Asthma

Asthma is an immunological condition that causes inflammation, excessive mucus secretion, and reversible constriction of the smooth muscle in the lung’s airway. Asthma can produce wheezing, coughing and shortness of breath; these symptoms may vary in severity. An asthma attack may be triggered by a person’s sensitivity to certain substances, exercise, dust, viral infections and other conditions that produce inflammation of the airways.

Symptoms

A dry cough at night or during physical activity may be the only symptom of asthma. The initial symptoms of an asthma attack are generally shortness of breath, coughing or chest tightness. In children, an itching sensation on the chest or neck may be the first hint of an approaching attack. The attacks sometimes have a sudden onset that can rapidly progress to pronounced wheezing and shortness of breath. In other instances, the attack starts slowly and symptoms gradually increase in intensity. An asthma attack may last for several minutes, for several hours, or even for days at a time. Anxiety may accompany an asthma attack, especially if breathing becomes difficult. In very severe attacks, speaking is difficult and little air moves in or out of the lungs. If a person’s air supply becomes seriously restricted, confusion and lethargy can occur, and the skin may turn blue. Emergency medical treatment is essential if these symptoms are present. Patients rarely die, even in cases of severe asthma attacks, if proper treatment is obtained early in the course of the attack.

Causes

The airway inflammation associated with asthma may be triggered by contact with an allergen to which a person is sensitive, by a viral infection, or by strenuous exercise. In some people with defined allergies, asthma may be triggered by an abnormal reaction of the airways to specific stimuli. These stimuli may include pollens, dust mites or animal dander, which certain cells in the airway recognize as allergens. The result is an immune response that causes certain cells to release substances such as histamine and leukotrienes that stimulate the smooth muscles in the airways to contract. Mucus secretion increases; white blood cells, which secrete chemicals that cause an inflammation response, are transported to the area; and the tissues lining the airways become swollen and inflamed. This produces a narrowing of the airways, a condition that is called bronchoconstriction. Bronchoconstriction, which can impede air movement and make breathing difficult, can vary in frequency, duration, and severity. Asthma also may occur in people who do not have defined allergies. Smoke, cold air, vigorous activity, stress, anxiety, a viral infection of the upper respiratory system, or any combination of these environmental conditions and events may produce similar changes that cause the narrowing of the airways in certain people. The resulting asthma attacks also vary in severity, frequency and duration.

Diagnosis

Asthma can be initially diagnosed on the basis of a description of characteristic symptoms. If a person has narrowed airways at the time he or she visits a doctor, the doctor may hear wheezing, in which case spirometry, a test that measures air movement in and out of the lungs, may confirm bronchoconstriction. Spirometry also may be used to determine the extent of airway obstruction and to monitor asthma treatment. If the diagnosis of asthma seems likely and spirometry results are normal, the doctor may recommend a trial of bronchodilators. If the symptoms resolve, then asthma is the probable diagnosis. In rare cases in which the diagnosis is uncertain, the doctor may give a small amount of a bronchoconstrictor to inhale. Inhalation at this dosage does not produce narrowing of the airways in a healthy person but does result in bronchoconstriction in a person with asthma. Identifying and avoiding asthma triggers is the first line of defence against asthma attacks. In cases in which it is vital to identify the substance that triggers asthma attacks, allergy skin testing may be done. To diagnose exercise-induced asthma, a person is given spirometry tests before and following exercise on a treadmill or stationary bicycle.

Treatment

The most commonly used medications to relieve asthma symptoms are bronchodilators, which stimulate certain receptors in the airway to relax the smooth muscle and dilate (widen) the airways. Bronchodilators may be taken by mouth, by injection or by inhalation. Inhaling devices deposit the medication directly into the airways during an attack and immediately dilate the airways, but in cases of severe bronchoconstriction they may not transport the medication to all the affected airways. Oral bronchodilators can reach all the obstructed airways but act more slowly than inhaled forms and usually have more side effects than inhaled bronchodilators; oral agents must be taken on a regular basis to prevent asthma attacks. They may be taken orally via short-acting tablets, sustained-release capsules, or in syrup form. Bronchodilators can be given by injection, but these are usually used to treat severe asthma attacks. Inhaled, oral or injected corticosteroids can counteract the inflammatory response and are very effective at controlling symptoms. Inhaled corticosteroids are used most often in those with moderate or severe asthma. When taken over time, these medications gradually act to prevent attacks by reducing inflammation and blocking the sensitivity of the airways to allergens and other stimuli. When severe asthma does not respond to other treatments, long-term oral corticosteroids may be prescribed to control symptoms. Long-term use of oral corticosteroids is limited to the most severely affected people because of the potential for serious side effects, including inhibited wound healing, weakening of the bones, slowed growth in children, bleeding from the stomach, cataracts, increased blood sugar level, weight gain, and mental disturbances. Inhaled corticosteroids used over the long-term do not have these same side effects. Other medications that may be prescribed to prevent or control asthma include cromolyn sodium and nedocromil, which inhibit the release of inflammatory substances and help prevent airway constriction. The newest medications used to control asthma are leukotriene modifiers (for example, montelukast, zafirlukast and zileuton), which prevent the action of chemicals that cause the inflammation associated with asthma attacks. Persons diagnosed with asthma are generally prescribed a handheld, metered-dose inhaler that uses pressurized gas to propel the bronchodilator medication, which is inhaled through the mouth into the airways. Inhaled bronchodilators work rapidly to relieve shortness of breath and wheezing by relaxing the smooth muscles of the airways. For people with frequent asthma attacks (more than two to three asthma attacks a week), cromolyn or inhaled corticosteroids may be added as daily medications. Another group of oral medications called leukotriene receptor antagonists is also used to control symptoms. Oral theophylline is prescribed less commonly but can be useful for treating persistent symptoms, particularly night time symptoms. An acute asthma attack should be treated immediately using additional medications or higher doses or different forms of the medications used on an ongoing basis to control or prevent asthma. A handheld inhaler may be used by a person during an asthma attack, or a nebulizer may be used to direct pressurized air through a solution of the medication. The nebulizer produces a continuous mist that can be inhaled. Intravenous asthma medications, including epinephrine or corticosteroids, are sometimes used to treat severe asthma attacks. Oxygen and intravenous fluids also may need to be given, and antibiotics may be necessary if an underlying infection is present. Excerpted from: Complete Medical Encyclopaedia, American Medical Association, 2003. If you would like information about purchasing the Complete Medical Encyclopaedia, click here. Copyright 2003 American Medical Association All rights reserved.

What is Bronchiolitis?

