of the severe infections have been in adults, especially older
adults. The more severe infections are also in those with underlying medical
conditions, such as asthma, heart conditions, and diabetes. As with other
respiratory illnesses, there will be some persons with COVID-19 infection where
the illness is very mild.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;">Testing For COVID-19<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>There are tests for this virus. The testing is NOT available at this
point in doctor’s offices and urgent cares. The testing is more available through
large hospitals, emergency departments, and health departments. At this time,
we do not have this testing available to us.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>Who should be tested? If someone with worrisome symptoms with a known
exposure to someone with the virus OR recent travel to a country where the
illness is more wide-spread (China, Iran, Japan, South Korea, Italy). Realize,
if a child had a possible exposure or concerning travel history AND had a
cough, fever, and respiratory distress, they likely have another virus – often influenza
with pneumonia.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;">What To Do<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>If your child has traveled to a country where the virus is more common
OR they have had an exposure to someone known to have the infection AND has a
fever and cough, especially if they have breathing problems, they should be
seen at the pediatric emergency room. You should CALL AHEAD to alert the
emergency room before you arrive to discuss how to avoid exposing others to the
infection.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>As with avoiding all common respiratory viruses, frequent hand washing,
avoiding places where ill people may be (large gatherings), and covering your
nose with sneezing and covering your cough. Wearing a mask Is appropriate IF
you have symptoms, but it is not currently recommended if you are trying to
avoid getting the virus.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">
</span>This information will very likely change quickly. The <a href="http://www.cdc.gov/">www.cdc.gov</a> website is an excellent source of up
to date information.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<br />Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-42547809142652018832018-04-17T15:05:00.001-04:002018-04-17T15:05:29.797-04:00Dr. Jeff's retirement on April 30, 2018 <span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px;"> We are fast approaching Dr. Jeff's retirement on April 30th, 2018!</span><br style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px;" /><span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px;"> Dr. Jeff founded Hilliard Pediatrics in 1990 after finishing his pediatric residency at Columbus Children's Hospital. Starting a practice on your own meant seeing all the patients, taking all the nighttime and weekend call, and seeing both healthy newborns and children hospitalized at Children's Hospital. The practice grew and grew with Dr. Jeff's hard work and excellent care. </span><br style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px;" /><span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px;"> Over the years, the office has </span><span class="text_exposed_show" style="background-color: white; color: #1d2129; display: inline; font-family: Helvetica, Arial, sans-serif; font-size: 14px;">moved locations - from Leap Court to Berry Leaf Lane (in 1996) to Trueman Court (2011) - and grown as other doctors joined the practice.<br /> Dr. Jeff has been passionate about Hilliard Pediatrics, his family, sailing and painting, and the environment. Dr. Jeff has run marathons, raised bees, painted exam rooms and portraits, and had some great life adventures.<br /> What has never changed is Dr. Jeff providing excellent pediatric care for his patients. The patients will miss him and we at the office will sure miss him. He will be remembered for his dedication to his patients, his infectious laugh, and how many lives he positively impacted.<br /> Thank you Dr. Jeff for all that you have done!</span><br />
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Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-24243439447722734172018-01-22T14:20:00.000-05:002018-01-22T14:20:11.984-05:00Dr. Mike Patrick's Pediacast pediatric podcasts Dr. Mike Patrick, M.D. from Nationwide Children's Hospital has a podcast called Pediacast that has an amazing amount of information for patients and families. I highly recommend it! He and guests cover many topics. If you are unfamiliar with it, <a href="http://here/" target="_blank">http://www.pediacast.org/</a> is the web address. It can also be found wherever you find other podcasts (iTunes, etc.).Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-3488380995236246192018-01-06T11:52:00.000-05:002018-01-06T11:52:09.166-05:00Is it too late to get the flu shot? The simple answer is <b>no</b>. It is not too late to receive the flu vaccine if you or your child has not yet received it this season.<br />
