Erythema Infectiosum… Kinda sounds like a Harry Potter spell, so what is it??

No magic wand is going to work with this virus… The only thing magical about Erythema Infectiosum, is the rash appearing out of nowhere. Erythema Infectiosum is a virus, aka Fifth Disease, and also “slapped cheek” disease. If you’re a HP fan, you understand my enthusiasm with the verbiage. Here’s an interesting fact about Erythema Infectiosum for you, it’s called Fifth Disease because it was the 5th documented childhood virus many years ago when all those childhood viruses, like measles, rubella, and scarlet fever were being documented.

Her cheeks are awfully pink, but she's happy! :-)

Her cheeks are awfully pink, but she’s happy! 🙂

Today, I thought… it’s time to write a post about Erythema Infectiosum, because I saw a 12 year old with a “lacy” rash; and just days ago, my cousin sent me pictures of her 4 year old with a rash… They both had Fifth Disease. So, that tells me it’s time for a post on Parvovirus B19. Doesn’t that sound disgusting? It’s not really a big deal, as long as you are healthy and not pregnant. This is NOT the parvovirus that animals get.

In healthy kids, Erythema Infectiosum/Fifth Disease is a rather benign ailment. Some kids have it, and you don’t even know it. Many kids get a fever and upper respiratory infection/URI symptoms (cough, congestion, headache, runny nose) before the rash. Some have no symptoms at all and just break out in a rash. And then, some have such a mild case, symptoms go completely unnoticed. Regardless, the virus leaves antibodies behind that are quite important for girls (more on this below). The rash may last for a few days to weeks, but may be more noticeable when the skin is hot from physical activity, hot bath water, etc.

You may be wondering what a “lacy” rash looks like…

Typical "lacy" rash of Fifth Disease

Typical “lacy” rash of Fifth Disease

Here ya go…Miss Molly’s legs and arms matched her cheeks. But, as you can see in her smiley face picture, she is feeling well. The rash can look more spread out, but commonly grows together into large red, lacy patches.

The 12 year old patient I saw today, was a little less happy. His rash was really itchy. I’ve seen very few Fifth’s rashes that are itchy, but his was pretty bad. I read somewhere that the itching is more common in teens and adults. I don’t promote any particular product, but I like to use Calmoseptine ointment. We applied this to his rash, and he immediately felt better. Do not apply Benadryl (diphenhydramine) cream to large areas of skin. Benadryl cream is absorbed through the skin and there is no way to monitor the dosing, it is not safe. Zyrtec or Benadryl can be taken by mouth to help combat the itchiness. Do not take both Zyrtec and Benadryl at the same time, be sure to follow the instructions on the package insert.

So, when can Parvovirus B19 be a problem? The first thing that comes to any providers mind is pregnancy. Parvovirus B19 can be detrimental to an unborn fetus. It has to do with depletion of the red blood cells (RBCs), leading to fetal anemia and the inability to replenish the lost RBCs to maintain adequate oxygenation, but I won’t get into the sciency stuff. The CDC reports that about 50% of women are immune to Parvovirus B19. If you want to read more about the science, check out CDC or KidsHealth.

What YOU need to know about Fifth Disease:

  • Contagious during the fever and URI period.
  • NOT contagious with the rash. Can attend school or daycare.
  • Incubation period is a few weeks after initial exposure.
  • Treatment should focus on comfort measures. Motrin for fever. Creams/oatmeal bath for itching. Zyrtec or Benadryl orally for itching.
  • There is no medication to prevent or cure Fifth Disease.
  • Pregnancy = Red Flag (see below)

One of the most important pieces of knowledge you can take away from this post is about Fifth Disease and Pregnancy. If your child has Fifth Disease, please think of anyone that you know that may be pregnant, and was in contact with your child during the contagious period. (Think about teachers.) There usually is not a problem, but it is important for a pregnant woman’s obstetrician to be aware of and monitor the exposure appropriately. If the pregnancy is into the 2nd trimester, the blood work is probably already done. For more information about Parvovirus B19 and Pregnancy, check out the CDC’s website.

Erythema infectiosum is one of the easier illness we will encounter on this journey called parenthood. If you have any questions or comments, let me know. If you want to know more about Erythema Infectiosum check out the CDC Parvovirus B19 and Fifth Disease website.