Bronchiolitis is infection and inflammation (swelling and blocking) of the very smallest breathing tubes in your child’s lungs, called the bronchioles. It is caused by infection with a virus, most often the very common respiratory syncytial virus (RSV). As the small airways become narrowed or blocked, you may hear wheezing (high-pitched sounds coming from the lungs) as your child breathes. If bronchiolitis becomes severe, your child may have difficulty getting enough air. If this happens, he or she may need to be admitted to the hospital for oxygen and other treatments.

What does it look like?

Bronchiolitis starts off with the symptoms of a typical cold, with sneezing and a runny nose. Your child may recently have been exposed to an older child with a cold. He or she may also have a fever. After a few days, your child may develop more severe breathing-related problems, such as:

• Coughing or wheezing (high-pitched sounds coming from the chest, especially when your child is breathing out).
• Shortness of breath (as if your infant is having trouble getting enough air).
• Fast breathing, which may make it difficult for your infant to nurse or feed.
• Dehydration (not drinking enough fluid), which may result from feeding difficulties. Symptoms of dehydration include:
  • Decreased urination
  • Dryness inside the mouth
• Agitation or irritability may be a sign that your child is not getting enough oxygen. Get medical help as soon as possible.

More severe signs of difficulty breathing (respiratory distress). Take your child to the emergency room immediately if any of the following symptoms occur:

• Chest caves in, ribs stick out, belly goes up and down, and nostrils flare (called retractions)
• The skin turns blue (called cyanosis). This is an emergency – call 911.

What causes bronchiolitis?

Bronchiolitis in infants is caused by viruses, most commonly RSV. Nearly all infants have been exposed to RSV by age 2. In older children and adults, RSV usually causes a cold. Only in infants and toddlers does the infection get into the small breathing tubes, causing bronchiolitis. Bronchiolitis is not caused by infection with bacteria, so antibiotic treatment probably will not be prescribed. Antibiotics may be recommended if your doctor suspects a bacterial infection is present in addition to bronchiolitis.

What puts your child at risk of bronchiolitis?

• Bronchiolitis usually occurs in infants under 2 years of age. Severe bronchiolitis requiring hospitalization is more likely in infants under 6 months old.
• It often occurs after exposure of your infant to older children with colds.
• It mainly occurs during the “cold season,” that is, late fall and winter.
• Premature infants and those with other lung diseases are more likely to develop severe bronchiolitis.

Can bronchiolitis be prevented?

The best prevention for bronchiolitis is taking whatever steps you can to avoid spreading colds. Avoid exposing your infant to older children with colds if possible. Wash your hands frequently, especially during the cold season. Premature infants and those with certain lung diseases may be treated with infection-fighting bodies called immunoglobulins to prevent RSV disease.

What are some possible complications of bronchiolitis?

Even when bronchiolitis is severe enough to require hospitalization, most children recover completely. However, it may take a couple of weeks before all of your child’s symptoms clear up.

How do I know if my child is constipated?

Your child is constipated if one or more of the following are true:

• He or she has fewer than 3 bowel movements a week.
• The stools are hard, dry and unusually large.
• The stools are difficult to pass.

What causes constipation?

Constipation is likely to happen when your child doesn’t drink enough water, milk, or fruit juices, or if your child doesn’t eat a healthy diet that includes enough fibre. Fibre is found in foods such as cereals, grains, fruits, and vegetables. If your child eats a diet high in fat and refined sugars (candy and desserts), he or she is probably not getting fibre, which may result in constipation. Constipation may also begin when you change your baby from breast milk or baby formula to whole cow’s milk, and when your switch from baby food to solid food. Young children often ignore the urge to have a bowel movement and may become constipated. Your child may not want to interrupt play, ask a teacher or use a public restroom. Sometimes constipation happens after your child has been sick or has taken certain medicines. You should not be concerned if your child becomes constipated. Constipation is common in children and usually goes away on its own.

What can I do if my child is constipated?

There are 3 things you can do to help your child:

1. Diet–You can start by increasing the amount of fluid your child drinks every day. It may also help to give your baby a bottle of prune juice every day or add corn syrup or brown sugar to your baby’s formula until his or her bowel movements become regular. Check with your doctor about how much corn syrup or brown sugar to add. You can give an older child large quantities of fluids every day, as well as prune juice, bran cereal, and fruits and vegetables that are high in fibre.
2. Bowel habit training–Your child should be taught not to wait to have a bowel movement. To establish a regular bowel habit, ask your child to sit on the toilet for at least 10 minutes at about the same time each day, preferably after a meal. Make sure your child can place his or her feet firmly on the floor while sitting on the toilet. If this is not possible, put a footstool in front of the toilet. While your child is sitting on the toilet, you might let your child read a storybook or listen to the radio.
3. Medicine–Many laxatives are available to treat constipation in children. The choice of laxative depends on the age of your child and how serious the constipation is. Ask your family doctor to suggest a brand name and tell you how much to use.

If constipation doesn’t get better, take your child to see your family doctor. Constipation can sometimes be a sign of a more serious problem.

Children’s Diet
for Constipation

Children with constipation need more bulky foods and more fluids. Use more of these bulky foods: Raw Vegetables – Carrots, cabbage, tomatoes, celery, lettuce, cauliflower Raw Fruits – Apples and pears (with peeling), oranges, grapes Dried Fruits – As is or cooked: Prunes, raisins, apricots Leafy Green Vegetables – Spinach, broccoli, turnip greens Bulky Grain Products – Whole Wheat bread, 40% Bran flakes, Bran buds, All bran, Shredded wheat, Graham crackers A child needs 2 cups of milk daily but no more when constipated. Increase fluids by using: Water – 4 to 5 extra small glasses daily Fruit Juices – (Not fruit drinks or fruit aides) Prune, orange, and apple juices are good

Eliminate these concentrated foods:

• Cheese
• Sweets (such as candy, puddings, rich fillings like pecan pie or custard)
• Bananas
• Peanut Butter

Enuresis (Bed-Wetting)

What is enuresis?

Enuresis (say “en-yur-ee-sis”) is the medical term for bed-wetting during sleep. Bed-wetting is fairly common and is often just a developmental stage. Bed-wetting is more common among boys than girls. What causes bed-wetting? Some of the causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)
• Difficulties waking up from sleep
• Stress
• Slower than normal development of the central nervous system (which reduces the child’s ability to stop the bladder from emptying at night)
• Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night)
• Urinary tract infections
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys
• Abnormalities in the spinal cord
• A small bladder
• Bed-wetting is not a mental or behavioural problem. It doesn’t happen because the child is too lazy to get out of bed to go to the bathroom.
• When do most children achieve bladder control?

