Clarithromycin is an antibiotic used to treat many different types of bacterial infections in children. You might see a brand name such as Biaxin on the label. It comes as liquid, tablets, or extended release tablets.

The extended release tablets should be taken with food, but the other forms are fine to take either way. If you find it upsets the stomach, taking it with food may help. Clarithromycin should be taken at least two hours before any antacids that contain magnesium or aluminum, because these can interfere with the absorption of the antibiotic.

Liquid clarithromycin should be shaken before giving each dose. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). It may be stored at room temperature. Do not keep the liquid in the refrigerator. Discard any unused clarithromycin 14 days after it was first prepared by the pharmacist.

Clarithromycin is a recommended first antibiotic for some children with ear infections who are allergic to amoxicillin. It is usually given twice daily, but the extended release form may be given once daily.

If your child is taking clarithromycin for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to another antibiotic, such ceftriaxone or clindamycin.

Do Not use clarithromycin if your child is known to be allergic to this or to any similar antibiotics such as azithromycin or erythromcyin. Other antibiotic options might include ceftriaxone, or clindamycin. Be sure the prescribing doctor knows if your child has any other medication allergies, or has kidney disease, liver disease, or a heart rhythm problem. Be sure to report any other medicines your child might be taking.

Diarrhea is a common side effect of antibiotics. Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

^{AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.
Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.}

Pizza, macaroni, breads, crackers, cereals, and spaghetti are among many children’s favorite foods. These foods and many others can be sources of gluten (protein found in wheat, rye, and barley). When some children eat gluten-containing foods, their bodies mistake the grain protein for a foreign invader and launch an attack on the protein, damaging the lining of the intestines in the process. This condition is called celiac disease.

Although only about 1 in 2000 or 2500 people have been diagnosed with celiac disease, a study published in the June 19, 2003 issue of the New England Journal of Medicine suggests that the condition is far more common than previously thought. In this study, apparently healthy children were tested for celiac disease. How common was undiagnosed celiac? Shockingly, 1 in 99 children tested positive for celiac disease, making it quite a common condition.

Some children with celiac have severe symptoms, such as failure to thrive, vomiting, diarrhea, and muscle wasting. Many children, however, have only subtle symptoms, such as clinginess, tiredness, or irritability. Some have only skin rashes.

Because celiac disease is now known to be so common, I am in favor of testing children who have unexplained tummy or intestinal troubles, skin rashes, slow growth, or behavioral problems. Often children who have celiac disease (and their parents) have been miserable for years before the child is tested.

When the test becomes inexpensive enough, it might be wise to routinely test children for celiac disease to prevent long stretches of time before starting the celiac diet and letting the child know what it feels like to feel comfortable, healthy, and strong.

Related concepts:

Chronic Urticaria, Urticaria, Welts, Wheals

What is hives?

Hives are a sign that the whole body is experiencing a hypersensitivity reaction. Hives occur when the body’s capillaries and tiny veins get leaky. Fluid escaping from some of these blood vessels becomes trapped in parts of the skin and lining membranes of the body, causing localized swelling.
This leakiness can be caused by classic allergic reactions in which histamine triggers an inflammatory response. It can also be caused by a number of other regulatory systems in the body in response to different types of triggers.
The most common allergic triggers are drugs, especially antibiotics; foods, especially fish, shellfish, nuts, peanuts, eggs, berries, and food additives; infections (which we’ll discuss below); insect bites or stings; inhalants such as animal danders, pollens, and molds; and contact allergens like plant substances, skin creams, cat scratches, moth scales, or animal saliva. In college I had a pet tarantula for a while and some of my friends got hives from petting her hairy abdomen.
There are also a number of distinct physical causes of hives (known as urticaria in doctor-speak):

• Cold urticaria – the most common of the physical causes. These hives are triggered by exposure to cold water or air. This would be a good excuse to avoid swimming in cold pools (something my kids love for me to do).
• Dermatographia — hives that appear where the skin is firmly stroked. (Named because you can write on someone’s skin by raising welts where your finger traced). This occurs in about 5% of people (and many more if you repeatedly stroke hard enough).
• Pressure urticaria — hives that appear under tightly fitting clothing or jewelry. Unlike dermatographia, which occurs in seconds, this can appear many hours later, obscuring the cause.
• Cholinergic urticaria — hives that occur in response to heat, exercise, or emotional stress. This usually doesn’t begin before adolescence.
• Aquagenic urticaria — hives that are triggered by contact with sweat or with water. In these people, exercise itself is not a trigger, and they can drink water without a problem.
• Solar urticaria — a rare disorder in which sun exposure results in hives. Sunscreen can help!