The influenza season started early this year. By late November, a number of cases were appearing in Central Ohio. The season usually runs from December through March.<br />
Although a report out of Australia reported that the vaccines effectiveness versus the H3N2 strain (one of 4 in the vaccine) was only 10% last year, the Centers for Disease Control and Prevention report the U.S. effectiveness was between 30-40% (significantly better) and it is likely going to be closer to that percentage in the U.S. this influenza season. <a href="https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm#effectiveness" target="_blank">Here</a> is a link to more information from the CDC.<br />
We have been out of the vaccine since early November. But there are other ways to get the vaccine:<br />
1. The Franklin County Health Department is able to give the vaccine to those <b>6 months and above</b>. You can schedule an appointment to receive the vaccine by calling 614-525-3719 or going to <a href="http://www.myfcph.org/shots" target="_blank">www.myfcph.org/shots</a> to make an appointment.<br />
2. The urgent cares staffed by nurse practitioners (such as Minute Clinics) are able to give the vaccine to children 18 months or <b>24 months and above</b> (it varies). Check <a href="http://www.cvs.com/minuteclinic/resources/flu-vaccination-iq" target="_blank">here</a> for more information.<br />
3. Many pharmacists are able to give the flu vaccine to those <b>7 years of age</b> and above. Check with your favorite pharmacy for more details.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-76121572029373139752017-12-23T09:46:00.002-05:002017-12-23T09:46:44.694-05:00Storing Breast Milk and Formula We are frequently asked in the office about how long breast milk and formula can be safely stored. The major risks for going past this limits is accidentally introducing an unhealthy bacteria to the infant ("spoiled milk") or the breast milk or formula having its ingredients break down.<br />
Although you can find a wide variety of guidelines on the Internet, I find it easier to keep it simple to remember: follow the <b>Rules of Six</b> for breast milk storage. Breast milk can be safely consumed if stored for <b>6 hours</b> at room temperature, <b>6 days</b> in the refrigerator, and <b>6 months</b> in the freezer. If the breast milk is kept in an insulated cooler bag, it should be used within 24 hours.<br />
The guidelines for formula are different. A bottle of formula should be kept at room temperature for no more than <b>1 hour</b>. Formula prepared from powder then stored in the refrigerator should be used within <b>24 hours</b>. Formula prepared from concentrate or ready-to-feed formula may be stored in the refrigerator for <b>48 hours</b>. A can of powdered formula should be used within <b>30 days</b> of opening.<br />
<a href="https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm" target="_blank">Here</a> is a link to some more detailed information about safely storing breast milk from the Centers for Disease Control. <a href="https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Sterilizing-and-Warming-Bottles.aspx" target="_blank">Here</a> is a link to an article about storing infant formula from Healthy Children.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-74091934903709380632017-12-20T14:38:00.003-05:002017-12-20T14:38:53.023-05:00Updated Information on the Prevention of Tooth Decay In the 23 years I have been in practice, the recommendations about fluoride and children has changed. Although there is great deal of information supporting the safe use of fluoride to prevent tooth decay, recommendations about how much and how often have frequently changed. Here is an updated description of the current recommendations.<br />
One note: you can find a lot of misinformation on the Internet. And a great example is the misleading, non-scientific, and sometimes outright false and outrageous anti-fluoride information on the Internet. Do not believe this misinformation. It safe to use fluoride to prevent teeth decay.<br />
The current recommendations:<br />
1. It is helpful to have your child <b>drink fluoridated water</b> and to cook using fluoridated water. In Central Ohio, our public water supply has fluoride added. Drinking bottled water does not reliably give enough fluoride. Most household water filters do not remove fluoride, but it is worthwhile making sure (by reading the filter's information).<br />
2. Once babies have their first teeth, brush their teeth daily with a grain of rice sized amount of <b>fluoride containing toothpaste</b>. Once they reach 3 years of age, it should be a pea sized amount of fluoride containing toothpaste.<br />
3. Routinely <b>see the dentist by 3 years of age</b>, sooner if recommended by the pediatrician.<br />