Children achieve bladder control at different ages. By the age of 6 years, most children no longer urinate in their sleep. Bed-wetting up to the age of 6 is not unusual, even though it may be frustrating to parents. Treating a child for bed-wetting before the age of 6 is not usually necessary.

How can my family doctor help?

First, your doctor will ask questions about your child’s daytime and night-time bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes. Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.

Your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child’s bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home.

What are the treatments for bed-wetting?

Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behaviour therapy and medicine.

Behaviour therapy helps teach your child not to wet the bed. Some behavioural treatments include the following:

• Limit fluids before bedtime.
• Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep.
• An alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
• A reward system for dry nights.
• Asking your child to change the bedsheets when he or she wets.
• Bladder training: having your child practice holding his or her urine for longer and longer times during the day, in an effort to stretch the bladder so it can hold more urine.

What kinds of medicines are used to treat bed-wetting?

Your doctor may give your child medicine if your child is 7 years of age or older and if behaviour therapy has not worked. But medicines aren’t a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

How can I help my child cope with wetting the bed?

Bed-wetting can lead to behaviour problems because of the guilt and embarrassment a child feels. It’s true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn’t be made to feel guilty about something he or she cannot control. It’s important for your child to know that bed-wetting isn’t his or her “fault.” Punishing your child for wetting the bed will not solve the problem.

It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).

Remind your child that it’s okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child’s mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

What are Febrile Seizures?

Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes. Less commonly, a child becomes rigid or has twitches in only a portion of the body. Most febrile seizures last a minute or two; some can be as brief as a few seconds, while others last for more than 15 minutes. Febrile seizures usually occur in children between the ages of 6 months and 5 years and are particularly common in toddlers. A few factors appear to boost a child’s risk of having recurrent febrile seizures, including young age (less than 15 months) during the first seizures, frequent fevers, and having immediate family members with a history of febrile seizures.

Is there any treatment?

A child who has a febrile seizure usually doesn’t need to be hospitalized. If the seizure is prolonged or is accompanied by a serious infection, or if the source of the infection cannot be determined, a doctor may recommend that the child be hospitalized for observation. Prolonged daily use of oral anticonvulsants, such as phenobarbital or valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing such seizures.

What is the prognosis?

The vast majority of febrile seizures are harmless. There is no evidence that febrile seizures cause brain damage. Certain children who have febrile seizures face an increased risk of developing epilepsy. These children include those who have febrile seizures that are lengthy or that recur within 24 hours and who have cerebral palsy, delayed development, or other neurological abnormalities.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to febrile seizures in its laboratories at the National Institutes of Health (NIH) and also supports additional febrile seizure research through grants to major medical institutions across the country. NINDS-supported scientists are exploring what environmental and genetic risk factors make children susceptible to febrile seizures. Investigators continue to monitor the long-term impact that febrile seizures might have on intelligence, behaviour, school achievement, and the development of epilepsy. Select this link to view a list of studies currently seeking patients.

Organizations

Epilepsy Foundation 8301 Professional Place Landover, MD 20785-7223 postmaster@efa.org http://www.epilepsyfoundation.org Tel: 301-459-3700 800-EFA-1000 (332-1000) Fax: 301-577-2684

Related NINDS Publications and Information

• Febrile Seizures Fact Sheet Febrile seizures fact sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS)
• Seizures and Epilepsy: Hope Through Research Information booklet on seizures, seizure disorders, and epilepsy compiled by the National Institute of Neurological Disorders and Stroke (NINDS).

Publicaciones en Español

• La Parálisis Cerebral: Esperanza en la Investigación
• Convulsiones Febriles

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What’s Fifth Disease?

Especially common in kids between the ages of 5 and 15, fifth disease typically produces a distinctive red rash on the face that makes the child appear to have a “slapped cheek.” The rash then spreads to the trunk, arms, and legs. Fifth disease is actually just a viral illness that most kids recover from quickly and without complications. Fifth disease (also called erythema infectiosum) is caused by parvovirus B19. A human virus, parvovirus B19 is not the same parvovirus that veterinarians may be concerned about in pets, especially dogs, and it cannot be passed from humans to animals or vice versa. Studies show that although 40% to 60% of adults worldwide have laboratory evidence of a past parvovirus B19 infection, most of these adults can’t remember having had symptoms of fifth disease. This leads medical experts to believe that most people with a B19 infection have either very mild symptoms or no symptoms at all. Fifth disease occurs everywhere in the world. Outbreaks of parvovirus tend to happen in the late winter and early spring, but there may also be sporadic cases of the disease any time throughout the year.

Signs and Symptoms

fifthdisease_illustrationFifth disease begins with a low-grade fever, headache, and mild cold-like symptoms (a stuffy or runny nose). These symptoms pass, and the illness seems to be gone until a rash appears a few days later. The bright red rash typically begins on the face. Several days later, the rash spreads and red blotches (usually lighter in colour) extend down to the trunk, arms, and legs. The rash usually spares the palms of the hands and soles of the feet. As the centers of the blotches begin to clear, the rash takes on a lacy net-like appearance. Kids younger than 10 years old are most likely to get the rash. Older kids and adults sometimes complain that the rash itches, but most children with a rash caused by fifth disease do not look sick and no longer have a fever. It may take 1 to 3 weeks for the rash to completely clear, and during that time it may seem to worsen until it finally fades away entirely. Certain stimuli (including sunlight, heat, exercise, and stress) may reactivate the rash until it completely fades. Other symptoms that sometimes occur with fifth disease include swollen glands, red eyes, sore throat, diarrhoea, and rarely, rashes that look like blisters or bruises. In some cases, especially in adults and older teens, an attack of fifth disease may be followed by joint swelling or pain, often in the hands, wrists, knees, or ankles.

Contagiousness

A person with parvovirus infection is most contagious before the rash appears? either during the incubation period (the time between infection and the onset of symptoms) or during the time when he or she has only mild respiratory symptoms. Because the rash of fifth disease is due to an immune reaction (a defence response launched by the body against foreign substances like viruses) that occurs after the infection has passed, a child is usually not contagious once the rash appears. Parvovirus B19 spreads easily from person to person in fluids from the nose, mouth, and throat of someone with the infection, especially through large droplets from coughs and sneezes. In households where a child has fifth disease, another family member who hasn’t previously had parvovirus B19 has about a 50% chance of also getting the infection. Children with fifth disease may attend childcare or school, since they are no longer contagious. Once infected with parvovirus B19, a person develops immunity to it and won’t usually become infected again. Parvovirus B19 infection during pregnancy may cause problems for the fetus. Some fetuses may develop severe anaemia if the mother is infected while pregnant? especially if the infection occurs during the first half of the pregnancy. In some cases, this anaemia is so severe that the fetus doesn’t survive. Fortunately, about half of all pregnant women are immune from having had a previous infection with parvovirus. Serious problems occur in less than 5% of women who become infected during pregnancy.

