Screening tests, Rashes, and Babysitters – PediaCast 006

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Topics

• Newborn Screening Tests
• Infant Rashes
• Ear Infections
• Babysitters
• Strep Throat
• Ringworm
• Athlete's Foot
• Mumps

Links

• national newborn screening status report

Music

• Song of Sixpence, by 4 and 20 blackbirds

Transcription

This is Pediacast Episode 6th for August 23rd, 2006.

[Music]

Hello Moms, Dads, Grand Moms, Grand Pas, Aunts, Uncles and anyone else who looks after kids.

Welcome to this week's episode of Pediacast. The Pediatric Podcast for Parents. And now, direct from Birdhouse studios here's your host, Dr. Mike Patrick Jr.

Hey Everyone! Welcome to this week's edition of Pediacast. It's episode number 6 and we'd like to say a special welcome to the newcomers. We had a lot of new subscribers this week and I'd like to thank Dennis gray over at 101 Uses of Babywipes. He played a couple of our promos in the last couple of weeks. So I think we have a lot of his listeners checking out Pedia cast. So I'd like to thank all of you.

Also with as many subscribers as we've had, you have propelled us for the first time into the top 50 in the Kids and Famiilies section over at the iTunes Music Store so I'd like to thank you and as a special way of saying thank you, we're going to be giving away a brand new free copy of the Lilo and Stitch DVD from Disney and details on how you can win that will be coming up later on in the show.

01:13

OK let's look at this week's program. In the infants segment, we're going to discuss the newborn screening test that's done after your baby is born and also we're going to look at rashes as well.

And then for toddlers, there's a new study out on the possible causes of chronic ear infections and we'll also look out babysitter guidelines. That's all coming up in the toddler segment.

In the school age section of the program, we'll discuss strep throat and ring worm this week, and then we'll wrap things up with the teenagers and talk about athlete's foot and mumps as well. So that's all coming up on this week's PediaCast. Also some Podsafe music a little bit later on in the show.

But first let's go ahead and move on right into our infant segment. The newborn screen panel — 4.1 million newborns have the newborn screen done. That's a blood test that's done right after they are born.

02:05

And actually 1 in 350 of them have an abnormal test that's picked up by the screening. Now, whether it actually ends up being a disease or a false positive that needs to be repeated and then it's shown to be normal, that's a possibility too. But about 1 in every 350 births results in an abnormal newborn screen.

Now since the 1970s all US states have routinely tested newborns for rare health conditions and the most importsnt of these are going to be ones where there are consequences to the disease before there are symptoms. So in other words, by testing them right after they are born you can really make an impact on their quality of life if you can figure out what disease they have before symptoms occur. And let me give you an example of that, and this was one of the first tests that was done in the newborn period back in the early 1970s. And that was for PKU.

03:02

And this is a disease that it makes it so you can't process one of the amino acids very well. That's called phenylalanine. And so you want to put these kids on a diet that is low in phenylalanine or else they can end up having mental retardation and seizures. But the problem is that the very first signs of PKU is just terrible vomiting and weight loss, and by the time you get to those kind of symptoms — mental retardation as a side effect is already going to be setting in. So the best way to diagnose PKU is to do it before they have any symptoms and that's the reason that you do the newborn screen test, because if you can identify these kids and put them on a diet that is low in phenylalalnine, then you are going to prevent the mental retardation and seizure problems that can happen.

Now certainly after the PKU tests was developed back in the 1970s, some other tests were commonly done and these include a thyroid check, to make sure that there's no hyperthyroidism. And then to check for sickle-cell anemia,& Maple syrup urine disease — yes, that's a real disease — that's when that's been tested for for a while.

04:10

And then a couple of other ones are galactosemia and homocysteinuria. Now why in the world they have such extreme-sounding names. Well, when you have rare diseases, no common name ever really develops so it's still just called galactosemia or homocysteinuria. So for years and years there was a panel of — yes, somewhere between 5 and 10 tests that most of the states ran. Well in the last few years that's greatly expanded with new, cheaper forms of genetic testing and today there are over 50 tests that can be done during the newborn period and then a lot of states also do newborn hearing tests as well. Now one of the issues here, is that there really is great disparity among the states in terms of which tests that they do. And as a example, Texas only does nine of these tests.

05:02

Whereas — another example — Ohio, where we are, tests for 39 of these disorders and these are mandated by law that all newborns have these tests. Now for instance in Texas,& there are nine required by law but you can request that other tests be done, and really probably it depends on your hospital in terms of whether they offer those tests. You may have to actually ask for them.

So and there's everything in between you know some states — I'd say most states offer somewhere in the 20-range, and then another 20-some that are done if you request them. But you can check with your state health department to see how many tests are done, which ones are performed automatically and which ones you have to actually request to have done.

If it seems like it's a small number compared to other states, you can always contact your state representative and urge them to add more tests because it's usually the state legislature that determines which tests are actually run as part of a mandatory screening program.

06:06

And again, if you are state does not require all of those states to be run, you can certainly request that more of them be run, but you might have to pay out of pocket for them, whether your insurance will pick it upor not really is pretty variable from one insurance company& to another.

Now, to help you out in terms of finding which newborn screen test that your state actually performs. If you look in the show notes, I'm going to have a link. There's a national newborn screening status report. This is a PDF file, so you want to make sure that you have the Adobe Acrobat Reader to be able to open up this file. But it does include a current list of all screenings that are done and it lists them by state, so you can see how your state fares, compared to others, and again, there will be a link to that in the show notes.

Now one other important thing with regard to the newborn screen test result. You do want to make sure that your doctor actually gets the results.

07:00

So you don't want to assume that everything is normal if you don't hear anything. Now I have to tell you of all —

I don't think in a given year, that I have more than a handful of patients who ask "Hey did you get the newborn screen test result back, was everything okay?" I think parents just assume that we're going to get in touch with them if there is a problem. And usually that's true. But you know, it is possible for something to slip through the cracks, so you definitely want to make sure that you ask about that.