I mentioned earlier that infections could trigger hives. We know that some parasites can be responsible for hives (including giardia and pinworms, which are common in day care settings). We also know that bacterial infections, most notably Strep, can be the culprit. Viruses of many types can trigger hives as well.
Over 70 percent of the time, no specific cause is found when children have hives. They were hypersensitive to something, but no one discovers what, and the hives go away. Doctors think that most of these unidentified cases may be from viruses, which would make them the most common cause of hives. This is particularly likely when there is a cluster of cases (although molds, animals, foods, parasites, etc. could also be responsible for clusters).

Who gets hives?

About 20 percent of people will experience hives at some point in their lives. Those who have known allergies or a family history of allergies are more likely to get hives. All other things being equal, girls are more likely to get them than boys.

What are the symptoms of hives?

Wheals or welts come and go on the skin or mucous membranes. These may itch intensely, itch only a little, or not itch at all.
Each typically has a whitish, raised patch of skin surrounded by a reddish halo. The welts may be tiny or large, and may be all over the body or confined to one area.

Is hives contagious?

Hives themselves are not contagious, but the triggers of hives, especially viruses, bacteria, and parasites, may be contagious.

How long does hives last?

The individual welts often disappear quickly and are usually gone within 48 hours, although new ones may continue to appear for days or weeks. If new hives keep occurring for six weeks, this is called chronic Urticaria.

How is hives diagnosed?

Usually hives can be diagnosed based on the history and physical examination. Sometimes specific allergy testing or testing for infection is needed to look for the underlying cause.
Chronic urticaria is usually not serious, but can be a sign of an underlying disease process. Children with chronic hives should have a thorough physical exam and lab work just to be sure there are no underlying illnesses. They are sometimes referred to an allergist for further workup and care.

How is hives treated?

Hives are usually treated with an antihistamine, such as Benadryl or the prescription Atarax. If drowsiness is a problem, one of the newer, non-sedating antihistamines may be a better choice. Sometimes antihistamines are coupled with a histamine H2 blocker, such as cimetidine, for a more powerful effect.
A variety of stronger treatments are available, but are usually unnecessary. If there are other allergic symptoms, such as wheezing or tightening of the throat, then a shot of epinephrine may be needed.
Hives can be quite uncomfortable. I remember getting hives after being stung by a jellyfish, and I couldn’t sleep without Benadryl for several nights. I discovered that distraction can sometimes help with the itching. This is one situation where videos and kid’s cassettes might be a real boon. And don’t forget to add an extra hug or two.

How can hives be prevented?

The best way to prevent another bout of hives is to identify your child’s triggers and avoid them. If you know in advance that your child will be exposed to a trigger, a preventive dose of antihistamine can prevent or minimize the hives.

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Arboviruses, CMV (Cytomegalovirus), Coxsackievirus, Eczema, Enteroviruses

Related concepts:

Food hypersensitivity, Oral allergy syndrome, Allergic proctocolitis

Introduction to food allergies:

Many parents of infants and toddlers are told that food allergies don’t happen that young, or that they are very rare. We’ve learned that food allergies certainly do happen and that they are common – affecting about 1 in 18 children before the 3rd birthday.

What are food allergies?

Food allergy is the name given to a variety of situations in which specific foods provoke some type of over-zealous immune response, which produces symptoms.
Because the developing immune system is quite complex and has mechanisms to protect us from what we swallow, food allergies are also complex, and can result from a variety of different mechanisms and cause a variety of symptoms.
Celiac disease is an immune response to gluten – proteins found in wheat and other grains.
Lactose intolerance is not a food allergy. A missing enzyme makes milk difficult to digest, creating gas and loose stools. And the flushed cheeks that some children get when eating citrus or tomatoes are not usually an allergy.

Who gets food allergies?

Food allergies are common, especially in the first 3 years of life. They are more common in those with a family history of food allergies, or in those with a broader allergic family history (allergy, eczema, or asthma).
Food allergies are also more common in babies who are exposed to allergic foods at an early age. About 90 percent of food allergies in babies and children are to one of 5 foods: cow’s milk, soy, eggs, peanuts, or wheat.
Most children with food allergies have an allergy to only one food, although multiple allergies are possible. A sizeable minority of those allergic to cow’s milk are also allergic to soy.