Prevention

There is no vaccine for fifth disease, and no real way to prevent spreading the virus. Isolating someone with a fifth disease rash won’t prevent spread of the infection because the person usually isn’t contagious by that time. Practicing good hygiene, especially frequent hand washing, is always a good idea since it can help prevent the spread of many infections.

Incubation

The incubation period (the time between infection and the onset of symptoms) for fifth disease ranges from 4 to 28 days, with the average being 16 to 17 days.

Duration

The rash of fifth disease usually lasts 1 to 3 weeks. In a few cases in older kids and adults, joint swelling and pain because of fifth disease have lasted from a few months up to a few years.

Diagnosis

Doctors can usually diagnose fifth disease by the distinctive rash on the face and body. If a child or adult has no telltale rash but has been sick for a while, a doctor may perform blood tests to see if the illness could be caused by parvovirus B19.

Treatment

Fifth disease is caused by a virus, and it cannot be treated with antibiotics used to treat bacterial infections. Although antiviral medicines do exist, there are currently none available that will treat fifth disease. In most cases, this is such a mild illness that no medicine is necessary. Usually, kids with fifth disease feel fairly well and need little home treatment other than rest. After the fever and mild cold symptoms have passed, there may be little to treat except any discomfort from the rash itself. If your child has itching from the rash of fifth disease, ask the doctor for advice about relieving discomfort. The doctor may also recommend acetaminophen for fever or joint pain.

Complications

The majority of kids with fifth disease recover with no complications. By the time the rash appears and while it’s present, they usually feel well and are back to their normal activities. However, some children with weakened immune systems (such as those with AIDS or leukaemia) or with certain blood disorders (like sickle cell anaemia or haemolytic anaemia) may become significantly ill when infected with parvovirus B19. Parvovirus B19 can temporarily slow down or stop the body’s production of the oxygen-carrying red blood cells (RBCs), causing anaemia. When a child is healthy, this slowdown of red blood cell production usually goes unnoticed because it doesn’t affect overall health. But some kids who are already anaemic can become sick if their RBC production is further affected by the virus. The RBC levels may drop dangerously low, affecting the supply of oxygen to the body’s tissues.

When to Call the Doctor

Call the doctor if your child develops a rash, especially if the rash is widespread over the body or accompanied by other symptoms. If you’re pregnant and develop a rash or if you’ve been exposed to someone with fifth disease (or to anyone with an unusual rash), call your obstetrician. Reviewed by: Joel Klein, MD Date reviewed: November 2007

DIARRHOEA AND VOMITING

The home treatment of diarrhoea consists of resting the stomach and intestines. Stop giving your child all solid foods and milk/formula. Feed the child according to the following diet:

DIET INSTRUCTIONS FOR INFANTS (6-12 months)

Clear liquids only for 24 hours: paedialyte or any weak tea, Kool-aid, Gatorade, flat soda, Jello water (1 pkg jello to 4 cups water). No fruit juices or milk. No rice water. It would be best to give the fluids mixed half and half with Paedialyte. After 24 hours on clear liquids, feed the infant on one-half strength formula for the next 24 hours. After 24 hours on one-half strength formula, begin feeding the infant full strength formula. If the infant tolerates the formula and the stools are becoming normal after the third day you may resume solid foods. If your child is vomiting, give small amounts of fluids frequently; for example, 1-2 ounces every 1-2 hours. If he only has diarrhoea, give larger amounts less frequently.

DIET INSTRUCTIONS FOR CHILDREN

Clear liquids only for 24 hours: Paedialyte/flat soda/weak tea/popsicles/ Jello/Jello water/Gatorade/Kool-aid – Thirst Quencher It would be best to give the fluids mixed with half and half with Paedialyte. No milk, fruit juices or rice water After 24 hours on clear liquids, you may slowly begin feeding the child bland solid foods: – toast/bananas/applesauce/saltine crackers potatoes/eggs/cereal without milk/rice/apples – pasta without sauce/clear broth soups/boiled or broiled chicken without the skin After 24 hours on the bland diet, you may feed the child a regular diet.

When to Call the Doctor

Call your doctor if you have questions or concerns or if any of the following is true: The child has not urinated for 8 hours. There are no tears when the child cries. There is blood in the vomit. The child has had stomach pain for more than 4 hours. The child has a fever exceeding 102°F. It is hard to wake the child. – You suspect the child might have eaten something poisonous, such as spoiled food or a household chemical. – Frequent vomiting has continued for more than 24 hours. The child does not improve within 48 hours or seems to be getting worse.

What happens when my baby spits up?

Babies spit up when they’ve eaten too much or when they’re burped. It can also happen when your baby is drooling. Spitting up is not vomiting. Babies usually don’t notice when they spit up, while vomiting is forceful and painful. Spitting up is a common occurrence for most babies. The medical term for “spitting up” is gastroesophageal reflux, or reflux. It happens when milk or solid food in the stomach comes back up into your baby’s esophagus. The esophagus is a tube that joins the mouth and the stomach. When the baby’s milk or food is in the esophagus, 3 things can happen:

• The milk or food can be spit out of the mouth.
• The milk or food can be sucked into the lungs.
• The milk or food can go into the stomach for a while, but then it can go back up into the esophagus. It stays in the esophagus for a while before going back into the stomach.

What can be done for reflux?

Feed your baby by placing him or her in an upright position. If you bottle-feed you baby, burp him or her every 3 to 5 minutes. Avoid laying your baby down following a feeding. Some babies spit up less if their formula is thickened with rice cereal. Ask your doctor if you can add 2 to 3 teaspoons of rice cereal to each ounce of formula. You might have to enlarge the nipple hole a little so the thicker formula will come out easily. Some babies also spit up less if they are given less milk at each feeding, but are fed more often.

Will reflux cause problems for my baby?

Spitting up is messy, but it is a normal occurrence during your baby’s early months. It rarely involves choking, coughing or pain. When problems do happen, they are related to the 3 things that can happen to milk or food when it goes back up into the esophagus. Some of these problems are listed here: Spitting up milk or food: growth problems, gagging. Breathing milk or food into the lungs: lung infections, asthma, coughing. Milk or food coming up into the esophagus for a while, then going back down into the stomach: crying from pain, not wanting to eat, vomiting blood.

Should I take my baby to the doctor?

