Note: Dr. Greene works with Scanadu, a participatory medical device company that is currently running an exciting Indiegogo campaign for Scanadu Scout, the first Medical Tricorder.

The first generation of medical students that went to medical school with smartphones in their pockets is still in training. They’ve just finished their second year of residency and they’re accustomed to having the world’s medical literature at their fingertips. So are their patients.

Access to information about medical conditions is now so easily available that it’s hard to remember that this is a new phenomenon. In the early 1990’s neither clinicians nor patients could easily look up a condition online. And many medical libraries wouldn’t even allow patients to visit.

Today this would be unthinkable. And I’ve met people on the streets of Kolkata with access to more medical information than the US Surgeon General used to have just a few years ago.

But…

Most people today do not yet have easy access to their own body’s specific health information. Much of this valuable stream of health data is never collected nor recorded. And most clinical data that is recorded ends up in clinical labs or medical records – not in people’s hands, not in people’s pockets. Tomorrow this will be unthinkable. A tectonic change is afoot.

Access to one’s own bank accounts and credit card statements allows better managing of personal finance. Access to the body’s changing parameters allows a new level of engagement in one’s health.

Three examples:

1)     The temperature fingerprint

People often think the normal human body temperature is 98.6⁰F. But 98.6 is a population average – and not even an accurate average. Each person has their own average temperature and their temperature cycles throughout the day. For me, 99⁰F at 4 o’clock in the afternoon is normal; the exact same temperature at 4 o’clock in the morning is a fever (>two standard deviations from my normal).

Easy access to one’s own temperature curves and how they change over time provides early information about the onset of illnesses, the progress of illness, fertility, changes in cardiovascular fitness, and changes in the circadian rhythm and sleep quality.

2)     The flu window

The big decisions about flu are best made in the first 48 hours of illness. Anti-viral treatment is most effective if started early. Stopping the spread of influenza is easiest if people with who have it are identified early.

But today, people must still engage the medical system to learn if they have the flu. A test requires a clinician’s orders and a visit to an office or a lab. Many people with flu are never diagnosed; many of those that are, miss the 48-hour window. What would the world be like if barriers to access to data about one’s own body were eliminated?

3)     The blood pressure bonanza

Over a billion people have high blood pressure. For those who do, controlling it could be the single most important thing they do to add healthy years to their lives. A healthy blood pressure adds brain-years (through reduced risk of stroke and dementia), adds heart-years (through reduced risk of heart attacks and heart failure), and adds years of sexual pleasure (through reduced risk of erectile dysfunction).

But today, perhaps 20 percent of people with high blood pressure don’t even know this basic data about their own body. And for those who do? Most don’t have it under control. They know they have hypertension, but don’t know how their own body responds to various everyday activities. Does having a drink raise or lower their blood pressure? How about 3 drinks? How does exercise affect their numbers? Or a massage? What does their blood pressure look like the afternoon after a fast-food lunch? A fresh salad? What’s the impact of medications?

Health-saving data is squandered because it is too cumbersome to collect and analyze.

Soon it will be hard to remember navigating life with so little information about our own bodies (like life before MapQuest). Data in hand is worth far more than data locked in the system.

Amoxicillin is an antibiotic used to treat many different types of bacterial infections in children. It does not help in viral infections such as a cold or flu. It’s often called “the pink stuff” or “the bubblegum-tasting one” by children. You might see a brand name such as Trimox, Moxatag, or Amoxil on the label. This common antibiotic comes as liquid, chewable tablets, regular tablets, and capsules. Any form can be given with or without food.

Liquid amoxicillin should be shaken before giving each dose. It’s fine to give the amoxicillin directly or to mix the medicine with another liquid if you’re fairly sure your child will drink it all. 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). Store it in the refrigerator between doses. It should not be allowed to freeze. Discard any unused amoxicillin 14 days after it was first prepared by the pharmacist. It may last only 7 days if stored at room temperature.

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.