Enjoy the journey, friends! 😉

Hand, Foot and Mouth…..and Butt??

I’ve been on call this weekend, and gotten quite a few calls about fevers and rashes that sound like Hand, Foot and Mouth Disease. This illness is very common during the Spring and Summer months, is highly contagious, and very common among young children. For those of you that are wondering, is this the same thing as Foot and Mouth Disease? NO, totally different!!!

Hand, Foot and Mouth is a Coxsackievirus that causes bumps, blisters, and/or ulcers 

  on the hands, the feet,

in and around the mouth, 

and Yes, on the buttocks and backs of the legs. 

The bumps that appeared on the backside and back of the legs of a toddler is what prompted one of the calls from a Mom this weekend. Actually, the only symptoms that this child had were fever and red throat when he was seen in the office. Over the past 24 hours, the bumps on the buttocks and back of the legs appeared. So far, there is no hand or foot rash involved. All cases of Hand, Foot and Mouth present differently, not everyone gets the typical rash. Some kids will only have a fever and sores in the mouth, and possibly go undiagnosed.

This virus is spread via direct contact with nose and throat secretions, saliva, fluid from blisters, or the stools. Most people will get Hand, Foot and Mouth as a child, and then more than likely never get it again. The incubation period is about 3-7 days.  Most parents will not get the virus because they were exposed as children. Although, I do know of one mom that got it, and got it pretty bad. Ouch!!

Hand, Food, and Mouth starts with a fever, and usually the fever is pretty high, up to 103’s. The fever starts prior to the arrival of the rash. During the febrile stage the child typically doesn’t want to eat. They aren’t eating because the sores in the mouth are painful. The goal of treatment during this stage is to keep the child hydrated. I highly recommend giving cold drinks, freeze pops, popsicles, pudding, yogurt, milkshakes, smoothies, etc. DO NOT give the child anything that is hot, spicy, or acidic. Orange juice, soda and pizza would be a NO NO!

There is no medicine to treat Hand, Foot and Mouth. The only thing Mom and Dad can do is keep their little one comfortable. Giving Tylenol or Motrin for the fever and for the pain caused by the ulcers is the best way to handle this difficult time. As with any other virus, antibiotics will not help! I’ve said it before and I’ll say it again – Antibiotics are for bacterial infections, they will NOT get rid of viruses. Viruses are not bacteria. Keeping your child comfortable and treating the fever are your top priorities. If you need to know more about fevers in children, please check out my blog on Fevers: To Treat or Not To Treat??

Hand, Foot and Mouth usually last about 5-7 days. Keeping the child home from daycare, school, and away from other children will help prevent the spread of disease. Unfortunately, the fever typically precedes the rash and may not be that high in the beginning, so others may be exposed accidently. I was guilty of this when Joshua was in pre-school. I thought he was cutting molars, and gave him Motrin because his temperature was 100-101F. After a few days, his temp when up to 102.9. I had him evaluated by his pediatrician, and that is when we discovered the ulcers in his mouth. So, the fever and not eating wasn’t teething after all, and I had exposed the whole preschool. Oops, I felt bad, but there wasn’t anything I could do except warn the teachers and other parents, and tell them what to watch for.

Hand, Foot, and Mouth is one of those childhood illnesses that everyone gets. As parents, it’s all part of the journey. Every parent has had to deal with Hand, Foot and Mouth. Some kids will only get a mild case, and their parents won’t ever know what that fever was because the rash was only in the mouth and never observed by a practitioner for diagnosis. Those children (and parents) that experience those mild, undiagnosed cases are the lucky ones! Hand, Foot and Mouth hurts, and if you child doesn’t have to suffer through it, be thankful!!

So, if you have a child that experiences a high fever anytime soon, keep in mind it could be this painful Coxsackievirus that should be called Hand, Foot, Mouth and Butt! 

Just another part of the journey for all of us parents to suffer through. As I always say, regardless of the difficulties, I hope you enjoy the journey! 😉

Is that sore throat Strep? How to know…

It’s spring time, which means it’s the season for Strep Throat! Not that strep has to be in season, but spring is the most common time for strep. I’ve gotten a call today from a parent asking me if I would call in an antibiotic because her daughter has a sore throat and stomach ache. This child may very well have strep throat, but of course, I said “No.” The only way to determine if a child has strep throat is to have them evaluated, and 99.9% of the time a throat culture is needed for confirmation. I’m grateful the mom was understanding and planned on going to an urgent care facility after I spoke to her.