If your baby experiences any of the problems listed above, you should see your doctor. First, your doctor will make sure your baby is healthy and growing well. Your doctor will also check whether your baby has breathing problems. If your doctor thinks your baby is fine, nothing else has to be done. Your doctor will want to see your baby regularly. If your baby’s reflux is causing excessive problems, your doctor may prescribe medicine to help stop it. This medicine is the same one used for heartburn in adults. If your baby continues to not gain weight or develops other problems, your doctor might do some tests.

Head Injuries: What to Watch for Afterward

What are the main causes of head injuries?

A serious head injury is most likely to happen to someone who is in a car wreck and isn’t wearing a seat belt. Other major causes of head injuries include bicycle or motorcycle wrecks, falls from windows (especially among children who live in the city) and falls around the house (especially among toddlers and the elderly).

Are head injuries serious?

They can be. Bleeding, tearing of tissues and brain swelling can occur when the brain moves inside the skull at the time of an impact. But most people recover from head injuries and have no lasting effects. See the box below for a list of types of head injuries.

Types of head injuries

A concussion is a jarring injury to the brain. A person who has a concussion passes out for a short while. The person may feel dazed and may lose vision or balance for a while after the injury. A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling. A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or another injury. A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it’s important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

How can the doctor tell how bad the damage is?

Your doctor will ask about how the injury occurred, about past medical problems, and about vomiting, seizures (fits) or problems breathing after the injury. The injured person may need to stay in the hospital to be watched. Sometimes, special pictures of the brain may be needed to find out more about the damage.

What happens after the injury?

It’s normal to have a headache and nausea, and feel dizzy right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired. The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time. These symptoms usually go away in a few weeks, but may go on for over a year if the injury was severe.

Will the head injury cause permanent brain damage?

This depends on how bad the injury was and how much damage it did. Most head injuries don’t cause permanent damage.

What about memory loss?

It’s common for someone who’s had a head injury to forget the events right before, during and right after the accident. Memory of these events may never come back. Following recovery, the ability to learn and remember new things almost always returns.

Is it true that the person must be kept awake after the injury?

No. If your doctor thinks the person needs to be watched this closely, your doctor will probably put the person in the hospital. Sometimes, doctors will send someone who has had a head injury home if the person with them is reliable enough to watch the injured person closely. In this case, your doctor may ask you to wake the person frequently and ask questions such as “what’s your name?” and “where are you?” to make sure everything is okay.

Get help if you notice

• Any symptom that is getting worse, such as headaches, nausea or sleepiness
• Nausea that doesn’t go away
• Changes in behaviour, such as irritability or confusion
• Dilated pupils (pupils that are bigger than normal) or pupils of different sizes
• Trouble walking or speaking
• Drainage of bloody or clear fluids from ears or nose
• Vomiting
• Seizures
• Weakness or numbness in the arms or legs

Post Head Trauma Instructions

The patient has been examined, and no evidence of skull fracture or concussion can be found; however, after a blow to the head signs of bleeding inside the head may sometimes show up only after several hours or even days later. Please follow these instructions and contact the doctor if anything abnormal occurs. Awaken the patient every ___ to see that he is arousable and can be awakened. Using a flashlight, check both eyes to see if both pupils are equal in size and react normally to light by getting smaller when the light is shined at them. Do not give aspirin or any stronger pain medication. Tylenol may be given for mild headache. Call the doctor or take the patient to the nearest emergency room if any of the following occurs:

• Unequal pupil size.
• Seizures or convulsions.
• Excessive drowsiness or inability to wake up.
• Unusual or bizarre behaviour or change in personality.
• Severe headache nor relieved by Tylenol.
• Continuous vomiting or vomiting associated with severe headaches.
• Difficulty in talking, walking, or inability to move part of the body. h. Inability to control bowel or bladder function. i. Clear or blood-tinged fluid coming from nose or ear.

copyright 1996-2005 American Academy of Family Physicians

Head Lice – What They Are and How to Eliminate Them

What are head lice?

Head lice are small wingless insects (bugs) that can get on your hair and scalp. Lice are parasites (say: pah-ruh-sytes) that feed on very small amounts of your blood. Lice bites may cause constant scratching, and lead to skin irritation or even infection.

Who is at risk of getting head lice?

Anyone can get head lice, but they are more common among school-aged children. Head lice spread more easily among children 3 to 12 years of age because they share their belongings more often than adults and play close together. It’s not true that people get head lice because they’re dirty. Head lice are very contagious. No matter how many times you or your child takes a shower or washes his or her hair, it’s still possible to get head lice from head-to-head contact with someone who is already infested with lice. You can also get head lice if you share hats, towels, pillows, combs or brushes with someone who has head lice.

Can head lice be prevented?

It may be difficult to prevent head lice from spreading among children, but the following are some steps you can take to help keep lice away:

• Ask your child not to share combs, brushes or hair decorations.
• Ask your child not to try on hats that belong to other children.
• If your child will be sleeping away from home, be sure to pack his or her own pillow and towels.

What are the signs of head lice?

Because lice move very fast, they are not always easy to see. Here’s what you can watch for:

• Frequent scratching
• Small red bumps or sores on the scalp, neck and shoulders
• Lice eggs, also called nits, which look like tiny, oval shaped, white or clear dots. Nits usually stick at an angle on hair shafts.
• If you think someone in your family has head lice, it’s probably best to check everyone in the family. If you’re not sure, your family doctor can help diagnose head lice.

How can I treat head lice?

Head lice can be treated with over-the-counter or prescription products. Shampoos and lotions that kill head lice contain pesticides and other chemicals, so it is important to talk to your doctor before using these products, especially if you are pregnant or nursing, or if you have allergies or asthma. It is also not safe to use products with pesticides on or near your eyes. If you find head lice or nits in eyelashes or brows, talk to your doctor. The products that kill head lice don’t usually kill all nits. To reduce the risk of another lice infestation, pick the remaining lice and nits by hand or by using a special comb (one brand name: LiceMeister comb) to remove them. Comb through all of the hair one section at a time every 3 days or more often, for at least 2 weeks or until you stop seeing head lice and nits. You should also use hot water to wash any bed linens, towels and clothing recently worn by the person who had head lice. Vacuum anything that can’t be washed such as the couch, carpets, your child’s car seat and any stuffed animals. Because head lice don’t live very long away from the scalp, you don’t need to use lice spray on these items.

Help with Hives

After eating some big, red strawberries, you decide to walk to your friend’s house. Just as you’re turning the corner, you notice reddish bumps and patches on your arms and chest. What are these itchy welts or blotches on your skin? Should you turn around and head home?

What Are Hives?