4. <b>Fluoride varnishes</b> are recommended once a number of teeth have extruded. We now do the fluoride varnish at 18 month, 24 month, and 30 month check ups. The kids seem to be tolerating it just fine. The varnish stays on your teeth for 4-6 hours. During those 4-6 hours, it is best to maintain a soft diet and avoid hot liquids. Do not brush or floss during that 4-6 hours after the varnish (you can resume normal dental care the next day). If you take supplemental fluoride, stop for 3-4 days after the varnish is applied.<br />
If you interested in reading more, <a href="https://www.healthychildren.org/English/healthy-living/oral-health/Pages/FAQ-Fluoride-and-Children.aspx" target="_blank">here</a> is a link to more information from the website Healthy Children.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-73746410628961683142017-12-08T10:49:00.001-05:002017-12-08T10:49:29.721-05:00What to do when children and teenagers vomit with exercise. Some athletes vomit during exercise. This can happen at younger ages, but typically occur when teenage athletes push themselves hard during workouts. There are some things to do to help prevent this issue.<br />
One of my teenage sons has struggled with vomiting when pushing himself during workouts. He does vomit more easily with bad coughs or stomach upset versus some other folks, but he did not have vomiting with exercise until high school.<br />
If someone struggles with this issue, we would ask some other questions to make sure it was not from something more complicated. We ask questions about acid reflux and and whether the vomiting happens after coughing. We ask about timing of eating and drinking when it comes to exercise.<br />
If nothing else is complicated about the history, there are some helpful recommendations to help reduce the chances of vomiting during exercise.<br />
-- Eat a small snack 30 minutes before exercise.<br />
-- Avoid exercising in extreme heat.<br />
-- Watch your exercise intensity. The athlete may need to dial-back their intensity.<br />
-- Stay hydrated. Drink 8 ounces of water every 20 minutes of exercise. If the exercise is going to be high-intensity for more than 45-60 minutes, drink sports drinks instead of water.<br />
-- Cool down gradually.<br />
<br />
If your child struggles with this issue and is not improving while following these recommendations, call during routine office hours to discuss.<br />
Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-61441264381589608172017-12-08T10:22:00.002-05:002017-12-08T10:22:58.338-05:00Why do children tell lies? At some point during your child's early life, they will lie to you. It is aggravating and frustrating for parents, but inevitably it happens. Our hope as parents is that it does not happen very often. Here is some more information about how to approach this issue.<br />
<b>Why does anyone lie? To get what they want or to avoid punishment.</b> "No, Dad did not give me a cookie today!" (when they have already had their once-a-day treat). "I was not running in the living room!" (when the lamp got knocked over again). "My brother was on the iPad longer than me!" (when they want more iPad time).<br />
Sadly, we are in a current situation where it is hard to point to well known adults that your child may look up to - athletes, politicians, etc. - as good examples of "always tell the truth". This makes it difficult when we all get mixed messages from daily life, including for children. When others see someone not tell the truth then get what they want or avoid punishment, even otherwise well-behaved children (and adults) are more tempted to not to tell the truth.<br />
Certainly, when you know (or are quite certain) that your child is not telling the truth, your best bet as parent is - as always -<b> consistency</b>. By that I mean that you should routinely give your child some negative consequences for lying whenever it happens. We all are more likely to keep repeating an action or behavior if we are not negatively reinforced for it. And we are more likely to stop an action or behavior if we are regularly and consistently negatively reinforced for it.<br />
Those negative consequences may be a time-out, a removal of privileges (no iPad for the day or no cookie for tomorrow), etc. Stick to your guns: if you say it ("no TV today"), follow through with it (they get no TV today). Otherwise, you are accidentally giving your child the idea that they can <i>sometimes</i> "get away with it".<br />
One more note: I think it is important to <b>model good behavior to your children. </b>I truly believe if you model to your child that it is important to tell the truth, they are more likely to tell the truth themselves. I recall a time my one son and I were in a fast-food restaurant. When I handed the cashier money, they gave me back too much money. I said "Here, take the $5 back. Then we are even. You gave me too much cash back." The cashier was happy and I was happy for a small moment to emphasize to my son that telling the truth is important.<br />