Symptoms of strep are sore throat, fever, headache, stomach ache, nausea, vomiting, rash, muscle aches, and petechiae on the palate.

Petechiae on the palate is usually diagnostic of strep.

Does the child always have a fever- No. Does the child always have a sore throat – No. Some kids will have no symptoms, but have a rash that presents with little red spots that are raised and feel like sandpaper. This sandpaper like rash is one of the symptoms that will cause me to forgo the culture. When children have lots of petechiae on the palate, and an extremely red throat, and usually really swollen tonsils, I don’t feel the need for a throat culture. When the throat looks this bad, it is strep and hurts to do a culture. When the throat has swollen tonsils with white spots, this is frequently, but not always strep, and a culture is needed.

I’m going to ask a favor of you – please help us! Children do not like throat cultures, but it is very important to obtain for proper diagnosis. When the parent is helpful, the culture is much easier for the child. I have had children beg their mom or dad “Don’t make me do it!!” This is when it is important as a parent to show some strength and be firm. Yes, the throat culture is necessary, please back me up!! Most kids really dislike having a throat culture done. I can’t say that I blame them, but it is a necessary evil. I often say that you would think we could figure out a better way to diagnose strep with all of the technology that we have nowadays. But, the bacteria that causes strep throat is hanging out on those tonsils.

Joshua has had strep throat twice. The last time he threw up so much I would have assumed it was a stomach virus if we hadn’t done a throat culture. The poor kid threw up for almost 8 hours, how miserable when you already have a sore throat. The first time he had strep he also had pneumonia. The poor guy had a high fever, was achy all over and was absolutely miserable! He didn’t even want to move. When he gets sick with strep, he really gets sick!

If you are worried that your child may have strep throat, please have them evaluated. Please do not ask your medical provider to just call in an antibiotic. Do not give your child an antibiotic that you have left over from a previous illness. If I child is on an antibiotic the throat culture will be negative even if they had strep throat. Also, you shouldn’t have antibiotics left over from other illnesses. When antibiotics are prescribed, they are usually meant be be given until the medication is all gone to properly treat the infection.

So, if it’s not strep, what could it be? It could be a URI, it could be allergies, it could also be mononucleosis. How do you know the difference, it’s not always easy to differentiate. It is very common for most upper respiratory infections (URI or cold) to present with a fever and sore throat. How do we know it is a virus and not strep?? Proper assessment, evaluation and culture. How do you know if it’s mono? Mono is confirmed by a blood test. Most sore throats (including mono) will go away without any treatment.

Sometimes a child can have more that one illness at a time. I spoke to a mom today that was wondering why her daughter wasn’t getting better after being on an antibiotic for strep throat (confirmed by culture) after 4 days on an antibiotic. The child started feeling worse 2 days ago. At the same time, she started with coughing and congestion. It sounds like she has a URI now, on top of strep throat, how miserable!!

(Update): This year, it seems like there are a good amount of kids testing positive for strep and the flu. That really is a double whammy! Miserable! Keep them as comfortable as you can, keep them hydrated, and have them rest as much as possible.

Strep throat can sometimes go away without treatment, but could cause complications if not treated appropriately. Some of the complications of strep throat could be quite serious, such as rheumatic fever, scarlet fever, and glomerulonephritis. This is why it is very important for proper diagnosis and treatment.

If your child has strep, 10 days of Amoxicillin is the best treatment. Traditionally speaking, strep throat is contagious for 24 hours after starting the antibiotic. More recent information states that it is contagious as long as the child has fever and/or a sore throat. Sometime it takes a few days for the sore throat to feel better. Treat your child with Tylenol or Motrin for fever and pain relief. You can find the links to Tyelnol and Motrin dosing in the sidebar on this page.

So, the next time your pride and joy has a sore throat, make an appointment with your doctor or nurse practitioner, and ask for a throat culture. Hopefully, I have helped you understand why we need to gag your child when we suspect strep. 😉

As challenging as it can be, I hope you are enjoying the journey! 🙂

Yuck, the “throw ups”…Do I need to be worried because my child is vomiting??