Amoxicillin is the recommended first choice antibiotic for most children with ear infections. When used to treat ear infections, the recommended dose is about 36 to 41 mg per day for each pound that the child weighs, up to a maximum of about 1500 to 1750 mg per day. This is much higher than the dose used for most other infections in children. The total daily dose is divided into two or three doses per day.

If you happen to miss a dose, you can go ahead and give it late – but try not to do two doses within about three hours of each other. If you happen to give too much at once (more than two doses), seek medical advice.

If your child is taking amoxicillin for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to a stronger antibiotic, such as amoxicillin-clavulanate or ceftriaxone.

Do Not use amoxicillin if your child is known to be allergic to this or to any of the penicillin-type antibiotics.

Depending on the type of allergy, other antibiotic options might include cefdinir, cefuroxime, azithromycin, or clarithromycin. Sometimes a non-itchy rash is a side effect of taking amoxicillin, and not an allergic reaction. If your child has had a rash with amoxicillin, discuss this possibility with your doctor.

Be sure the prescribing doctor knows if your child has any other medication allergies, or has mono, asthma, liver or kidney disease, or a bleeding problem. Be sure to report any other medicines your child might be taking. 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. Black hairy tongue, a fairly common temporary side effect of amoxicillin, is not an allergic reaction.

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.

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.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.

Amoxicillin-clavulanate is a strong combination antibiotic used to treat many different types of bacterial infections in children. The clavulanate makes it difficult for some resistant bacteria to withstand the amoxicillin, resulting in a very powerful antibiotic. Nevertheless, it does not help in viral infections such as a cold or flu.

This common antibiotic comes both as liquid and as chewable, regular, or extended release tablets. You might see a brand name such as Augmentin on the label. Different forms contain different proportions of clavulanate and aren’t simply exchangeable with each other at the same dose of the amoxicillin portion (e.g., a 400 mg tablet is not the same dose as 400 mg of liquid).

No matter which form of amoxicillin-clavulanate you use, it’s usually best to take the medicine at the start of a meal to reduce stomach upset. The tablets also should be taken with a full glass of water. The chewables should be chewed thoroughly before swallowing; the other tablets should not be chewed so that the medication is released in the body at the appropriate rate.

Liquid amoxicillin-clavulanate 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). Store it in the refrigerator between doses. It should not be allowed to freeze. Discard any unused amoxicillin-clavulanate 10 days after it was first prepared by the pharmacist.

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).1 Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Amoxicillin-clavulanate is the recommended first choice antibiotic for most children with severe ear infections who have high fevers and/or severe ear pain. It’s also recommended for most children with ear infections whose first antibiotic didn’t improve the symptoms within 48 to 72 hours.²

If you happen to miss a dose, you can go ahead and give it late – but try not to do two doses within about four hours of each other. If you happen to give too much at once (more than two doses), seek medical advice.

If your child is taking amoxicillin-clavulanate 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 as ceftriaxone.

Do Not use amoxicillin-clavulanate if your child is known to be allergic to clavulanate, to amoxicillin, or to any of the penicillin-type antibiotics. Depending on the type of allergy, other antibiotic options might include ceftriaxone or clindamycin. Sometimes a non-itchy rash is a side effect of taking amoxicillin, and not an allergic reaction. If your child has had a rash with amoxicillin, discuss this possibility with your doctor.

Be sure the prescribing doctor knows if your child has any other medication allergies, or has mono, asthma, liver or kidney disease, or a bleeding problem. Be sure to report any other medicines your child might be taking.

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. Black hairy tongue, a fairly common temporary side effect of amoxicillin, is not an allergic reaction.

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.

Dr. Greene`s Answer:

My favorite recipe for a cold (if he’ll drink it) is 2 cups of water combined with the juice of one lemon, zest from half that lemon, 1/8 tsp. cayenne pepper, 2 cloves of chopped garlic, an inch of chopped fresh ginger, and honey to taste. Bring it to a boil, pour through a strainer, and drink it hot. All of these ingredients have proven natural anticold properties.