Hives are pink or red bumps or slightly raised patches of skin. Sometimes, they have a pale center. Hives usually itch, but they also can burn or sting. Hives can occur anywhere on the body and vary in size and shape. They can be small like a mosquito bite or big like a dinner plate. Hives also might look like rings or groups of rings joined together. Hives can appear in clusters and might change locations in a matter of hours. A bunch of hives might be on a person’s face, then those might go away. Later some more may appear on a person’s arms. Hives are common – between 10% and 25% of people get them at least once in their lives. They are usually harmless, though they may occasionally be a sign of a serious allergic reaction. (So, yes, you should go home and tell your mom or dad.) The medical term for hives is urticaria (say: ur-tuh-kar-ee-uh). When a person is exposed to something that can trigger hives, certain cells in the body release histamine (say: his-tuh-meen) and other substances. This causes fluid to leak from the small blood vessels under the skin. When this fluid collects under the skin, it forms the blotches, which we call hives.

Why Do I Get Hives?

People can get hives for lots of different reasons. Often, the cause is not known. One common reason for getting hives is an allergic reaction. Some common allergic triggers are certain foods (like milk, shellfish, berries, and nuts), medications (such as antibiotics), and insect stings or bites. Other causes of hives are not related to allergies and these can include:

• exposure to the cold (like diving into a cold pool)
• exercise
• sun exposure
• nervousness or stress
• infections caused by viruses
• No matter what the cause, a case of hives can last for a few minutes, a few hours, or even days.

What Will the Doctor Do?

Doctors usually can diagnose hives just by looking at you and hearing your story about what happened. The doctor can try to help figure out what might be causing your hives, although often the cause will remain a mystery. If you’re getting hives a lot, or your reaction was serious, your doctor might send you to another doctor who specializes in allergies. Sometimes, doctors will suggest you take a type of medication called an antihistamine to relieve the itchiness. In many cases, hives clear up on their own without any medication or doctor visits. Less often, hives can be a sign of a more serious allergic reaction that can affect breathing and other body functions. In these cases, the person needs immediate medical care. Some people who know they have serious allergies carry a special medicine to use in an emergency. This medicine, called epinephrine, is given by a shot. Ordinarily, a nurse gives you a shot, but because some allergic reactions can happen really fast, many adults and kids carry this emergency shot with them and know how to use it, just in case they ever need it in a hurry.

Can I Prevent Hives?

Yes and no. The answer is “yes” if you know what causes your hives – the strawberries at the start of this article, for example. If you know they cause you trouble, you can just avoid them. If you get hives when you’re nervous, relaxation breathing exercises may help. But if you don’t know why you get hives, it’s tough to prevent them. Some kids get hives when they have a virus, such as a bad cold or a stomach flu. Other than washing your hands regularly, there’s not much you can do to avoid getting sick occasionally. The good news is that hives usually aren’t serious and you might even grow out of them. Who wouldn’t want to give hives the heave-ho? Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: October 2007

What is Influenza?

Influenza is an infectious illness caused by a certain family of viruses. Worldwide outbreaks of influenza occur each year, with young children being at high risk for infection. Influenza is highly contagious and can spread rapidly through communities, especially in places like schools and hospitals. Influenza can develop suddenly, and become quite severe. Although most children with influenza recover completely, there is a risk of further infection such as ear infections and pneumonia.

What does it look like?

The symptoms and severity of influenza depend on several factors, including the characteristics of the influenza virus that is being spread in your community. Illness may develop quite suddenly: within 2 or 3 days after your child is exposed to the influenza virus. Some common symptoms of influenza are:

• Fever and chills, usually lasting 2 to 4 days
• Dry cough, which may continue for a long time
• Sore throat
• Headache and muscle aches
• Runny nose and eyes
• Malaise; feeling sick
• Diarrhoea
• Other members of your family may be sick at the same time. Infants and young children may develop more severe symptoms, including high fevers.

What causes influenza?

Influenza is caused by a family of related viruses “going around” each year. Once your child has been exposed to a specific influenza virus, he or she will usually become immune to it. Because babies and young children have not been exposed to as many influenza viruses, they may be more likely to catch influenza.

What are some possible complications of influenza?

• Ear infections (otitis media) occur in up to one fourth of children with influenza.
• Pneumonia (infection of the lungs)
• Other complications such as myositis (inflammation of the muscles) or myocarditis (inflammation of the heart muscle) are possible, but uncommon

What puts your child at risk of influenza?

• Infants and young children are more likely to be infected with influenza virus and may have more severe symptoms
• Influenza is most common during the winter months
• Influenza is more likely to cause more problems in children with pre-existing health problems (such as heart disease, asthma, or cystic fibrosis).

Can influenza be prevented?

• Getting a yearly influenza vaccination (“flu shot”) can help prevent influenza. Currently influenza vaccination is recommended for all children between 6 months and 5 years old. It is also recommended for children with certain high risk diseases, such diseases of the heart and lungs (including asthma), cancer, or HIV or other conditions causing reduced immune function.
• Influenza vaccination is also recommended for adults who are in close contact with “high-risk” children, and for women who will be in second or third trimester of pregnancy during “flu season.” Ask your doctor whether your child, you, or other family members should get vaccinated.
• Certain antiviral drugs may be used to treat or prevent influenza in children and adults who have been exposed to influenza outbreaks at home, school or work.

How is influenza diagnosed and treated?

• Diagnosis is based on symptoms and whether a lot of cases are occurring in the community at the time. If necessary, tests on mucous from the nose and throat can be done.
• Make sure your child gets plenty of rest and drinks extra fluids.

What Is Meningitis?

Meningitis means inflammation of the membranes surrounding the brain and spinal cord called the meninges (pronounced: muh-nin-jeez). It often occurs when an infection elsewhere in the body spreads through the blood and into the cerebrospinal fluid (the fluid that circulates in the spaces in and around the brain and spinal cord). Although most cases of meningitis happen in kids age 5 and younger, and in 16- to 25-year-olds, people can get it at any age. There are several types of meningitis, and their severity and treatment can vary depending on which type a person has. Most cases of meningitis are caused by viruses (viral meningitis) or bacteria (bacterial meningitis), but fungi and other organisms can also cause infectious meningitis. Some cases of meningitis result from head injuries, certain cancers or other diseases, or reactions to medications.

What Are the Signs and Symptoms?

Viral and bacterial meningitis can cause similar symptoms. Although it may be difficult to identify which type a person has, a doctor can find out. Some symptoms of both viral and bacterial meningitis are:

• fever
• stiff neck
• severe headache
• sensitivity to light
• vomiting
• nausea
• extreme sleepiness
• confusion
• seizure

If you or someone you know has these symptoms – especially if you’ve been around someone with meningitis – be sure to talk to a doctor. Treating the infection early is very important.