What are the symptoms of food allergies?

Food allergy can be so severe that the most trivial contact with the food causes immediate itching, tingling, and/or swelling of the lips, tongue, and throat.
A food allergy can trigger full-blown anaphylactic shock. Most life-threatening food allergies are to peanuts, nuts, shellfish, or fish.
Usually the symptoms of food allergy are much more mild. Still, babies with food allergies may well be fussier than their peers. Colic can be caused by food allergies (either to the formula or to a food in the mother’s diet).
Gastrointestinal symptoms are often the easiest to recognize. A food allergy might cause loose stools, excess gas, diarrhea, nausea, or vomiting. Infants will sometimes have streaks of blood or mucus in the stools, especially with allergies to cow’s milk. Sometimes the amount of blood is too small to see, but still enough to cause anemia. Sometimes food allergies cause constipation.
Symptoms elsewhere in the body are also common. These include hives, ear infections, stuffy noses, runny noses, watery or red eyes, wheezing, asthma flare-ups, and eczema. Sometimes eczema (or fussiness) is the only sign of a food allergy, and the eczema (or fussiness) will disappear if the offending food is eliminated.

Is food allergies contagious?

Food allergies are not traditionally contagious.

How long does food allergies last?

Most young children outgrow their food allergies. Outgrowing milk and soy allergies is common by the 1st birthday. The great majority have outgrown them by the time they are 3. Even those who still have food allergies at 3 will often outgrow them, especially if they are not exposed to the offending foods for a year or two.
Some food allergies, however, are lifelong. Allergies to peanuts, nuts, shellfish, and fish are classic examples.

How is food allergies diagnosed?

Food allergies might be diagnosed when eliminating a food improves symptoms and reintroducing the food causes the symptoms to recur.
Allergy testing can also be helpful. Skin testing and RAST testing can both be used to detect food allergies. In babies, a positive result is usually a sign of a real allergy, but a negative result doesn’t give much information either way.
In preschool kids, the opposite is true. A negative result is a good indication that a child is not allergic to the food. A positive result, however, may or may not represent an allergy.
Also, many people think that having been allergy tested once tells the whole story. Allergy testing is a snapshot in time. Allergies themselves are a moving picture. Repeat allergy testing is very helpful.

How is food allergies treated?

Eliminating the offending food is the core of treatment. This can be difficult because some foods occur as hidden ingredients in many other foods. Usually symptoms will improve greatly within 3 days of eliminating the food that causes them.
Breastfeeding is wonderful for babies with food allergies. Sometimes, however, offending foods are best removed from the mother’s diet. When a baby with a cow’s milk protein allergy is fed formula, it often needs to be a protein hydrolysate formula. Lactose-free formulas and partial hydrolysate formulas do not help with real milk allergies.
If food allergies cause wheezing or other respiratory symptoms, an allergist should be involved in the care. If necessary, parents should have access to emergency medications.

How can food allergies be prevented?

Breastfeeding can prevent many food allergies. This is especially true if the mother forgoes some of the most allergic foods (especially peanuts and perhaps milk or eggs). On a positive note, mothers who eat beneficial bacteria, as in yogurt, while pregnant and nursing may help prevent food allergies.
Delaying the introduction of solid foods until the latter part of the acceptable window may prevent some allergies. Delaying particularly allergic foods even longer can further reduce the risk of allergies.

Related A-to-Z Information:

Allergies (Allergic Rhinitis), Anemia (Low hemoglobin), Asthma, Attention Deficit Hyperactivity Disorder (ADHD), Blocked Tear Duct, Celiac Disease, Colic, Common Cold, Conjunctivitis (Pink eye), Constipation, Cough, Croup, Diaper Rash, Diarrhea, Ear Infection, Enuresis, Food Poisoning, Galactosemia, Gastroenteritis, Gastroesophageal Reflux, Giardia Lamblia, Head Banging, Headache, Hives, Otitis Media with Effusion (OME), Peanut Allergy, Poison Ivy, Oak, and Sumac, Pyloric Stenosis, Reye Syndrome, Rotavirus, Sinusitis, Vomiting, Wheezing