The length of time it takes to get those results back — here in Ohio, if there is a problem, usually we get the result back before the baby is two weeks old. I would say a third of the time at the two-week visit, I do not have the newborn screent test results back and that's usually because they are normal. And the normal ones, you know, just gets run routinely. They have to go under the computer and then someone sticks them in an envelope. They go out in the regular mail. And sometimes it takes more than to weeks to get those results back that usually when the baby is about three or four weeks old. That's when we get those.

08:05

The abnormal ones, though, almost always come before the two-week visit plust if it is something serious, most of the time the state health department is calling our office or faxing us over something or even calling the parents or sending out a letter to them. So it is rare for someone to slip through the cracks but it is possible and the best thing to do is just to, when you are going for your two-week check up, make sure you ask your doctor, "Hey did you get the state newborn screen tests results, and were they normal?" So, that's something to think about.

Alright, we're going to move on to newborn rashes. You know, we always talk about baby's soft skin, and that really gives you a false impression of what most babies' skin is like. When you have a baby, you expect the perfect little infant with unblemished skin. But infant rashes are common and they are often quite disturbing to new parents who are expecting perfect skin. And just keep in mind that the babies you see in advertisements are usually wearing make up, believe it or not.

09:02

So no babies are going to have perfect skin, especially like the ones that you see in advertisements and magazines. So what are some of these newborn rashes. Well the first one — again, this is one that does not have a common name. I'm always going to use the easiest name when possible. It's called erythema toxicum. And this is one that more than 50% of newborn infants develop this rash and it's usually seen in the first week of life. It shows up as dark red blotches that are a half- to 1-inch in diameter with a small white lump in the center. So this is just sort of a blotchy rash, sort of large blotches, with a white lump in the center — almost looks like an insect bite. Usually they are pretty numerous. They can occur anywhere on the body. You don't usually see them on the palms of the hands or the soles of the feets. And they do tend to sort of come and go. They's harmless and they appear to have no symptoms associated with them so they don't seem to itch or be painful at all.

10:02

What causes them is unknown. It's never eally been investigated because we know it's usually gone by 2 to 4 weeks of age. It's harmless, there's no symptoms, so no one's really done much research into what actually causes them. And because they go away on their own and they're harmless and have no symptoms, no treatment is needed. You just have to understand that that's what they are.

Okay, another type of newborn rash that you see pretty commonly, is actually baby acne. Now why would babies get pimples? Well it is pretty common. More than 30% of them would develop baby acne during the newborn period, and it's most common on the face. It usually starts out as small red bumps that look like pimples — well, because they are pimples — and really they occur by the same process as acne in teenagers and adults. So you have these oil glands who have increased oil production and then they start to get clogged because the cells that are making the oils start to fall off and then clog the glands.

11:01

And we did talk about that in our last episode of Pediacast in a lot more detail in terms of acne. Now why would little babies get acne? Well, remember, teenagers get it because of the hormones that are being released in their adolescence and these same hormones are also being released by pregnant moms and right before a baby is born, a whole load of these hormones go into the baby's body through the placenta and they probably have a lot to do with surviving outside of the womb during the first few weeks of life, in terms of helping with bodily processes. So these hormones are important but one of their side effects is that they cause acne.

Now other hormones that are also released into the baby's body can cause breast enlargement, and that's true for both male babies and female babies. And for the little girls, sometimes we even have some vaginal blood that sort of corresponds with having a period. And again this is just because mom's hormones are going to the placenta and to the baby's body.

12:03

Now the baby is not making any of their own hormones until adolescence. If they do, then that would be a disease process, but they're not making of their own. Eventually, these hormones are going to get metabolized by the body,& and then they'll be gone and that'll greatly diminish the effect that they were having.

So that by the time the babies are a few weeks old, usually the acne is going away. If they had some breast enlargement, that's also going away, and they'll stop having little spotting of blood from the vagina. &

No this baby acne is temporary — just lasts a few weeks. It does not leave any lasting effect. So really, no treatment is needed for this either.& This doesn't seem to bother the babies much at all. It bothers parents looking at it a lot more than it actually bothers babies. You don't want to try to squeeze and pop the pimples because that can make them worse. And baby oils and creams can also make them worse by increasing the gland clogging.& &

Now, sort of a similar process to the baby acne is something called milia.

13:00

Now these are seen in about 40% of newborns. They are also most common on the face. And they show up as tiny little white bumps, almost sort of pearly looking. And these are blocked skin pores. So this is more like the normal kind of sweat that's getting blocked. So it's not the oily glands that are becoming clogged but just regular skin pores. It's smaller than acne, not very inflamed, just like a little white bump. They'll open up on their own and disappear — usually gone by the time the babies are 1 to 2 months of age. And again no treatment is necessary. They go away on their own. And they don't seem to have too much symptoms associated with them.

And again baby oils and creams can make them worse by contributing to more pore-blocking. So you got to be careful about using creams and lotions on your baby's skin because that can make the milia and the acne worse, at least during the first month of life.

Okay, another infant rash that we commonly see is contact dermatitis. So this i just irritated skin from one thing or another — red blotchy skin.

14:04

Usually, it's an association with contact to chemicals. Now, it can be natural chemicals. So drool and spit up has digestive enzymes in which it can irritate the skin. Also on their clothing, you know, a lot of times even with your best effort you get a little trace of laundry soap or fabric softener in the clothing or sheets or blankets or also soaps and shampoos can use it too. It's not really difficult to treat. Usually, you just have to prevent contact and then it'll get better.

The best way really to treat it is to prevent it in the first place. So you want to try your best to keep up with drool and spit ups, washing it off with a warm damp cloth so those things don't touch the skin too long. Also use a hypoallergenic detergent for laundry such as Dreft. Use a small amount of detergent. I would double-rinse if your baby is having frequent contact dermatitis type rashes. Also avoid dryer sheets because they leave a layer of chemical residue on the clothing that your baby can have a reaction to.