So to conclude, do not be too frustrated if your children lie, be consistent with your negative reinforcement, and - as always - call us during routine office hours if you have other concerns.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-90154836434795363612017-12-01T12:16:00.002-05:002017-12-01T12:16:41.717-05:00Keratosis Pilaris Keratosis pilaris is a chronic skin condition that is quite common. It is one of the skin issues we are asked about frequently in the office. It often appears in the first few years of life, it is worse when the weather is colder, and cannot be entirely cured. The rash rarely itches, but it does for some folks. It tends to be genetic with some families having multiple folks who have keratosis pilaris.<br />
Keratosis pilaris appears as small rough bumps on the back sides of the upper arms, sides of the thighs, and cheeks of the face. It tends to look flesh colored in paler skinned individuals, but can look darker pigmented in persons with naturally darker pigments. It can spread from these areas or be just in one of these areas (arms) but not others. It may worsen when the air is more dry (during the winter months when heating the house drops the humidity in the house).<br />
Keratosis pilaris is more common in families with allergic illnesses - eczema, allergic rhinitis/hay fever, asthma, and food allergies. Many times, a person only has <i>some</i> of these issues, not all. So if dad has allergies and mom has had eczema, their children could have keratosis pilaris even if they have no other of these issues.<br />
Keratosis pilaris is not curable. You can keep it under control, but it cannot be made to go away permanently. It keep it under control, it needs to be regularly treated. Often that treatment will be on a daily or multiple days per week.<br />
For many years, our go-to treatment for keratosis pilaris was a lotion called Lac Hydrin Lotion. Sadly, it appears the manufacture has discontinued the product. Some of the available products are ones you may need to check in stores and online to find. All of these products are available at Amazon.com. Here are the products I would recommend now, with the CeraVe product being the best:<br />
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CeraVe Renewing SA Lotion<br />
AmLactin Alpha-Hydroxy Therapy Daily Moisturizing Body Lotion<br />
Geritrex Geri-Hydrolac Lotion<br />
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If you have tried one of these for a few weeks without relief, try a different listed product. Note that many other great creams and lotions used for dry skin (Eucerin, Aveeno, Cetaphil, or other CeraVe products) often do not work on keratosis pilaris.<br />
If all else fails and the rashy bumps are bothersome, we often refer a patient to a dermatologist for further help.<br />
<br />Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-30444138881306104862017-11-28T09:46:00.001-05:002017-11-28T09:46:31.784-05:00Prenatal Meetings With the Pediatrician Many pediatricians hold meetings with expectant families. This allows parents who are expecting their first child to meet with the pediatrician before the birth of their child. This allows you to meet the doctor, see the office, and ask questions.<br />
We call these meetings "prenatals". We schedule those with one of our doctors and a handful of couples. They are scheduled in the early evening and we meet in our lobby. The doctor will tell you more about themselves, our office, and what you can expect at the hospital and with bringing your child to our office. We will show you our exam rooms. You will have an opportunity to ask questions of the doctor. The meetings usual last 20 minutes or so. If there are a number of questions, they can go longer. If you see a particular doctor at a prenatal, we anticipate that you will have that doctor as your primary care doctor here in the office.<br />
You do not need to do a prenatal to bring your newborn to our office. You also will not need to let us know prior to the birth of your infant that you are bringing your infant to our office. In other words, you do not need to tell us at the prenatal that you will bringing your child to our office.<br />
If you are interested in scheduling a prenatal meeting with a doctor here in the office, call our routine office number 614-777-1800 during routine office hours and speak with the front office staff.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-64225910789078453032017-11-10T16:17:00.001-05:002017-11-10T16:17:18.387-05:00What happened with your flu shot supply? You may be asking yourself this question: what happened with Hilliard Pediatrics flu shot supply?<br />
I will answer that. But some background. We order the vaccine from a supplier. Most offices place their order in February to receive the vaccine in August to September. How do we determine how much we order? We look at previous years supply and use and make an educated guess. The year that FluMist went off the market, we dramatically increased our flu shot order to have enough vaccine for those who had received the flu shot and those who received the FluMist in the past.<br />
We have about 10,000 patients. If we gave each of the infants two doses and all the older children 1 dose a year, we would go through more than 10,000 doses a year. We do not use that many. We realize some families do not vaccinate their children with the flu vaccine routinely. Other patients receive the vaccine in other places.<br />