Well, tonight’s post wrote itself when friends of mine called to make sure they were doing the right thing for their daughter that had been vomiting all day. I saw kids of all ages today that had nausea, vomiting and diarrhea.  So, it sounds like the best parenting advice right now would be on managing that nasty stomach virus also know as gastroenteritis.

Poor little Maddie has been vomiting all day.  Her brother had vomiting and diarrhea a few days ago, and now it sounds like it’s her turn.  One question her Dad had; could it be something else? Well, maybe…but, probably not.  Dad told me he had been giving Maddie about a 1/2 ounce of Gatorade every 20 minutes or so.  She had been doing fairly well, then started having really bad stomach cramps. It seems that Maddie took a big drink of Mom’s tea, which wasn’t a good idea, but who can blame her, she was probably really thirsty.  Maddie probably had more than her stomach was able to tolerate.  It probably didn’t help that the tea had caffeine in it, which can be irritating to an empty stomach.  Drinking too much or eating or drinking the wrong thing can cause the pain and vomiting to start again. With rest and small amounts of fluids, Maddie will probably get throght this stomach virus just fine.  Slowly staying hydrated, and then eating small amounts of bland foods.  No doubt, she will be back to her happy playful self, and keeping up with that brother of hers.

Most vomiting spells will usually last 8-12 hours, but can come and go for a few days.  If your child vomits for more than 24-48 hours, you might want to consider having them evaluated by their pediatric provider.

Most children will have diarrhea with or after vomiting. This is just another way for the virus to exit the body.  Do not give children medication to stop the diarrhea or vomiting.  If this is necessary, medication should be prescribed and supervised by your provider.

Dehydration is usually the worst complication of gastroenteritis. Keeping your child hydrated after the initial vomiting spell is very important.  If your child is vomiting, don’t give anything by mouth the first couple hours; then give small sips of pedialyte or Gatorade (1/2 oz.) every 15-20 minutes.  For young children, Pedialyte popsicles can be really helpful.

If children tolerate fluids after several hours, try bland foods such as saltine crackers and toast.  Slowly, increase the diet with bland, salty foods over the next few days.  Do not give your child milk products, acidic products, or greasy foods. French fries and chicken nuggets are NOT a good idea.  Yes, too many parents of 3 or 4 years old children will come into my office and say, “Well, she said she would eat chicken nuggets” (or hot dogs, you can fill in with either)…. I want to scream “Are you kidding me?”   Fortunately, I learned to bite my tongue a few years back.  Trust me, it took some practice, I usually say what I think, but have learned that I just can’t do that sometimes.  Those of you that know me are smiling and laughing right now, no doubt. 😉

So, What else could it be??

  • Some people are concerned that their child could have appendicitis.  Believe me, that is the first thing I want to make sure a child doesn’t have either.  Appendicitis does need to be ruled out if a child is having severe or ongoing abdominal pain.  Appendix pain is usually in the lower right quadrant of the abdomen, but the pain can radiate elsewhere.  If you are worried your child may have signs of appendicitis, please see your provider.  This is not an easy diagnosis to make, even with physical exam.
  • Sometimes children will have vomiting, with a fever, sore throat and headache; beware, this can be strep throat.  Some children with strep throat will vomit.  My poor Joshua is one of these kids.  He has only had strep twice in his life,  first, with pneumonia.  Then, a few years ago he presented as fever, nausea and sore throat.  The poor kid vomiting for over 8 hours, he was pitiful.  If I hadn’t seen the positive strep test myself, I would have really thought it was a stomach virus.  It’s always safest to check if you have any doubt.  Strep throat cannot be confirmed without a throat culture, and MUST be treated with an antibiotic.

Again, I want to stress the importance of HYDRATION! Slow but steady hydration is the key to avoiding dehydration. If your child does not urinate at least once in 12 hours, please have him evaluated for dehydration.  Fever, along with vomiting and diarrhea can increase the risk for dehydration.  For more advice on fevers or hydration, please see my related posts.

Remember, sick kids need a little more patience, understanding, and TLC.

At some time or another, a vomiting child is something we all deal with….kind of like a rite of passage. Every Mom or Dad has a gross vomiting story to tell. Good luck with the vomiting thing when you experience it along your parenting journey.

It’s just a “cold”…so now what??