15:02

And then you might need to use hypoallergenic baby soaps and shampoos. Usually just regular — like Johnson and Johnson's going to work fine. Every now and then you have a baby that reacts even to that in terms of soap and you have to use something like the unscented Dove which is pretty hypoallergenic. In terms of treatment, if it's there, and it doesn't seem to be going away, even though you're doing your best to prevent contact with chemicals, ask your doctor about it. Sometimes hydrocortisone cream will help. Usually we use like a half to a whole 1 percent hydrocortisone cream a couple of times a day.

But keep in mind if you use that, you might increase the incidence of baby acne and milia because that comes in cream form and it could block off the pores. So you only really use the hydrocortisone creams if it's a severe case, and I would definitely ask your doctor first about that.

Another common rash in the newborn period — they are going to be the yeast rashes. And we talked about diaper rash last week. So I don't want to go into this too much. It's going to be a red rash in the skin folds, also in the diaper area, of course in the neck and in the armpits. Anywhere you have a skin fold.

16:06

Usually it's a red, with some red dots around it. We talked about that before. Again this is going to be in a warm, moist environment where there's not a lot of skin bacteria competing. And best way to treat, that's going to be with the anti-fungal creams — something like Lotrimin& that you can get over the counter. Do use that 3 or 4 times a day for a week or two, and usually that'll take care of it.

Another common — not necessarily a rash, but a skin condition that goes along with the newborn rashes, and this is sort of the skin flaking that you may have seen where it just looks like they're — not peeling in sheets, but just peeling in little spots, especially on the extremities, but it can be anywhere too. Just looks like a really bad dry skin. And it's usually seen during the second and third week of life. Basically what it is is those outer layers of skin that were soaked in the amniotic fluid for so long. Those are just coming off and they have to come off and there's not much that you're going to be able to do to make it look better.

17:05

Keep in mind, if you use a moisturizing cream it may help with the flaking a little bit but then you're going to increase the milia and the acne. So you're probably better off just letting it be. Usually the flaking process only lasts a week or two so by the time they are about a month older, so you don't see it anymore.

So those were all normal rashes that we see. Now what are some dangerous signs in terms of things you might find on your baby's skin. Well one, if you find any fluid-filled blisters of any size, you're going to want to bring that to your doctors's attention. We really worry about herpes in the newborn period. And that shows up almost like a little chicken pox-looking thing. So if you have anything that looks like a fluid-filled blister, make sure you would talk to your doctor about that.

Also, what we call peechiae. These are really a danger sign in any age child. Basically they are made up of small broken blood vessels that can range in size from like a pen dot to a pencil eraser kind of size, sometimes even a little bit larger.

18:05

And the way that you can tell that they're petechiae is that they don't blanch when you push on them. What that means is if you take one of these red spots and push down with your thumb, and then let go, immediately the skin's going to have sort of a whitish look to it and then it'll get red again. But if you push down and the surrounding skin is white, but that little red dot stays just as red as it was before you pushed, then that might be a petechia, which is a broken blood vessel. And again those are a sign of pretty serious diseases. They're unusual to see but if that happens, make sure you'd bring that to your doctor's attention right away.

Okay, and of course, bruises of any kind. That would also be a concern. So if any of those things are happening, call your doctor and get your baby and have a look at righ away. That's not something I'd wait a couple of days if you're appointment is coming up.

Okay that concludes our infant segment this week. If you have a baby at home and you have a question that you would like us to address here on the program,& you can reach us at podcast@pediascribe.com (email) or you can go to our website which is www.pediascribe.com/podcast and use the contact link and get to us that way.

19:13

We also have a phone in line: it's 347-404-KIDS. You can call and leave us a message with a voice mail that way.

Okay we're going to be coming up with our toddler section and we'll get to that right after this.

[Music]

Eew it stinks in here.

Passing gas: Is there a right time and a wrong time to do it?

Come on, huh? I'm trying to eat.

When indoors in the company of others, passing gas is not only taboo. It can be deadly.

[Child coughing] I'm gagging.

Passing gas releases a plume of toxic vapors like ammonia and hydrogen cyanide.

Ah you're killing us over here.

Every year hundreds of infants exposed to passed gas die.

What? I cracked the window.

And just opening a window isn't enough. These deadly fumes can linger in the room for hours after odors have dissipated.

Child: Daddy you'll promise you'd smoke outside &
Man: Yeah right, Pumpkins. Excuse me.

If you smoke, take it outside. Don't pass gas.

A message from the American Legacy Foundation and the Ad Council.

Get the facts at dontpassgas.org.

20:34

Okay, welcome back to the program. We're going to move on to our toddler segment right now.& This is a research study that was published in the journal of the American Medical Association on July 12th, 2006. So it's a recent study. It looks at a new concept in chronic ear infections for yong children. Now chronic ear infections, this is going to include what we call otitis media, which just means the middle ear infection with effusion which is constant fluid behind the ear drum.

21:05

So if you have otitis media with effusion, it just means that you've got fluid back or behind the ear drum and it's not going away even in between acute episodes of ear infection. There's nothing cute about it. But you know, acute just means "bad at that time."

So if you have a bad ear infection and it goes away but you have fluid and then the bad ear infection comes back, that would be considered chronic ear infection. And then also if you have a recurrent ear infection that comes and goes even if it resolves between episodes and the ear drum looks great but then a month later, you've got an ear infection back again, that would also be considered a chronic ear infection.

Now there are three bacteria that are most commonly associated with these: strep pneumoniae, haemophilus influenzae, and moraxella catarrhalis. These are three different bacteria that are associated with& chronic otitis media. Now if you culture fluid from, you know, your ear drum ruptures a little bit, and when it ruptures, it's not like a "ka bang" it's just a little pin hole where the fluid comes out of.