Can It Be Prevented?

Washing your hands really well and often is one way to defend against meningitis and other infections. Although bacterial meningitis can seem scary, the chance of getting it is quite low. It’s most likely to happen in places where lots of people get together – like schools and college dorms. This is why doctors now recommend that teens who are about to go to high school or head off for college get vaccinated against meningococcal meningitis. Many colleges actually require their students to get meningitis vaccines. Depending on the type of vaccine a person gets, it can last between 3 and 10 years. It’s also sometimes recommended for people traveling to countries where meningitis is more common. There are also vaccines for some other types of meningitis. If you have a medical condition that affects your immune system, for example, a doctor may also recommend a vaccination against the S. pneumoniae type of bacteria. But vaccines don’t exist for all types of bacterial meningitis.

When to Call the Doctor

If you have meningitis symptoms, call your doctor right away. Early detection and treatment of meningitis is very important to avoid serious health problems. If you’ve been in close contact with someone who has bacterial meningitis, see your doctor, even if you have no symptoms. The doctor might prescribe antibiotics to help prevent you from getting the infection. A fast diagnosis can also keep the infection from spreading to others.

What Do Doctors Do?

To diagnose meningitis, a doctor may do a spinal tap, in which a small amount of the cerebrospinal fluid is removed and tested in a lab. If the meningitis is bacterial, this can help the doctor decide which type of antibiotic to prescribe. To find out more about the infection, sometimes the doctor will also do a brain scan (called a CT scan). Bacterial meningitis is treated in the hospital with intravenous antibiotics (for example, through an IV – a drip that delivers the correct dose of a medication directly into a person’s vein). Antibiotic treatment for bacterial meningitis may last for a couple of weeks, although a person may not need to spend the full time in a hospital. Lyme meningitis is usually also treated with IV antibiotics, although this can be done at home. Doctors may also prescribe corticosteroids to protect a person from hearing damage as a result of bacterial meningitis. If there are problems caused by the infection, the doctor will need to treat those problems, too. Sometimes people can have permanent brain damage from the disease – especially if it is not diagnosed and treated quickly – so if you have symptoms, it’s important to get checked out and treated right away. If the meningitis is viral, it usually goes away on its own (antibiotics are not effective in treating this type of meningitis because it’s not caused by bacteria). The doctor will recommend as much rest as possible to help the recovery. He or she may also recommend medication to help relieve any headaches or body aches

Disease Risk for Contacts of Individuals With Meningcoccal Disease

High risk: chemoprophylaxis recommended (close contact)

*Household contact: especially young children *Child care or nursery school contact during 7 days before onset of illness *Direct exposure to index patient’s secretions through kissing or through sharing toothbrushes or eating utensils, markers of close social contact during 7 days before onset of illness *Frequently slept or ate in same dwelling as index patient during 7 days before onset of illness

Low risk: chemoprophylaxis not recommended

*Casual contact: no history of direct exposure to index patient’s oral secretions (eg, school mate) *Indirect contact: only contact is with a high-risk contact, no direct contact with the index patient *Health care professionals without direct exposure to patient’s oral secretions

What is mononucleosis?

Mononucleosis (often called “mono”) is an infection caused by the Epstein-Barr virus. Signs of mono include fever, sore throat, headaches, white patches on the back of your throat, swollen glands in your neck, feeling tired and not feeling hungry.

How is mono passed?

Mono is not spread as easily as some other viruses, such as the common cold. The mono virus is found in saliva and mucus. It is usually passed from one person to another through kissing, although it may rarely be passed in other ways, such as coughing. Signs of mono usually develop 4 to 6 weeks after you’re exposed to the virus. Generally, people only get mono once. It’s most common among people 15 to 35 years old.

How is mono diagnosed?

Your doctor will probably first ask you some questions about your symptoms and then may do blood tests to confirm the diagnosis. One common test used to diagnose mono is called the Monospot test. Sometimes other blood tests are needed if the results of the Monospot test aren’t clear.

Does mono have any complications?

Sometimes. The main serious concern with mono is that the spleen will enlarge and even rupture (tear open). The spleen is like a large gland. It’s located in the upper part of your abdomen on the left side. It helps filter your blood. Although a ruptured spleen is rare in people with mono, it’s wise to be aware of the signs and call your doctor right away if you notice any of them. Signs of a ruptured spleen include pain in the left upper part of your abdomen (under the left chest), feeling lightheaded, feeling like your heart is beating fast and hard, bleeding more easily than usual and having trouble breathing.

Can mono be cured?

No. But mono will go away on its own. Symptoms usually last about 4 weeks.

How is mono treated?

The main point of treatment is to relieve your symptoms. The following list includes tips on treatment:

• Rest.
• Drink plenty of fluids.
• If you have a sore throat, gargle with salt water, or suck on throat lozenges, hard candy or flavoured frozen desserts (such as Popsicles).
• You may want to take acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names: Advil, Motrin, Nuprin) to relieve pain and fever. Do not give aspirin to children. Aspirin should be avoided because it has been associated with a disease called Reye’s syndrome in children. Reye’s syndrome is a serious illness that can lead to death.

Do I need an antibiotic?

Antibiotics like penicillin are of no help in mono. Mono is caused by a virus, and antibiotics don’t work against viruses. If you have a bacterial infection in addition to having mono, your doctor may give you an antibiotic.

What about sports and exercise?

Avoid sports, activities or exercise of any kind until your doctor tells you it’s safe. Moving around too much puts you at risk of rupturing your spleen. You need to avoid physical activities for about 3 to 4 weeks after the infection starts. Reviewed/Updated: 02/06 Created: 9/00 This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.

• Take antibiotics by mouth as prescribed. Be sure to complete the full course that the doctor prescribed.
• Use Phisohex soap if prescribed for bathing for 2 weeks. Rinse well. Do not use in children under 6 months of age.
• Wash hands thoroughly and frequently, for 20 seconds, in warm water and soap or Phisoderm (OTC).
• Add 1 tsp. Clorox to each gallon of bath water (not to be used on hair). Rinse tub well after each use.
• Apply Bactroban inside nostrils, to toenails, fingernails, and nicks or skin scratches, and the perianal area daily.
• Keep nails clean and cut short.
• Do not share personal items such as towels, wash cloths, or razors.
• Use fresh towels daily.
• Wash linens, blankets, stuffed toys, etc. in hot water and/or use a hot dryer.
• Adults may gargle with antibacterial mouthwash twice a day for two weeks.