The cold virus lives best at 98.6 degrees, so raising the temperature in the throat and nose can help. Drinking lots of hot tea and chicken soup and breathing in steam can help. Salt makes it more difficult for the cold virus to replicate–another good reason for chicken soup, which is often loaded with sodium. Some canned soups have more salt than salt water. Acid is also tough on the cold virus, which is why lemons and tea are a great idea. Honey helps as well, but shouldn’t be used in children under 1 year of age due to the risk for botulism.

Related concepts:

Rhus dermatitis, Contact dermatitis

Related concepts:

Respiratory syncytial virus

Introduction to RSV:

Very few things are more frightening than watching a small baby struggle to breathe. What is just a common cold to an adult can be a major threat for some small babies.

What is RSV?

RSV, or respiratory syncytial virus, is the most important respiratory infection of early childhood. The virus lives inside the cells lining the respiratory system, causing swelling of this lining coupled with the production of large amounts of excess mucus.
In adults, this shows up as a bad, lingering cold with thick nasal congestion and a deep, productive cough. In infants, however, the excess mucus can be enough to plug their small airways or bronchioles, resulting in a severe illness that requires hospitalization. RSV is the most significant cause of bronchiolitis and pneumonia in babies and young children.

Who gets RSV?

Almost all children have had RSV by the time they are two years old. Children who first get it under 6 months of age (or who have serious underlying illnesses) are at the highest risk for severe disease. Thankfully, severe RSV infection is very uncommon in the first 6 weeks of life, because these babies still have antibodies from their mothers.
RSV occurs throughout the world, and in each location, it tends to occur in yearly winter outbreaks. In the northern hemisphere, the peak of the epidemic is usually in January, February, or March, although in some years it may begin earlier and/or end later. Although most babies have mild illness, almost 125,000 infants are sick enough to be hospitalized with RSV each year in the United States.

What are the symptoms of RSV?

Typically, a parent, or more likely an older sibling, comes down with a bad cold first. He or she exposes the baby to the virus. The time from exposure to illness is usually about 4 days, give or take a few.
Then the infant typically develops a runny nose and a red throat. Over the next 3 days or so, the infant gets sicker. Symptoms might include cough, wheezing, and sometimes a fever or an ear infection. In most infants, this is as severe as RSV gets.
Some, though, will get progressively sicker with fast respirations (>60 per minute), difficulty breathing, and listlessness. About 3 percent of infected infants get sick enough to require hospitalization.
The specific symptoms will depend on the specific child and on the parts of the respiratory tract infected (croup, bronchitis, bronchiolitis, pneumonia, etc.). In very young babies, less than a month old, the only symptoms might be poor feeding, irritability, or perhaps lethargy.

Is RSV contagious?

RSV is very contagious. The disease spreads when infected droplets in the air or on the hands encounter someone else’s mouth or nose. It has never been shown to be passed from someone standing as far as 6 feet away. It can remain on the hands for half an hour, and on fomites for hours.

How long does RSV last?

The disease usually lasts 5 to 12 days. Most who are hospitalized are well enough to go home within a few days.
Children who are sick enough to come to medical attention and be diagnosed with RSV have an increased chance of having recurrent wheezing later in life. This is even more likely if the child has eczema or if there is asthma in the family. The older a child is (over the age of 1) with severe RSV, the higher the likelihood that the child eventually will be diagnosed with asthma.
A simple blood test can predict which children are most likely to go on and develop asthma. In one study of children sick enough to be hospitalized with RSV, those who had a high eosinophil count had a 56 percent chance of later developing asthma. The others with severe RSV had only a 22 percent chance.
While RSV and asthma certainly go together, even with severe RSV and a high eosinophil count, there is a good chance of avoiding asthma altogether.
It is not known whether the virus damages the respiratory system thereby causing the asthma, or if people’s susceptibility to asthma predisposes them to severe RSV. I suspect that it is a little of both.

How is RSV diagnosed?

Rapid RSV tests are available, and are done using nasal swabs.

How is RSV treated?