22:09

But if you culture that fluid, you'll find one of those three organisms in about 25% of kids with chronic otitis media. But if you do a DNA analysis of that fluid, it's actually there in over 80% of them. So what that means is that one of those three bacteria is there over 80% of the time because the DNA analysis just looks for one organism. You know it's going to be a positive culture, the bacteria actually have to grow. So if 25% are growing, that means that between the 25% and the 80%, all of those bacteria are actually existing in a dormant state. So they're not actively reproducing. So it's almost like having a carrier kind of state inside the middle ear. And antibiotics really don't work very well.

23:00

Most of the antibiotics that we use for this carrier state or dormant state that bacteria can be in. So given the fact that these bacteria are present but they're not growing in culture very well, and the antibiotics aren't working very well, this new hypothesis was formed that maybe there's what they call a biofilm inside the middle ear space. Now, biofilm consists of an aggregation of bacteria. They're usually adherent to a surface and surrounded by some kind of what we call "extracellular matrix." That just means, probably some proteins or some barrier that is blocking them off from the space inside the middle ear and they are adherent to some portion of the inside of it. So basically you've got this sheet of dormant bacteria that antibiotics can't get to because of a little barrier. And so in between acute ear infections or bad episodes of ear infection, these things are dormant.

24:03

But they're there and can reactivate and can cause infection again. And then the fact that the matrix — this protein barrier — also, not only blocks out antibiotics but probably also to some degree blocks out components of your immune system. So antibiotics are not working. Your immune system is not going to be able to get to it, and any time that these bacteria decide to reactivate, they can cause the ear infection to come back again. Now this was a theory. So in order to test this theory, this is the study that was reported in the Journal of the American Medical Association. Researchers obtained biopsies of the middle ear lining from 26 children. And these were kids — they didn't do this just for the fun of it. These were kids that were having ear tubes put in. So while in the process of putting the ear tube through the ear drum, they got a biopsy of a little bit of the lining from the middle ear space from 26 children, and then they also obtained biopsies from 8 children and adults who have no history of otitis media and these patients, again, they didn't just do it for the sake of it.

25:07

They were having surgery for cochlear implant. So they were hearing-impaired, and were having cochlear implants put in . But they didn't have any middle ear infections so they had normal lining of the middle ear space. So this was the control group.

Now, the results: 100% of the kids with recurrent otitis media in this study had evidence of one of those three organisms that I talked about when DNA analysis was done. And 92% of them had evidence of a biofilm. So there was a little protein layer matrix surrounding a sheet of bacteria in 92% of these kids. And none of the control patients had bacteria or biofilms. So 100% had bacteria where you had chronic otitis media present, and none of them had bacteria in the ones who had normal middle ear.

26:04

So this is a small study. We talked about, you know, the larger number you have, the more convincing it is. But I mean this is pretty convincing to have 100% in one group and 0% in the other group. And it is a reasonable explanation of why these infections don't go away and that they keep recurring.

Or you could also argue, and this is why probably some more studies are needed, is that this biofilm is there and these dormant bacteria reactivate and cause re-infection. Or, is that biofilm of dormant bacteria just a consequence of having chronic otitis media, and not really related at all. So it's something we don't know for sure. All this means is that more study is needed and we might need to find some new ways to deal with these dormant bacteria because if they are the cause of it, if you can design an antibiotic that's better at killing bacteria when it's not actively reproducing and it's in a dormant state you might be able to get rid of these biofilms a little bit easier.

27:01

And get rid of the chronic otitis media that a lot of kids get. And that's important then if you can get rid of that, you can get rid of the tube surgeries that we have to do. Of course, there's always risks and dangers associated whenever you have to go under anesthesia. So, and if we could come up with a medicine that will get rid of what's causing the recurrent ear infection, that certainly would be better. But again we don't know for sure that that's the cause but it sure seems like it might be.

OK moving on in our toddler segment, we are going to discuss some babysitter guidelines. Now this is enough for daycare or if you're going to work and you have a responsible adult who is watching your child day in and day out. This is more babysitter guidelines for if you're going on a night out, especially if you have a teenager who's going to be watching your kids. First you want to pick a babysitter that you know and trust and who has the maturity that's needed for the job. So absolutely age is not as important as the maturity level of the person who's going to be watching the kids. And some areas offer babysitter classes and it might be worth paying for babysitter class for someone who might be watching your children frequently.

28:06

It might be almost a little job benefit. You say, "Hey, you know you can watch our kids once a week and we will pay for you to go to these babysitting classes in return." When you do leave your baby or your child, you want to make sure you'll leave good contact information via the phone and this includes listing where you will be, your cellphone number to get ahold of you and you might want to have, if you both have separate cellphones, leave both numbers so in case there was a problem with one cellphone, the sitter can still get ahold of you. Also leave emergency numbers for police, fire and EMS or ambulant service. And you also might want to put a phone number of a nearby friend or relative or neighbor that you trust. You know, someone who you think will be home, so if all else fails, they'll have someone close by — an adult that can get over to the house if they needed to. And again you want this information on a prominent location. Also it's a good idea to keep a printed list of all the rules that you feel are important, and you might even have your babysitter sign it like it's a contract.

29:05

Rules about television viewing, stereo listening, roughhousing, playing outside. Pool probably should not be used when there's a babysitter in the house. So make I'd make sure that's listed there — no pool playing.

You know what are your rules in terms of snacks and what time is bed time. Also a reminder of "don't answer the door for strangers," and "don't leave the children unattended." What are the rules for high chair use, walkers, strollers, bath safety. Again, bathing is probably something you want to avoid, if at all possible.

And then explicit directions for any medications, and again I would try to avoid that as well but if you have to have a dose of medicine given while you're gone, make sure that the exact directions are listed. You should also know the laws involving kids who are home alone and babysitter guidelines for your state, if your state has any and you can visit the National Child Care Information Center, which is part of the US Department of Human Services — their administration for children and families.

30:06

And they have at the National Child Care Information Center a list of guidelines for babysitters, and also links to resources for your individual state, so you can look up and find what the specific laws are for your state regarding leaving kids home alone and babysitter guidelines. And we'll post the links to that in the show notes as usual.