We have all suffered with colds throughout our lifetime.  A cold or URI/upper respiratory infection can be miserable. URI symptoms are cough, congestion, runny nose (clear or yellowish), low-grade fevers (<102F), sore throat, decreased appetite, disturbed sleep and overall just miserable feeling.  If fevers accompany the cough and congestion, a day off to rest isn’t a bad idea no matter what your age. If there is no fever with the cold symptoms,  most people just continue on through their daily routine.

I know what you are thinking… Yes, children do get colds more frequently than adults!  Fortunately and unfortunately, childhood is a time of building  immunity; good in the long run, but growing pains along the way.  It is true that the more organisms you are exposed to, the stronger your immune system gets.

So, what can you do to make life a little less miserable for your child with a cold??

There are a few simple rules….

Rule #1HYDRATION, HYDRATION, HYDRATION!!!  Drink plenty of fluids.  Adding Pedialyte or Vitamin water can help, this helps to replace any loss of electrolytes, salts, sugars, etc. from the cold and fever.  I’m not a fan of Gatorade, too much high fructose corn syrup. If you learn nothing else from my post, you will learn about how important it is to be hydrated! 🙂

Rule #2Blow your nose.  This is hard for young children, but can be accomplished with continued practice and effort. For babies, use saline drops and a bulb syringe to help with the nasal drainage.

Rule #3 – Increase your Vitamin C intake.  I recommend 500-1000mg to my young patients, 1000-1500mg to the adolescents.  Vitamin C is great for boosting the immune system into gear, helping it fight off the cold.  We like the chewable Vitamin C in my house, they taste like sweet-tarts, just a little more tart.  Josh ate 8 of them one day (500mg each x 8 = 4000mg), and then told me how good they were!  I told him that he really shouldn’t have that many, although Vitamin C is not toxic.  Crazy kid! (You will start seeing a pattern with this kid, he keeps us on our toes around here.)

Rule #4 – Use a cool-mist humidifier in your child’s room while they are sleeping.  Don’t forget to pull the door closed, leaving a few inches for ventilation. Keeping the child’s head elevated is helpful too. Infants should have their mattress elevated on an angle, a pillow should never be used under an infant to elevate his head.

Rule #5 – Get plenty of REST! Children and adults need to take time to rest and let their body fight off the cold.  Our bodies heal during sleep, sleep is so important to maintaining good health.  (I will address sleep soon.)

All of the above can help your child be more comfortable.  There are some other helpful hints that may or may not be useful for you.  Keep in mind, all children are different, and have similar but different needs.  Some children will be more clingy and want to be with you 24/7.

Some children just need you to hold and love them because they don’t feel good.  It makes them fell better to have your hugs and kisses.  There is nothing like the love of a parent to make you feel better!

Other helpful hints:

  • Take Motrin (Ibuprofen) for comfort.  It can also be helpful with the swelling and inflammation in the upper respiratory tract.  Nasal congestion is not just a runny nose.  Most of the little noses I see are so swollen inside,  some of them hardly have any room to breath, and many are breathing through their mouth.   I’m sure this sounds familiar, most children will breath through their mouth when they have a cold, and this is exactly why!
  • The latest research shows that giving a spoonful of honey is more helpful than a spoonful of cough medicine!  I advise my patients to use Honey for that daytime cough.  Honey tastes good, isn’t full of chemicals, and you cannot overdose on it!  I think it is great that we are getting back to natural vs. chemical!! 🙂
  • Taking an antihistamine or decongestant is helpful for some people.  I frequently recommend Benadryl (Diphenhydramine) at bedtime. I think this helps the child get some sleep and also helps to dry up some of the congestion. I think Benadryl is too sedating to give more than 1-2x a day, and don’t recommend daytime dosing unless the child is home and can nap. For Drew Elizabeth I use Claritin (Loratadine) instead of Benadryl. I do this because she has mild allergies and takes Claritin on a daily basis anyway. Also, I can give her the Claritin in the morning and it doesn’t make her sleepy. DO NOT use 2 allergy medications at the same time! Some decongestants such as Dimetapp and Robitussin can be helpful, but usually do little more than treat the cough for a few hours. DO NOT give Dimetapp Cold and Allergy with another allergy medication.  Dimetapp makes a Cold and Cough and a Cold and Allergy. Please read labels carefully!!
  • I think cough drops can be helpful too. I personally like Ricola.  No, I don’t get paid by Ricola. Do you hear the horn in the background, Riiicooolaaaa ;-)! The natural herbs just seem to be helpful for the sore throat and cough that accompany most colds.  Please keep in mind any hard object like cough drops can be a choking hazard for young children.
  • Another helpful tip that a friend reminded me of after I wrote the cough post, was sinus rinses.  Thanks, Ami Jo! 🙂 If you have never tried it, don’t knock it.  Most people will say yuck, until they have tried it.  A sinus rinse is a great way to help with a cold or allergies. I have parents that report back to me and swear by them.  Sinus rinses can be really helpful for allergy sufferers.