Last year, it was the second year without the FluMist. We felt like the demand in the office was steady but not high. By the end of January, we ran out of our supply and most of the families seeking the vaccine from our office received it here. Typically we run out of the vaccine between late November and early January.<br />
This past Winter, we placed our current order for the same number of flu shots as last year. Although we added a new doctor, our total number of patients has not changed much. We received the vaccine in August (earlier than some years) and then began vaccinating our patients. As usual, we were giving the vaccine in the office and check-ups and (were appropriate) sick visits. We also had our usual flu shot walk-in clinics. How busy each flu shot clinic is seems to vary over the years. This year, we were less busy than usual <i>until</i> the last few clinics where the numbers went up.<br />
The week before we ran out, we realized we would need more vaccine. When we called, we were initially told we could order as much as we needed. After discussing in the office, we called the next day to be told the previous days information was in fact not true -- they could not supply us with any further vaccine.<br />
We have been asked why we do not hold back vaccine for the youngest of patients who need a second dose. We do not do that. In fact, we could not as we believed up until the last minute that we could order more vaccine. And we fully intended to order more. There other logistical issues with holding back vaccine to give to someone else.<br />
So what about next year? Surely we will order more vaccine. But we have found that each year has its challenges. We appreciate that many of our patients are able to and do receive the vaccine in the office each year.<br />
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Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-42278057749756309362017-10-23T10:59:00.001-04:002017-10-23T10:59:33.037-04:00Children with Easy Bruising Who Take Fish Oil Supplements We are asked regularly about children who <b>bruise easily</b>. If children have impressive bruises that occur after minor injuries, we will likely ask about your child's history with other issues that make us worry about a bleeding disorder. These questions include:<br />
Does your child have easy bleeding with minor mouth injuries or teeth cleaning?<br />
Does your child have frequent or hard to stop nose bleeds?<br />
Has your child had excessive bleeding after minor procedures?<br />
Does your child pass blood with a bowel movement?<br />
Has your child had painful, swollen joints after minor injuries?<br />
What medications or supplements does your child take?<br />
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A combination of history and physical exam can prompt us to do screening labs or a referral to the hematologist at Nationwide Children's Hospital. Other histories and physical exams are reassuring.<br />
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On a personal note: I spoke with my eye doctor in the last year about my eyes being dry. I had already tried some other remedies, so my eye doctor recommended that I try taking fish oil supplements. I began taking Occuvite and noted only so much improvement. I then switched to a higher dosed supplement, this time Member's Mark Triple Strength Wild Alaskan Fresh Fish Oil Softgels with 900mg of Omega 3. At my annual check up last week, I mentioned my easy bruising this year and the first thing my doctor said was "It is those Omega 3 supplements you take!". So now I am weighing the "eyes less dry" with the "easy bruising" tendencies.<br />
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So a good thing to know is that fish oil/omega 3 supplements can increase the tendency to easy bruising. If your child is regularly taking these supplements, let your doctor know this if they are going to have surgery or if they have been prone to easy bruising.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-88896313175425924312017-08-25T15:04:00.001-04:002017-08-25T15:04:38.103-04:00Safe Sleep for Newborns and Beyond My oldest son is now 22 years of age. Back in 1990's, the cribs had wide enough slates that it was possible to get an arm or leg stuck between the slats. This prompted it to become nearly universal to use bumper pads to keep the arms or legs getting stuck and to pad the area so an infant would not "get hurt".<br />
This was not the safest sleep environment. We know now that there were more cases of SIDS and injured arms and legs with that setup. Now the slats are close enough to prevent these issues and it is recommended to not use any bumper pads. The chairman of the Consumer Product Safety Commission, Elliot Kaye states "I reiterate my belief that the public should stop using padded crib bumpers. The overwhelming evidence show that they do nothing more than contribute to the deadly clutter in many of our nation's cribs. Based on the real risk they present, it is a mystery to me why they continue to be sold." I agree.<br />