Okay that concludes our toddler segment. And again if you have a toddler at your house, and you have a question — a medical question or even a family behavior question is fine too –& you can reach us at podcast@pediascribe.com or you can go to www.pediascribe.com/podcast and get to us through the contact page or you can use our voice line at 347-404-KIDS and leave us message that way.

Okay, coming up, we're going to have our school age segment and then we'll also talk about how you can win a free copy of the Lilo and Stitch DVD. That's all coming up and it'll be right after this.

30:11

[Music]

Nothing inspires imagination like reading and it's never too early to start reading to your children. When you open a book, you can explore new worlds, like the ones in the Chronicles of Narnia.

"Everthing you see is Narnia."

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Do find out more about the wonders of reading. You can visit the Library of Congress website at www.loc.gov. There, you can learn more about books, play fun games, discover cool facts and so much more. YOu can log on to www. loc.gov and let your journey& begin.

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32:11

Welcome back to Pediacast and in our school age segment this week, we're going to discuss strep throat and ringworm.

So we're going to strep throat first.

Strep throat is an inflamation in the back of the throat or the tonsils and is caused by a bacteria called Group A streptococcus. Now, that's important because there are a lot of streps out there, and the other streps, even if you have a sore throat from those, typically you do not have to use an antibiotic for those. Your immune system is able to take care of those infections on its own. Group A strep is the one that you really have to treat. And then when we talk about strep throat, that is the specific bacteria that we are talking about.

Now the way that you diagnose it is with a rapid strep test and if that's positive, then you go ahead and treat it. That's something that your doctor can do in the office usually within about 10 minutes. If the rapid strep test is negative, it really needs a followup study and the reason for that is because the rapid strep tests are correct about 93 to 95% of the time.

33:12

So anywhere between 5% and 8% of the time, you can have a negative rapid strep test but still have strep throat and you don't want to miss any of those kids and talk we'll talk about why that is in a couple of minutes.

So what& you do to follow that up with a negative strep test is to do a throat culture or you can also do a DNA analysis called a Gen-Probe and that just looks for individual DNA from a strep organism, so even dead strep will show up on that. Or the throat culture, and then even one of those is positive — the Gen-Probe usually just takes a day and the throat culture can take a couple of days to come back and then if it's positive, an antibiotic can be called in at that point. Other symptoms of strep throat are going to include fever, headache and abdominal pain. You might have a mild cough from the throat irritation. Usually you don't have much cough like bad cough or runny nose and congestion.

34:04
That's usually a virus that's going to cause those sort of symptoms. But it is possible to have a virus and strep throat at the same time. So if you have a bad runny nose and a sore throat, you should still see your doctor so they can test you for strep. Treatment of your strep includes antibiotic and this can be an oral antibiotic or an injection — a one-time dose of antibiotic. Really the injection does not have any advantage over the oral route unless you have a young child who's really going to fight you on taking the medicine, then the injection is a one-time thing and then it's treated so that makes that a little bit easier. Or if you're have a habit forgetting things and you think you are going to forget to give your child their medication then the injection would have an advantage or if you child's vomiting a lot with their strep throat there in the beginning, an injection may help if you are worried that they're not going to be able to keep the oral antibiotic down.But in terms of efficacy or how well it works, the injection is really not going to have any benefit over the oral route as long as you remember to give it and your child's able to keep it down. &

35:07

Penicillin is still the first choice. Usually we use amoxicillin because there is a generic of it. It tastes better than plain pennicillin, and you can get away with just giving it 2 or 3 times a day. With the old-fashioned penicillin, you have to do 4 times a day. So a little bit easier to remember and since there is generics out there for amoxicillin makes it a little cheaper. More and more across the country, we are seeing resistance to Zithromax. Before if you were allergic to penicillin you would use Zithromax a lot but more and more there is resistance to that. And then there's even some resistance to plain amoxicillin or penicillin but usually it's not the strep itself that's resistant to that. Usually there's other mouth bacteria inside your mouth that might be making a chemical that protects the strep against the penicillin. So if you do amoxicillin and your strep throat comes right back you might have to try a fancier medicine such as Omnicef or Cefzil or there's other what we call cephalosporin type antibiotics that we might have to use, not necessarily because the strep is a problem and it's resistant but because there's some other bacteria in your mouth that are protecting the strep and you have to use someth2t will kill them as well.

36:15

The sulfa antibiotics tend not to be quite as good for strep throat. Other treatment, you know, you want to treat the symptoms of strep, Motrin and Tylenol for pain and fever. I find if you can tolerate Motrin, that probably works a little bit better because it's an anti-inflammatory drug whereas Tylenol is not. So it'll help reduce the inflammation back in the throat, and I think probably provide a little better pain control than the Tylenol. But there's some people who can't tolerate the ibuprofen products which is what Motrin and Advil are, especially if you have bleeding problems or clot disorders, you know, you might not be able to take those. And some people get stomach upset with them and so you might want to avoid ibuprofen or Motrin if you are sensitive to it. But if you're able to take it then it may help you out a little bit more than Tylenol does.

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Also for the throat discomfort, if it's an older kid, you can try some throat lozenges. I find the chloraseptics stuff, if it helps, great, but I knew when I have a sore throat it helps for what about 10 seconds or so. I'm sure the chloraseptic people don't like me saying that, but I've just never& found it to be very helpful when I have a sore throat. Also softer foods, warm chicken broth for the older kids — that seems to help settle things down a little bit.

Now the primary goal of treating strep throat, there are really two of them: one is to stop you from being contagious. And after about 24 hours of being on the antibiotic, you're not contagious anymore. So you can go back to school once there's no fever and you've been on antibiotic for 24 hours. But the most important reason to treat strep throat with group A strep is to prevent rheumatic fever .

Now, don't confuse rheumatic fever with scarlet fever. Scarlet fever is just a rash that you get with strep throat and you have the fever. That's not particulary dangerous. It's just strep throat with a rash. And the rash is caused from a chemical that that particular strain of Group A strep is making.