There are no specific medicines for treating RSV at home. It is important to give plenty of fluids to prevent dehydration. Also, a humidifier or saline nose drops might be recommended to thin the mucus.
Some children need supplemental oxygen or even mechanical help to breathe. A powerful aerosol treatment specifically against RSV is sometimes used for hospitalized children.
Steroids and antibiotics are not usually helpful.

How can RSV be prevented?

If possible, protect your baby from exposure to sick individuals during the peak RSV season. In addition, good hand washing, particularly just before anyone handles susceptible infants, can decrease spread. Use a tissue when you cough or sneeze!
Two products are now available to prevent RSV infection in children at high risk for serious disease (e.g., infants with a history of prematurity, cardiac defects, and lung disease). RSV-IGIV (RespiGam) and palivizumab (Synagis) have been approved for high-risk children.

Related A-to-Z Information:

Asthma, Bronchiolitis, Common Cold, Contact Transmission, Cough, Croup, Cystic Fibrosis, Dehydration, Droplet Transmission, Ear Infection, Fomites, Pneumonia, Respiratory Distress, Sinusitis, Sudden Infant Death Syndrome (SIDS), Tonsillitis, Wheezing

Related concepts:

Whooping cough, Bordatella pertussis

Introduction to pertussis:

I stood outside the closed door of the hospital room where an adorable 6-week-old baby lay all alone in her crib. As I scrubbed my hands in the sink outside the isolation room, an electronic monitor allowed me to hear her breathing peacefully.
Suddenly the quiet was shattered by a fit of coughing. And she couldn’t stop. The coughs came so closely together that she couldn’t catch her breath. I grabbed a mask from above the sink and, pressing it over my face, entered her room. The coughing continued. The pulse and oxygen monitor at her bedside complained insistently that her blood-oxygen levels were dropping. The EKG monitor sounded an alarm that her heart rate was dropping too. And she continued to cough. Even before I reached her bedside, I could see that her face was turning blue. She began to vomit.
Moments later the peace had returned. Her various monitors beeped tranquilly. The coughing spasm was over. This little girl with pertussis survived, but she had many more weeks of coughing spasms before she could return home to her parents.

What is pertussis?

Pertussis is caused by bacteria that attach themselves to the cilia (little hairs) that line the respiratory tract. These bacteria produce a potent toxin that inflames the respiratory tract and prevents the cilia from functioning properly. The disease can be serious or fatal in infants and unimmunized children. It is much milder in teens, adults, and in immunized children, but it can still be a real nuisance. As you might guess, it can be far worse in people with asthma or with immune deficiencies.

Who gets pertussis?

I have spoken with many parents who believed that pertussis was a disease of the past. Nevertheless, pertussis is a common cause of chronic cough illness in adults and older children. A study published in the June 15, 2001 issue of Clinical Infectious Diseases found that pertussis was the cause of chronic cough in 19.9 percent of the patients studied.
For healthy teens and adults, this is usually nothing more than a long nuisance (lasting months, sometimes with vomiting). For unimmunized babies and those at high risk, pertussis can be severe or even life-threatening.
Pertussis, or whooping cough, which once ravaged children around the world, is again on the rise. Worldwide, about 300,000 people die from pertussis each year. Serious disease is uncommon where immunization rates are high. Still, about 1 out of every 200 babies who get pertussis in the US will die from it. Another 1 out of every 200 will have lifetime brain damage. As many as 2 percent will have seizures, 22 percent will get pneumonia, and most (even in this modern era of reduced hospitalization) will be sick enough to be hospitalized. (Red Book Online,2009)
Pertussis is found only in humans.

What are the symptoms of pertussis?