The Ohio legislature recently passed a law, Sub Senate Bill 332. It includes a bumper ban. I believe it goes into effect at the end of 2017. The law prohibits the manufacture or sale of non-mesh crib bumpers. The law allows for the sale of mesh crib bumpers for the next 3 years. The law will then ban the mesh crib bumpers if the Consumer Product Safety Commission (CPSC) has not created safe standards for mesh crib bumpers.<br />
"Bumpers are unnecessary and pose a real risk to the safety of infants." - Dr. Sarah Denny, Nationwide Children's Hospital.<br />
For more information about safe sleep for infants: <a href="http://ohioaap.org/SafeSleep" target="_blank">here</a> on the Ohio AAP website.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-63383263765405571582017-08-25T13:58:00.001-04:002017-08-25T13:58:19.805-04:002017 Flu Shot Walk-In Clinic Dates and Times It is the flu shot season! We have a good supply this year of the flu shot. We are announcing the dates for walk-in flu shots for Sept.-Nov. 2017. Depending on the supply, we will schedule further dates in the Fall. We have shifted the weekday clinic date to Wednesday from Thursday (to accommodate our exam room needs in the office).<br />
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Wednesday clinics are from 2-5 p.m. Saturday clinics are from 9 a.m.-12 noon.<br />
Wednesday dates: September 13, September 27, October 11, October 25, and November 8.<br />
Saturday dates: September 23, October 7, October 21, November 4, and November 18.<br />
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We occasionally have to cancel/reschedule dates due to our supply of the vaccine. We will announce on the Hilliard Pediatrics Facebook page (maintained by Dr. Tim) if that occurs.<br />
<br />Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-16301802023489637112017-08-21T09:13:00.000-04:002017-08-21T09:13:07.984-04:00Solar Eclipse Safety Here it comes! The solar eclipse! Exciting as it is a fairly rare event. Now let us experience it safely!<br />
I love the Healthy Children website. <a href="https://www.healthychildren.org/English/news/Pages/Solar-Eclipse-Tips-2017.aspx" target="_blank">Here</a> is their article about safely enjoying the solar eclipse. <a href="https://www.aao.org/eye-health/tips-prevention/solar-eclipse-eye-safety" target="_blank">Here</a> is an article about eye safety during a solar eclipse from the American Academy of Ophthalmology.<br />
Be safe out there!Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-31262084824442670842017-08-18T13:53:00.000-04:002017-08-18T13:53:09.919-04:00Car seat and car safety website I became aware of a very nice, accurate website recently. It is maintained by the National Highway Traffic Safety Administration. It has lots of resources regarding proper car seat use, safety tips for teen driving, and other safety information regarding cars. The website can be found at the <a href="https://www.safercar.gov/parents/index.htm" target="_blank">Safer Car</a> website.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-83240428661890171642017-08-15T09:31:00.002-04:002017-08-15T09:31:26.816-04:00Nationwide Children's Dublin Urgent Care has reopened. Due to staffing issues, Nationwide Children's Hospital's Dublin urgent care was temporarily closed for some months. As of August 2nd, 2017, it has reopened.<br />
We recommend using Nationwide Children's Hospital facilities when your child needs an urgent care or emergency room.<br />
The hours for the Main Campus (downtown) and Lewis Center Emergency Departments are 24 hours a day, 7 days a week. The Hilliard and Dublin (the two closest to our office) Urgent Cares are open Mon.-Fri. 3-10 p.m. and Sat.-Sun. 12-8 p.m.<br />
Laboratory and x-ray services are available as walk-ins with a doctors orders at both the Hilliard and Dublin locations. Laboratory hours are Mon.-Fri. 8:30 a.m. - 10 p.m., Sat. 9 a.m. - 8 p.m., and Sun. 12-8 p.m. X-ray services are available at both locations Mon.-Fri. 8:30 a.m. - 10 p.m. and Sat.-Sun. 12-8 p.m. Of note: patients needing TB screenings (often for volunteering, work, or college) can be seen from 3-7 p.m. everyday with no appointment needed at either the Dublin or Hilliard Close to Home Centers.<br />
As always, further information is available at <a href="http://www.nationwidechildrens.org/" target="_blank">www.nationwidechildrens.org</a>Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-48922920839040797092017-08-14T11:45:00.000-04:002017-08-14T13:14:27.822-04:00The flu vaccine has arrived! The influenza vaccine ("flu shot") has arrived for the 2017-2018 season. We received hundreds of doses. We will receive further doses in the future months.<br />
There are 4 strains of influenza in the vaccine and one is a new strain this year. Each year, scientists predict what strains are most likely to be in the communities for the coming season. For the '16-'17 season, the protection was only fair. On average, for every year like last year, we will have two years where the protection is much better.<br />