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But rhematic fever is very serious and usually that happens down the road when you have untreated strep. And that can cause rashes, joint pain, heart problems. It's a very serious illness and it's usually something that, again, it doesn't happen right after you have the strep, you know. It's more like a few weeks later when it occurs and again it's from untreated strep. So that's the reason to treat Group A strep. Now the thing about this with strep throat is when you do an antibiotic for strep throat, it helps you not be contagious, and it helps prevent rheumatic fever. It does not help you get better much faster –& maybe a day or two. So you're still going to have a sore throat that lasts for 2 or 3 days. You're still going to have a fever that lasts for a day or two. And you're still going to have the sore throat and the inflammation. So it is important to remember that even with strep being treated with an antibiotic, you're still going to have those symptoms for a little while.

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And incidentally, if you don't treat strep with an antibiotic — usually you're better in about a week, your immune system will take care of strep, but you're in a much higher risk of developing rheumatic fever if it doesn't get treated with an antibiotic. So that's an important thing to remember. And that is why the other streps often don't need to be treated with an antibiotic because your immune system will take care of them in about a week or so and they do not have the same risk of developing rheumatic fever as the Group A strep does. So that's why that's important.

Now, one special topic with recurrent strep — if your strep throat comes back or you have a history of recurrent strep, where it gets better then your sore throat comes right back, you really do need followup. And if I have a kid who has strep throat, they come back because her throat hurts again a couple of weeks later, I always have them come back a third time even if they have no symptoms just to swab their throat and make sure they are not a carrier.

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Again we talked about this with the biofilms, but this is also true of strep. If you can have some dormant strep back in the throat and then they can reactivate and cause an acute illness, a bad illness, right away, if you have the carrier state, and no symptoms, you do want to try to kill those dormant strep to prevent another episode of the actual disease. And you might have to use a different antibiotic that's better at treating dormant bacteria than treateing rapidly producing bacteria.

One example of that is clindamycin. That's a good antibiotic for getting rid of the carrier state. If it still recurs then what I do is test everybody in the family and anybody who's a carrier in the family, treat all of them, even mom and dad with some clindamycin. If you do that and the strep keeps coming back, then that's when you talk about getting the tonsils out. But remember, tonsillectomy is not this great thing that's going to make everything all better. Even if you have your tonsils and adenoids out, you can still get strep throat.

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And then also, remember your tonsils are a protective barrier. They are there to keep disease out of the sinuses, out of the middle ear space, out of your lungs. So, if you get your tonsils out, you are losing a layer of protection and now instead of getting a tonsillitis, or infected tonsils, now you're going to get sinus infection or pneumonia or an ear infection instead, so it is important. Tonsils do have a function. And you want to try to keep them if you can. But if you keep getting recurrent strep, and you know you've tried to treat the carrier state, you've tried to treat everybody in the family, and you're still getting it over and over again, because of the risk for rheumatic fever, it is a good idea to get your tonsils out at that point. Another reason not to get your tonsils out is of course it's not a benign procedure. You know, it can have a lot of bleeding associated with it and it's right there by the airway. Then you can have complications from the surgery itself. So it's not a walk in the park and you want to avoid it if you can, but sometimes you can't avoid it.

42:00

Okay, so then moving on in our school age segment we're going to talk about ringworm, another fungal infection. This one's — we'll get over these fungal infections real soon, I promise. This one's caused by a type of yeast called dermatophytes. It's not a worm. There's no worm in ringworm. It begins as a pink patch that's half to 1-inch in diameter and it has a scaly, raised border. The center begins to clear. It slowly enlarges and it can be mildly itchy. And that's the typical picture but you can have a variation on that. And if in doubt, always let your doctor see the rash. Rashes are not good things to diagnose over the phone. You really got to take look at it and see what it looks like. But for general purposes, ringworms going to have that scaly, raised border, center starts to clear, and the outside of it slowly enlarges and it's a little bit itchy. If it's on your skin, treatment is pretty easy: antifungal creams — Lotrimin, again, is a good example of that. You apply it two to three times a day.

43:02

You want to extend your application about an inch or so beyond all the borders of the ringworm, and you keep using it for about a week, after the rash seems to be gone because if you even leave a couple of those little fungal elements behind, it can come back. And it usually takes about 3 or 4 weeks to complete the treatment. Now if the ringworm is in your scalp, then the yeast is living down inside the hair follicle and topical treatment alone doesn't work very well. So for these kids, you're going to need usually an oral medication and Griseofulvin is the most common one of those that you use. It's a medicine that's given once a day and it works best if you give it with a high fat food. You just get better absorption in the gut into the bloodstream if it's taken with fat. So I always suggest taking that with like a glass of whole vitamin D, whole milk, the red cap usually, because that's high in fat and it'll get absorbed a little bit better. Now you usually have to take that once a day for about four to six weeks in order for it to work. It just is a long process, treating these fungal infections.

44:02

And then along with the oral medication when the ring worm is in the scalp, you can also use a prescription strength Selsun Blue type of shampoo. The over-the-counter Selsun Blue is 1%. The prescription one is 2.5%. And if you use that a couple of times weekly, that sometimes I hope it'll go away a little bit faster.

In terms of ringworm being contagious, it does spread through a skin to skin contact, and then the scalp form of it can also be spread through the use of hair accessories, pillows, combs, towels, even seatbacks can spread it. And then in terms of contagiousness, it's not contagious for about after you've been treating it for about 24 hours or so.

Can you get ringworm from pets? Well the answer to that is, you can especially form puppies and kittens, but the animal dermatophytes that cause ringworm, even though they can pass from animal to human, it does not happen very commonly, and this type does not spread from person to person.

