Lingering stomach symptoms after a viral infection

     We are winding down in the "stomach flu" season. There have been at least two viral illnesses (probably quite a few more!) this year, norovirus and rotavirus. They have very similar symptoms (vomiting, diarrhea, possible fever) and it really is not possible to tell the difference between the two or other viruses that cause the gastrointestinal viruses. They generally run their course with help from rest, clear liquids, and a bland diet. The things that worry the pediatrician: dehydration, doubled-over abdominal pain not quickly relieved by vomiting or diarrhea, blood in the vomit or diarrhea, or a late fever. See our website for more information here.
     I want to review a common thing that happens after the viral illness starts to calm down. Your child is starting to feel better, act better, and wants to return to their normal diet. But many times, when you return to the normal diet, some cramping, vomiting, or diarrhea happen. The younger you are, the longer it takes to recover from these viral gastrointestinal illnesses. Many times when these symptoms come back, it is frustrating, but it is your body's way of saying it needs more time to recover. And the way to do that is to return to a bland diet and clear liquids. That means no dairy, no spicy foods, and no fried foods. That is not easy -- I know! But take the return of the symptoms as your body sending you a message.
     There are good studies that show rotavirus symptoms can linger with diarrhea in young infants for 4 weeks. And many other "stomach flu" viruses can cause lingering symptoms for 1-2 weeks after the viral infection has finished. Remember that we do not recommend any medication that says it is for vomiting, nausea, or diarrhea. We share your frustration with how these symptoms disrupt life, but the worry is that the medication is delaying how quickly your body is able to clear the viral infection out of its system.
     Certainly call our office during regular office hours if you have questions or concerns about these gastrointestinal symptoms. Children with dehydration or doubled-over pain need to be seen right away. We recommend the Nationwide Children's Hospital Emergency Department. More information about their services is available here. Warning: the link loads slowly.

Fifth Disease

     Fifth disease is a common viral infection of childhood. It is the "slapped cheek, lacey rash" viral illness. We have seen and heard of more cases of Fifth disease recently, so we believe there are more cases in the community. The Kids Health website has an excellent description of the illness here. Although if you have questions or concerns about the rash or are unsure if the rash is indeed Fifth's disease, we can see your child for walk-ins or a routine illness appointment. However, most children with Fifth disease do not need to see the doctor.

Hot Tub Folliculitiis

     A common rash pediatricians see is called "hot tub folliculitis". The rash appears most commonly on the areas where some one's swimsuit covered. It appears as small to larger pimplish bumps and sometimes other small red bumps. One can have a few or hundreds of these bumps. It usually breaks out in 2-5 days after the initial irritation.
     The hair follicles can become clogged with oil from our skin or sunscreen. Exposure to changing temperatures, as with getting in and out of a pool or hot tub, make the follicles open then close -- potentially clogging these follicles.
     The rash may cause no symptoms or can cause itching or mild pain. Many children do not seem to be bothered by the rash. The rash may fade on its own over a few days. If the itching or discomfort are more troublesome, a mild antibiotic ointment or hydrocortisone cream may be used. Occasionally, with worse inflamed-looking pimples, an antibiotic by mouth is needed.
     To avoid hot tub folliculitis, these things are all helpful: 1. Shower before you enter a pool or hot tub. This helps clean off the germs and oils on your skin, making hot tub folliculitis less likely. 2. Take a shower after being in the pool or hot tub. Get out of the swimsuit soon after being in the water and get into clean clothes. If you have plugged your pores while being in the water, getting out of your swimsuit, showering, and getting into clean clothes will make it less likely the you will end up with folliculitis.
     If your rash is larger pimples, very itchy, getting worse, or something you have other questions or concerns about, call your pediatrician's office during regular business hours.