We agree with the recommendation that all children 6 months and above routinely receive the vaccine each year. This provides the best protection against influenza and it's complications, including dehydration and pneumonia.<br />
The only influenza vaccine we will stock this year is the flu shot. Although the "flu mist" is back on the market after concerns about its effectiveness, we want to make sure that it provides equal or better protection versus the flu shot before potentially recommending it in the future.<br />
Although the flu shot contains a small amount of chicken egg protein, the majority of egg-allergic patients can safely receive the flu shot. If a child has a history of anaphylaxis (a severe allergic reaction) to eggs, we should further discuss the issue. Some of these patients will see the allergist to receive the vaccine at their office.<br />
For those patients receiving the vaccine for the first time AND before their 9th birthday, two doses of the vaccine are needed one month apart. This supplies them with the best protection for that season. All other children need one dose each year.<br />
The flu shot cannot "give you the flu". In other words, if you or your child felt ill soon after receiving the vaccine, it was just a coincidence. Mild local reactions including soreness, redness, or swelling at the site are common. Less common are fever, achiness, headache, or nauseousness.<br />
We will soon schedule walk-in flu shot clinics. These have typically been scheduled on select Thursday afternoons and Saturday mornings in the Fall. We will announce on our Facebook page and on our website (www.hilliardpeds.com) when we know the schedule.<br />
One thing we are often asked about: Is my child too sick to receive the flu vaccine? The answer is "It depends". Mild cold and coughs, mild diarrhea, and low grade temperatures 100.4 degrees and below are not reason to postpone the vaccine. In fact, it has been shown that it is still safe and effective to receive the vaccine if someone has active asthma or croup and will need a steroid -or- has recently been on a steroid.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-30791892615183904652017-08-01T08:58:00.001-04:002017-08-01T08:58:48.711-04:00Menveo vaccine back in stock. As of last week, our office received the previously back-ordered Menveo vaccine. We are contacting by phone the families whose children had been in the office and had not received the vaccine due to the shortage. We have a good supply of the vaccine now and anticipate being able to vaccinate on-time the patients who need the vaccine.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-55992719825019174962017-07-18T09:39:00.001-04:002017-07-18T09:39:16.112-04:00Meningitis Vaccine for 7th and 12th graders on back order. The Menveo meningitis vaccine is recommended by the CDC and AAP for prevention of bacterial meningitis. It is required for Ohio schools to be received before starting 7th and 12th grades. We have consistently given to 11 year olds and 16-17 year olds in our office.<br />
We were recently informed that the vaccine was on back order by the manufacturer. Soon afterwards, we ran out of our supply of the vaccine. As of this morning, we do not have any further doses of the vaccine. Many pre-teens and teens have appointments with us in the weeks before school who will be due for the vaccine. What to do?<br />
When this happens, we typically are not informed when we will receive further doses of the vaccine. This is true now. We anticipate receiving more vaccine before school starts. Since we ran out of the vaccine, we are keeping track of those who needed the vaccine at a visit but did not receive it. We plan to contact those families when the vaccine arrives. In addition, we will post on Dr. Tim's Hilliard Pediatric page on Facebook when the vaccine is available. When it arrives, those patients will be able to be promptly scheduled for a nurse-only vaccine visit.<br />
In the unlikely event that the vaccine is still unavailable to us when the school year begins, we can provide a note to the school detailing the situation.<br />
We will keep you informed!Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0tag:blogger.com,1999:blog-2016517413075600803.post-57687880494248011762017-04-18T09:33:00.000-04:002017-04-18T09:33:05.719-04:00Testing for Food Allergies -- a great article by Dr. Stukus Food allergies and the testing for them can be befuddling for many families (and their doctors). We very often use the expertise of an allergist in these cases. Testing for food allergies can be a challenge (yes, that is a pun). Dr. David Stukus, M.D., pediatric allergist at Nationwide Children's Hospital here in Columbus, Ohio has an excellent discussion of testing for food allergies. <a href="http://www.kidswithfoodallergies.org/page/food-allergy-test-diagnosis-skin-prick-blood.aspx#.WPSfamNLOYM.twitter" target="_blank">Here</a> is the article.Dr. Tim Teller, M.D.http://www.blogger.com/profile/18060226342701619735noreply@blogger.com0