45:05

So once that kitten or puppy kind of ringworm gets on your skin, you're not going to spread that to another human. But everybody in the family who has contact with that puppy or that kitten can get it, so you know if you do see everybody in the house with ringworm and you have a new puppy at home, it could be the puppy or kitten that's doing it. Although that — again, it's not nearly as easily spread that way as it is. The person-to-person type is. So the puppy and kitten ringworm would rather stay on the puppy or kitten rather than infecting you. But sometimes, it does come from the puppy or kitten, and you have to have, not only the people treated in the house, but you also have to have the pet treated as well so you don't keep getting it back. So you want to — anytime your pet has a rash and you don't know what it is — take it to your vet so it can get some treatment.

Okay that concludes this week's school age segment.

46:00

If you have a question about your school age child at home and you'd like to have it addressed here in the show, just write to us at podcast@pediascribe.com or go to www.pediascribe.com/podcast and use our contact link or once again, you can call our phone-in line 347-404-KIDS.

Okay, coming up right after this message, we're going to give you details on how you can win a free copy –brand new! — of the Lilo & Stitch DVD and that is coming up right after this.

Janine Marks, at 12-year-old was fairly normal. She spent a lot of time online. One day, she met a new friend. The new friend had the same problems at home. They liked the same bands. They worried about the same subjects in school. They promised to keep each other's secrets. They wished they went to the same junior high.

47:00

The new friend had good news. He said he was going to be in Janine's area one Saturday. They thought it would be amazing if they could just hang out, go to the mall. Janine agreed. The new friend didn't want parents messing this up. Janine showed up alone. So did her new friend, who wasn't in junior high, wasn't nice, and wasn't a 14-year-old boy. Everyday, children are sexually solicited online. Help delete online predators. Call 1-800-THE-LOST. Or visit cybertipline.com to learn how to protect your kid's online life. A message from the National Center for Missing and Exploited Children and the Ad Council.

Okay, as a special thank you to all of our new subscribers out there, this week, we're going to be giving away a free copy of Lilo & Stitch, the DVD.& It's important really, I want this program to address the topics that you want to hear about. It's easy for me as a pediatrician to say, this is what's important. But if it's not what's on your mind, you know then it's not as important to you. And that's what I really want this to be.

48:06

If you have a question about your child and it's not time for the regular well checkup, and it's not something that's urgent, we can address disease process here on Pediacast.

Now, I won't be able to give you specific advice for your specific child, because in order to tell for sure, you really do need to have an interactive history and hands-on physical examination. But we can talk in general about disease processes. So if there's something that's on your mind, make sure you let us know.& So to encourage you to do that, what I'm going to do, is if you contact me, either through our email address or thru the contact page on pediascribe.com/podcast or use our call-in line, then I will put our name in to a hopper and we'll draw a name out at random and that will be the winner of the Lilo & Stitch DVD.

49:03

If you just contact me and say "hi, how are you doing," we'll put your name in. If you have a question, we'll put your name in twice. Now we won't be able to answer alll of the questions on our next show but we will put them in queue and try to get to all of them during the course of the next several programs. So again, if you email me at podcast@ pediascribe.com or use the contact link at www.pediascribe/podcast or call us at 347-404-KIDS, then we'll — if you just say "hi," "hey, I'm out here," we'll put your name in. And if you ask a question about your child, we'll put your name in twice and you want to do that before midnight Eastern Standard Time on Sunday night, and then on Monday morning we'll draw the winner. And the winner will be contacted and also announced on next week's show.

Okay we're going to move on right into our teenage segmentt this week.

50:00

And our first topic is athlete's foot. Okay, I promise, for at least a couple of weeks, this will be our last fungus discussion, I promise. I really do.

Athlete's foot is caused by a fungus and symptoms of are red scaly rash with sort of cracked skin, usually starts between the toes, and then it spreads. And again, the foot is a warm, moist environment, especially if you're an athlete and you're sweating and you're in your socks and shoes most of the time, so it's easy for these yeasts and funguses to grow in warm, moist environments. Your feet may itch and burn, may become even raw and weepy, especially if you scratch the skin often and then some bacteria can actually get in that raw, weepy skin and crossed over a little bit, you can get some impetigo on top of the athlete's foot. And then you probably have a foot odor too.

Treatment is going to be an anti-fungal cream like over-the-counter Lotrimin — I promise I don't have stock in Lotrimin, I really don't — and you can certainly use the generic equivalent of Lotrimin.

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Do use it two or three times a day for about 3 to 4 weeks and you want to use the cream about a week after the rash is gone just to make sure you've got all of that fungus and yeast taken care of so it won't come back. Also if you have a secondary infection with a bacteria, like the impetigo on top of it, you'll probably also need a topical antibiotic, and you want to see your doctor for that. And if it's really bad sometimes you even need an oral antibiotic needed to treat.

Also, you want to keep your feet as dry as possible during the treatment stage. Dry your feet really well after baths and showers. You want to use shoes that allow the feet to breathe. And you want to use cotton socks because they're going to absorb your sweat the best and keep it away from the skin.

In terms of prevention, you know athlete's foot — the type of fungus that causes it does not pass easily from person to person, but you do pick it up pretty easily from surfaces such as locker room floors and shower stalls and it's important to remember that it will not grow if your feet are pretty dry.

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I mean you really have to have a warm, moist environment in order for it to grow. So there's instructions we talked about keeping your feet as dry as possible. They are not only important for treating athlete's foot, but they are also important for preventing athlete's foot as well. Now how do you get rid of that awful foot odor that you get with athlete's foot. Well keep in mind that it usually doesn't prove when the rash goes away. You want to rinse your feet with water& and change your socks at least twice a day until the rash is gone. And in severe cases, you can soak your feet in warm water with about an ounce of vinegar added to it. That sometimes will help with the smell. And you may need to wash the tennis shoes in a washing machine with soap and maybe even some bleach in order to get rid of the smell. So those are some helpful hints. And keep in mind again the foot odor does get a lot better when you get the athlete's foot treated and the rash goes away.

Okay and our last topic in the teenage segment, we're going to discuss mumps here a little bit.