Teething and fever

     Traditionally, pediatricians tell families that teething does not cause a fever (a body temperature of 100.5 degrees or greater). Pediatricians do not want families to dismiss a fever when there may be a more serious cause. Parents feel more comfortable placing blame for the fever on something they cannot control (teething) versus something they potentially can control (another illness after an exposure to someone else who was ill).
     Pediatricians base their recommendation on many things. One is that there was a large study of young children in the "teething age" (3 months to 2 1/2 years of age) who where carefully screened for bacteria or viruses when they had a fever but little other symptoms. Over 85% of this group were found to indeed have a virus (usually) or bacteria (less often). Many times, as your immune system fights off an infection, the only symptom is a fever. The authors of the study felt it was likely there were even more fever-causing  germs they did not find.
     We certainly do find some of these not-too-sick-appearing feverish children do have a viral or bacterial infection that needs some attention. Some of these would include urinary tract infections, ear infections, and viral or bacterial throat infections. Another common viral infection to cause a prominent fever with little other symptoms (until a rash occurs when the fever breaks) is roseola.
     On an interesting note, a study published last year on infants in Italy showed that they found temperatures peaking at 100.6 degrees with infants that they felt had no other sign of infection. The limiting factors in this study is that the temperature was only taken once a day by the researchers and they were not doing any lab studies to confirm or deny the idea that there may be viral or bacterial infections that were not evident on exam.
     So we want you to not assume that a fever is from teething. The usual worrisome things about fever (not perking up when the temperature comes down, a fever for five straight days, temperatures of 106 degrees or more) should be taken seriously. And remember these important facts about fever: fevers are caused when your immune system is trying to fight off an illness; we treat fevers for comfort reasons (not because they are dangerous) until the temperature is 108 degrees or more; and the chances of your child having a "dangerously high" fever (108 degrees or more) is very, very unlikely. Make sure you read our "Fever" protocol on our website here.
   

Clear fluids for vomiting

     In the Winter, we see and hear about many children with vomiting from the "stomach flu". One of the hallmarks of treatment is doing clear liquids while you have nausea and vomiting. I want to clarify some things about this instruction to help you avoid potentially making the situation worse. Remember to avoid milk, dairy (cheese and yogurt), and greasy foods (chicken nuggets, french fries, hamburgers, etc.) during the illness.
     For infants and young children, Pedialyte(r) is the best option. It has an ideal combination of sugars and salts for infants and young children. We want your child to take enough to stay well hydrated (urinating at least every 6 hours, tears if they cry, moisture in their mouth). If your child will take as many ounces in a day of what they normally would drink, that is great. If your child is 18-24 months of age and will not take the Pedialyte because of the taste, it is okay to try Gatorade(r) or Powerade(r) instead. Some children like the taste better with the sports drinks.
     For older children, water, Gatorade(r) or Powerade(r), lemon-lime sodas, or ginger ale are all likely to be well tolerated. Two big things to mention: the bubbles of carbonated sodas (7-Up(r), etc.) are NOT easy on an upset stomach. It is better to let the soda "go flat": pour it into a cup or glass then leave it out on the counter for a while before drinking it. Also, sometimes if it is cold, it is worse for the nausea. Letting the soda be flat and at room temperature is most likely have it not bother the stomach.
     Call your doctor's office if you have further questions about how to help your child through a vomiting illness.
   

Learning to swallow pills.

     There are many reasons to want to have your child be able to swallow pills: to avoid the taste of liquid medications your child may not like, to avoid spilling liquid medications, to make it easier to carry the medicine with you, and to avoid having to buy multiple forms of over the counter medications.
     We meet young grade schoolers who can swallow pills and teenagers who cannot swallow pills. There is no magic age where "you should be able to swallow pills" but the average child learns to swallow pills at about 11-13 years of age. Many children can start to take pills aimed at adults when they reach more of a petite adult size (85-100 pounds). Check with your doctor's office about specifics for fever reducers, cough and cold medicines, and antibiotics.
     Drink something: Every pill we would recommend for or prescribe to your child can be taken with something to drink. For many children trying to swallow a pill, having something to drink before and after helps tremendously. Take a drink and swallow first. This makes it less likely a tablet or capsule will feel more "stuck to your tongue" and more likely it can "slide down" well. Then pop the pill into your mouth and quickly follow that with a good-sized drink to "wash it down". If the pill did not go down, follow it with a few more swallows of something to drink.
     Mind where you put the pill in your mouth: Some folks find it helpful to "toss the pill back" as far as you can on the back of your tongue -- closer to where we want the pill to go. My partner Dr. Jeff Crecelius often advises tossing the pill onto your tongue, taking a drink of something and briefly hold it in your mouth, tuck your chin to your chest, then try to toss your head back and swallow at the same time. The idea is that this motion as well as the swallowing the liquid will propel the pill back so that it is easier to swallow.
     Practice with something small: Small bits of candy are a good way to practice. One of my sons liked starting with Nerds(r) candies. He would try those one at a time. If they went down easy with a drink or two of water, we moved onto something a little bigger: TicTacs(r) or M&Ms. If you can swallow one of those with water, you can swallow a reasonably sized pill. The good news is that if your child does not swallow the pill, they can always chew up the piece of candy and try again.