Measures for preventing staphylococcal skin infections among sports participants

• Cover all wounds. If a wound cannot be covered adequately, consider excluding players with potentially infectious skin lesions from practice or competitions until the lesions are healed or can be covered adequately.
• Encourage good hygiene, including showering and washing with soap after all practices and competitions.
• Ensure availability of adequate soap and hot water.
• Discourage sharing of towels and personal items (e.g., clothing or equipment).
• Establish routine cleaning schedules for shred equipment.
• Train athletes and coaches in first aid for wounds and recognition of wounds that are potentially infected.
• Encourage athletes to report skin lesions to coaches and encourage coaches to assess athletes regularly for skin lesions.

ABCESS with Incision & Drainage

An abscess (sometimes called a “boil”) is a pocket of pus under the skin that starts when bacteria get trapped under the skin and begin to grow. This can occur with an infected hair root, oil gland, “pimple,” cyst, or puncture wound. Treatment of your abscess has required an incision to drain the pus. If the abscess pocket was large, a gauze packing has been inserted. This will be changed on your next visit. Antibiotics are not required in the treatment of a simple abscess, unless the infection is spreading into the skin around the wound (known as “cellulitis”). Healing of the wound will take about one to two weeks depending on the size of the abscess.

Home Care:

The wound should be kept covered with a dry sterile bandage. If the dressing becomes soaked with blood or pus, change it. You may be advised to soak or irrigate the wound. Follow your doctor’s instructions and reapply a sterile dressing. If you were prescribed antibiotics, take them as directed until they are all gone. Follow up with your doctor as advised by our staff. If a gauze packing was inserted in your wound, it should be removed in 1-2 days. If no packing was used, and you were not given a specific follow-up appointment, look at your wound every day for the signs listed below.

Return promptly or contact your doctor if any of the following occur:

• Increasing redness around the wound.
• Red streaks in the skin leading away from the wound.
• Increasing local pain or swelling.
• Fever over 100.0 oral

What causes nosebleeds?

The purpose of the nose is to warm and humidify the air that we breathe in. The nose is lined with many blood vessels that lie close to the surface where they can be injured and bleed. Once a vessel starts to bleed, the bleeding tends to recur since the clot or scab is easily dislodged. Nosebleeds, called epistaxis, can be messy and even scary, but often look worse than they are. Many can be treated at home, but some do require medical care.

Common causes of nosebleeds include:

• Dry, heated, indoor air, which dries out the nasal membranes and causes them to become cracked or crusted and bleed when rubbed or picked or when blowing the nose (more common in winter months)
• Dry, hot, low-humidity climates, which can dry out the mucus membranes
• Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and nose blowing
• Vigorous nose blowing or nose picking
• The insertion of a foreign object into the nose
• Injury to the nose and/or face
• Allergic and non-allergic rhinitis (inflammation of the nasal lining)
• Use of drugs that thin the blood (aspirin, non-steroidal anti-inflammatory medications, warfarin, and others)
• High blood pressure
• Chemical irritants (e.g., cocaine, industrial chemicals, others)
• Deviated septum (an abnormal shape of the structure that separates the two sides of the nose)
• Tumors or inherited bleeding disorders (rare)
• Facial and nasal surgery

How are nosebleeds stopped?

Follow these steps to stop a nosebleed: Relax

• Sit down and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause nausea, vomiting, and diarrhoea. (Do NOT lay flat or put your head between your legs.)
• Breathe through your mouth.
• Use a tissue or damp washcloth to catch the blood.
• Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop bleeding.
• Keep pinching your nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
• You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then hold apply pressure to the nose as described above.

WARNING: These topical decongestant sprays should not be used over the long term.

• Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy; and DO NOT blow, rub, or pick your nose for several days.

Under what conditions should I seek physician or emergency care?

Seek medical care through your physician or an emergency room if:

• You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure.
• You experience repeated episodes of bleeding.
• The bleeding is rapid or the blood loss is large (exceeds a coffee cupful).
• The bleeding was caused by an injury, such as a fall or other blow to the nose or face.
• You feel weak or faint.
• The blood goes down the back of your throat rather than out front through the nose even though you are sitting down with body and head leaning slightly forward. (This may indicate the rarer, but more serious, “posterior nosebleed,” which almost always requires a physician’s care. This condition occurs more frequently in older people and individuals with high blood pressure).

Call your physician if:

• You get nosebleeds often.
• You get a nosebleed that seems to have occurred with the start of a new medication.
• You get nosebleeds accompanied by unusual bruising all over your body. (This combination may indicate a more serious condition and will need to be investigated by your doctor.)

Follow the instructions for P.R.I.C.E.

Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to crutches. Rest the injured limb. But don’t avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you can use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning. Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to apply ice as soon as possible after the injury. If you use ice, be careful not to use it for too long, as this could cause tissue damage. Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best. Elevate the injured limb whenever possible to help prevent or limit swelling. After the first two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) may be helpful to manage pain during the healing process.

Get emergency medical assistance if:

• You heard a popping sound when your joint was injured, you can’t use the joint, or you feel unstable when you try to bear weight on the joint. This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
• You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
• You have a severe sprain. Inadequate or delayed treatment may cause long-term joint instability or chronic pain.
• You aren’t improving after the first two or three days.

Swimmer’s Ear (Otitis Externa)

Causes of Swimmer’s Ear Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but since the cause of the infection is water trapped in the ear canal, bathing or showering may also cause this common infection. When water is trapped in the ear canal, bacteria that normal inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection progresses, it may involve the outer ear.

Symptoms of Swimmer’s Ear

The most common symptoms of swimmer’s ear are mild to moderate pain that is aggravated by tugging on the auricle and an itchy ear. Other symptoms may include any of the following:

• Sensation that the ear is blocked or full
• Drainage
• Fever
• Decreased hearing
• Intense pain that may radiate to the neck, face, or side of the head
• The outer ear may appear to be pushed forward or away from the skull
• Swollen lymph nodes

Treatment of Swimmer’s Ear

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and ear drops that inhibit bacterial growth. For more severe infection, antibiotic drops are needed, sometimes with ear wick. Pain medication may also be prescribed.

Prevention of Swimmer’s Ear

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Removable ear plugs, sometimes worn for hearing protection, can be used to keep moisture out of the ear canal. Q-tips should not be used for the purpose, because they may pack material deeper into the ear canal, remove protective ear wax, and irritate the skin of the ear canal creating the perfect environment. The safest way to dry your ears is with a hair dryer. If you do not have a perforated eardrum, rubbing alcohol or a 50:50 mixture of alcohol and vinegar used as eardrops will evaporate excess water and keep your ears dry.