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Since 2001, there has been an average of about 300 cases of mumps in the United States every year until this year. And this year, instead of 300, we've had over 4,000 cases of mumps in the Mid-West. The epicenter is Iowa; they've had about 50% of the cases; Kansas has been next with 25% of the cases; the Iowa rate of infection in the 18 to 24 year age group, is about 200 cases of mumps per 100,000 people who are between the ages of 18 and 24. So it's really bad in Iowa and these are mostly college students that we're talking about. But where did these mumps come from? Well, we don't know for sure, We suspect that came from the United Kingdom, because the same strain of the mumps virus that's causing this outbreak, caused an outbreak between 2004 and 2005, of about 72,000 people in the United Kingdom.

54:00

So we think that maybe a college student from the United Kingdom came over to college somewhere in Iowa and then it started to spread from there. So we don't give the British too bad of a name. That particular strain of mumps virus is also coming in other countries that have a little vaccine rate. So I mean we can't blame the British for sure. Ah, we can blame them for the revolutionary war but we can't blame them for them mumps outbreak in Iowa for sure.

MMR is the Measles, Mump, Rubella vaccine. And you have to keep in mind, for mumps, it's only about 90% effective. It's more effective for measles prevention but for mumps, it's only preventative in about 90% of the people who get it. So if your child gets the MMR, 10% of all the kids who get the MMR are still going to be susceptible to mumps and your best protection from getting mumps is going to be that everybody else in your community gets immunized.

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So these people who don't want their kids immunized, they're putting your child at risk because if your kid is one of these 10% who do not respond to the MMR in terms of making immunity and protection against the mumps, then you could have a problem, if you get exposed to it, because if one of these other kids who would have had a good immune response but they don't because they didn't get the shot. So not only are their children affected when they don't get immunizations, but they also put your kids at risk as well.

The two-dose regimen of the MMR also begins to wane a little bit as you get to young adulthood. And so, when you combine the fact that your immunity is kind of wearing off a little bit as you get to young adulthood, and the 10% of the population is still susceptible to mumps, and then you combine that with the social structure of college campuses and dorms and close contact with each other through classrooms, that's why it spreads so easily amont the college population for those three reasons.

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The good news is that in that age range, mumps has few complications and rarely requires hospitalization. I mean, the most common symptoms in young adults, and including in this outbreak, is fever and a swollen salivary glands or spit glands underneath the jaw on both sides, kind of at the back of the jaw area. You get huge lumps there. That's the mumps when you have those swollen. If you look terrible, I mean, your face is just all swollen, it hurts, and you really look like you're very sick, but the good news is it goes away. It's usually not too much of a problem — and it's a virus — keep in mind, so there is the potential for your ovaries in girls and testicles in boys to become involved and rarely that can lead to sterility. But that's rare in the young adult population. And in this particular outbreak, that has not been a big problem. So that's the good news.

57:00

Now, if these cases were younger kids, we might see some more serious complications and those include deafness and encephalitis, which is brain swelling. Now I'm not tyring to scare people out there. We just don't know for sure.& But back in the day when we did not have the MMR and a lot of younger children were getting the mumps, deafness and encephalities were seen quite frequently, which is why they wanted to come out with an immunization to protect against the mumps in the first place. But I guess the good news is that in the younger child population in this particular outbreak, we have not seen that very much as mostly college students who have been getting it.

Treatment for mumps: you know, it is again, a viral infection, so antibiotics are not going to work. Treatment is mostly supportive. You want to control pain and fever. You want to provide fluids, so that you're not dehydrated. Again you will just look terrible when you have this but most of the teenagers who are getting it in the Midwest are doing well.

Keep in mind that even though we have this outbreak, it is still important for young children to get MMR because they're going to probably be at a higher risk for developing severe complications if they get it. The outbreak is kind of quiet at the moment but here, school gets going and college students start going back to class.

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If it revs back up and we're seeing more mumps in the college age population, officials in the Midwest may recommended a third MMR vaccine for college students so you want to keep an eye on the news and if you have a kid who's in college or you are a college student listening to this broadcast — podcast, excuse me, old habits die hard — if you are a college student or you have a college student you pay attention to the news because if the health officials in your area are recommending a third MMR vaccine, you definitely want be able to get in and have that done to avoid getting the mumps because you'll definitely miss some school and have to catch up on your classes if you get it. Plus you do have potential for some serious complications.

Alright, well that concludes our information section of pediacast this week. I'd like to thank all the listeners especially the new ones out there and the returning listeners, okay we'll thank you too.

Again to get a copy of the Lilo & Stitch DVD, there are three ways to enter: if you just say "hi," then you'll get put in once; if you have a question, you'll get put in the hopper twice, and we'll pick someone and the winner will get a brand new Lilo & Stitch DVD sent to you.

And again to ask a question, you just email at podcast@pediascribe.com or you can go to www.pediascribe.com/podcast or use our phone-in line 347-404-KIDS.

And again, those questions are important because I really want this program to address your concerns and your questions and not necessarily just the ones that I think is important.

Alright we're going to leave you this week with a song. This is courtesy of the Podsafe Music Network, which is at music.podshow.com.

This is Four and Twenty Blackbirds with a song called "Song of Sixpence."

So we'll leave you with that and until next week!

This is Dr. Mike Patrick Jr. saying, so long everybody.

[Music]

A boy was walking his bumblebee
He tied it to a string
The sky was lit up with violet light
A bird began to sing a song of sixpence

A girl went looking for blackberries
She stayed out half the night
And when she came back to her surprise
She saw herself inside her kitchen window

Four and twenty blackbird pie
Did your wings forget to fly
And did you sing or did you sigh
When they took you from the sky

A man was looking to please his bride
He loved her heart and soul
He tied up the moon with a crimson bow
And such a smile she smiled
And swallowed it whole

Hey cat with the fiddle
Could you play me a sad tune
I am waiting for the spoon
And do you think if the cow comes home soon
We could all go to the moon

What's it like on the moon
How high is the moon
Is it really as beautiful as it seems

A boy was walking his bumblebee
He tied it to a string
The sky was lit up with violet light
A bird began to sing a song of sixpence