Please visit your child’s pediatric provider if they have a high fever, are uncomfortable when laying down (can be a sign of an ear infection because the pressure increases when they lay down), aren’t drinking and eating, or exhibit any signs of breathing problems.  Colds should get worse for a few days (3-5), then start to gradually get better.

Well, that is enough information for now, this was supposed to be a short post! Oops.  Too many helpful tips, I guess.

Keep in mind, all children are different!!  Some need more intervention then others while they suffer through yet another cold along this journey we call Life. Hope this information is helpful for all of you Moms and Dads out there! (Yes, this one’s for you, Ryan!) Thanks for reading.

I hope you are taking time to enjoy the journey!

Fevers: To treat or not to treat???

For those of you that wonder if you should treat a fever, here is what you need to know:

What is a fever? By definition, a true fever is a temperature of 100.5F and above.  To treat or not to treat does not always depend on the thermometer.  I worked with an awesome pediatrician that taught me, “Look at the child, not the numbers.”  This is great advice!  A fever is not an illness, it is the body’s defense against  illness.  Don’t be scared of a fever in a healthy child.  It’s burning up the germs!

When should you treat a fever?  Is the child uncomfortable or lethargic?  Is he in pain?  Is his temperature 101.0 and rising? If yes is the answer to any of these questions, it’s time for Motrin or Tylenol.  Keep in mind, when the medication wears off (4-6 hours) the fever will probably return.  The body’s immune system elevates body temperature in defense of the offending organisms.  Most viruses and bacteria do not tolerate much change in temperature.  So, if the numbers on the thermometer are 99-100, don’t medicate, let the elevated temperature burn up those germs.  

Does Tylenol (Acetaminophen) or Motrin(Ibuprofen) work better?  Typically, Motrin will work more quickly, usually within 20-30 minutes; but every child is different, some children will respond better to Tylenol.   Beware of a child that takes Motrin and then runs around the room thinking he’s Superman. As soon as the Motrin wears off, he is going to crash as his temperature rises.  Tylenol and Motrin will not get rid of fevers indefinitely.  Children under 6 mo should not be given Motrin, Tylenol is acceptable for children of this age.  If a child is less than 2mo of age, and has a temperature of 100.5F, ALWAYS have the child examined by a pediatrician.  

Aspirin should NEVER be used to treat a fever in children.

Many parents wonder if they should trust their temperature taking skills.  Anal temperatures are not necessary in children over 6 months of age.  Many parents ask me if they should add a degree to the temperature if they take it under the arm (axillary)? Not necessarily, if the thermometer is placed properly, axillary temperatures can be quite accurate.  I personally think the easiest way to take a child’s temperature is in their ear with a tympanic thermometer.  It’s least invasive and kids don’t seem to mind as much.

One of the most important things to remember about fevers is how easily they can cause dehydration.   It is very important to encourage lots of fluids during a fever.  If the child doesn’t have an appetite, no big deal, but they MUST DRINK!  Drinking just water is not good enough, having an electrolyte replacement drink is preferable.   Drinks that contain caffeine do not count as fluid intake.

Regarding febrile seizures:  Keep in mind, they occur most often in children 6mo – 5 yrs.  The incidence of febrile seizures is 2-5% in this populations.  Just because a child has a febrile seizure does not mean he has a seizure disorder; but once a child has one febrile seizure, they are at higher risk for febrile seizures in the future.  Any child with a history of febrile seizures should be treated aggressively with medication to minimize the fever.  I will cover febrile seizures more in depth in another post.

Hope this information helps you through your parenting journey! Good luck!

For more information, please refer to:

NIH/Medline’s website about fever.

Motrin dosing

Tylenol dosing