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Digestive Health Lesson #2 – It all Starts with Inflammation

/ Katie P. Tolley, RN, MSN, CPNP-PC / 3 Comments

Dr. Tanya Edwards, director of the Center for Integrative Medicine (Cleveland), wrote that inflammation is now recognized as the underlying basis of a significant number of diseases.

Inflammation

Inflammation 101

Inflammation defined by the free online medical dictionary: 1. A localized protective response elicited by injury or destruction of tissues, which serves to destroy, dilute, or wall off both the injurious agent and the injured tissue.  2.The inflammatory response can be provoked by physical, chemical, and biologic agents, including mechanical trauma, exposure to excessive amounts of sunlight, x-rays and radioactive materials, corrosive chemicals, extremes of heat and cold, or by infectious agents such as bacteria, viruses, and other pathogenic microorganisms. Although these infectious agents can produce inflammation, infection and inflammation are not synonymous.

Dr. Edwards points out that anti-inflammatory foods have been used to combat Cancer and many other diseases, i.e.: Parkinson’s disease, Alzheimer’s Disease, many Autoimmune diseases, asthma. Here is the abstract from her article:  Continue reading →

Is that sore throat Strep? How to know…

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

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! 🙂

The scoop on poop…Could your kid be constipated??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

From infants to teenagers, constipation seems to be a problem for so many kids! I had a visit with a 9 year old and her mom about her stomach pain related to constipation problems. As soon as I left the room I realized that Dr. M was seeing a 2 month old for ongoing constipation issues. Then, at the end of the day, Dr. T’s first call of the evening came in before we ever left the office, and it was about a 3 month old with constipation problems. So, you see, this is a daily problem in pediatrics. Anyone that works in pediatrics will tell you that we talk about poop everyday, sometimes all day. Inadequate nutritional intake and hydration is usually the problem. 

In my house, my kids are 2 for 2 on this topic. Drew Elizabeth has been as regular as clockwork until just a few months ago. I’m sure most of you remember my Paranoid Mom post about Drew Elizabeth’s chest pain. She has never had a problem in the past, but in the past few months she hasn’t been eating her veggies as she should, and as she used to for the past 5 years. Kids…I can’t always explain why they do the things they do… I usually have more problems with my own than with yours! 😉

My poor Joshua has had constipation problems since he was an infant.  Joshua is the child that taught me all about children’s constipation. Well, Joshua and a PNP GI specialist ;-)!  Joshua eats an apple almost everyday. He loves apple slices with cinnamon; I highly recommend this, it’s great for the bowels.  Even with adequate fruits and veggies, Josh still doesn’t drink enough water (hence, the importance of hydration) to keep himself regular.

Most kids do not eat enough fruits and vegetables. For proper nutrition information, you can check out Let Them Eat Cake…For Breakfast??  Not only do most kids need to eat more fruits and veggies, they need to drink more water. Yes, I’ve tried to cover that too, you can read more about hydration in The Importance of Hydration. If adequate amounts of fiber and hydration don’t help your child with their constipation problems, I would recommend an evaluation with your child’s medical provider. Ongoing constipation can cause the large colon to expand and cause nerve damage and leaky gut and multiple other systemic problems that don’t even seem related to the bowels, but they are. Our immune system is centered in our gut, a healthy gut really matters.

By definition, constipation is having 3 or fewer bowel movements in a week that are hard, dry, and usually hurt.

A few facts about constipation:

  • When kids are constipated, they usually eat less.
  • When kids are constipated, they will usually have stomach pain, and usually on the lower left side.
  • When kids are constipated, they may have nausea and vomiting.
  • When kids are constipated, they may have more urinary incontinence (accidents), urinary frequency, and bedwetting.

So, what can you do to help your child with constipation? 

  • High fiber foods: fruits and vegetables (the crunchier, the better), beans, fresh popcorn, baked potato w/skin, berries, oatmeal. (The one fruit to avoid with constipation is bananas, they can make stools harder.)
  • Drink more water!!
  • Decrease processed foods, like carbohydrates made with white and wheat flour.
  • Getting normal exercise can help with bowel movements also.
  • Do not rush potty time. Children will often not take the time that they need to sit and eliminate their bowels.
  • Infants will frequently have temporary constipation problems when they are transitioning to new foods such as cereal, or  from breastfeeding to formula feeding. Do not give cereal under 4 months unless instructed by a medical provider.
  • In infants, try a couple ounces of 100% apple or pear juice, if this doesn’t work, you can try prune juice. Baby juice does not need to be diluted, adult juice should be diluted with half water.
  • Abdominal massage. I recommend abdominal massage to all the infants I work with that have constipation issues as a first line treatment! Massaging clockwise around the belly button and then doing the I Love You massage can work wonders for infants. With the I Love You massage, start with a few strokes of the I (left of belly button), then the L is upside down (above and to the left of the belly button), and then the U (around the belly button). This helps massage the large bowel, and can be quite helpful. Be sure to use mineral oil and apply a moderate amount of pressure. Most babies will enjoy this once they start to relax.
I hope you found some of this information helpful! Constipation can definitely make this parenting  journey a little painful for you and your child!
The ‘I Love You’ massage works! Ask the massage therapist that taught me about it when Joshua was an infant. 😉

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

/ Katie P. Tolley, RN, MSN, CPNP-PC / 1 Comment

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.