Classically, people with pertussis go through four stages:

1. Incubation. For 5 to 21 days after exposure (usually 7 to 10 days), there are no symptoms at all while the bacteria multiply.
2. Prodrome. For the next 1 to 2 weeks, pertussis is not unlike a cold. People have runny noses, sneezing, and perhaps a low-grade fever. A mild cough begins that gradually worsens.
3. Paroxysms. The worst part of the illness lasts from 1 to 6 weeks. Spasms or attacks of coughing may come up to 15 times per day. Sometimes, especially in children, the cough is followed by a “whoop” noise as they breathe in rapidly, attempting to get air. Even so, young infants will often turn blue with the spells from lack of oxygen. The coughing spasms can make it difficult to eat, drink, or breathe. The mucus is often thick and sticky. Gagging, choking, and vomiting are common. Sometimes young infants will stop breathing for varying lengths of time between coughing spasms.
   This stage of pertussis is much milder in adults, teens, older children, and immunized children. Often an older child will just report a nagging cough for a month or more. Sometimes they hack up mucus with the cough. Sometimes the cough comes in fits. Once or twice, they might cough until they vomit. Otherwise, they feel pretty well — they just can’t seem to shake the cough.
4. Convalescence. As if this disease were not already long enough, the cough continues for another 2 to 4 weeks, but gradually becomes less severe and less frequent. Even after the cough seems finally over, the spasms often recur briefly for the next several months, especially during colds and during exertion.

Is pertussis contagious?

Pertussis is contagious through close contact via respiratory tract secretions.
You or your child have been exposed if you spend a total of 5 hours (over a week) in the same room with someone with the disease, if you sit next to someone with pertussis for any length of time, or if you have any contact at all with infected mucus or saliva. Between 70 and 100 percent of susceptible people will catch pertussis if they are exposed.
Currently, most adults and teens are susceptible because the protective effect of their childhood pertussis immunizations has waned. To address this problem, it is now recommended that all teens receive a booster vaccine at 11-18 years of age (preferably between 11-12 years).
Most infants are protected after the first 3 doses of vaccine, but this protection begins to disappear when they are toddlers. After the 4th immunization at 18 months old, 80 percent are protected for the next 3 to 4 years. The 5th dose, at kindergarten entry, protects them for another few years.
A booster dose is recommended during the teen years to bolster immunity to pertussis.

How long does pertussis last?

Pertussis lasts for weeks or months. It has been called the 100-day cough. People remain contagious until they have been on a pertussis antibiotic for 5 days, or until they have been having coughing spasms for 21 days.

How is pertussis diagnosed?

According to the Centers for Disease Control and Prevention, people are considered to have pertussis if they have a cough lasting for at least 14 days (with no other confirmed cause) and any one of the following symptoms (even if they have been immunized):

• Coughing spasms or fits (coughs coming in clusters)
• A whooping noise while breathing in
• Vomiting caused by a cough

The case is called confirmed pertussis if there is a positive lab test or if there has been exposure to someone with a positive lab test.
During a pertussis outbreak, anyone who has a cough lasting at least 14 days (with no other known cause) probably has pertussis, even in the absence of other specific symptoms.
The lab tests to detect pertussis are either slow, cumbersome, not readily available, or often fail to pick up the disease. For this reason many physicians rely on the working definition of pertussis. Also, the number of proven cases reported to the health department vastly underestimates the number of cases in the community.

How is pertussis treated?

Babies younger than 6 months, and all others with potentially severe disease, are likely to need care in a hospital, or even a pediatric ICU.
Several of the medicines used in asthma are often used to help control the cough.
In addition, pertussis is treated with an antibiotic. Unless the antibiotic is given early in the course, it doesn’t much affect the length of the illness, but is still very effective at stopping its spread. People with pertussis are highly contagious for up to 5 days after starting the antibiotic.

How can pertussis be prevented?

The pertussis vaccine, even with its side effects and problems, has saved many lives by stopping the wildfire spread of pertussis epidemics. Recent pertussis deaths in the United States are a haunting reminder that this disease is still lying in wait.
People who have been exposed to probable or confirmed pertussis should either receive a course of preventative antibiotics (and I say this as someone strongly opposed to the overuse of antibiotics), or be kept home from day care, school, or work for at least 3 weeks. If the exposed individual develops symptoms, they should receive antibiotics to prevent further spread of pertussis to others.
Children under age 7 who have been exposed should receive a pertussis vaccine, unless they have already had 4 doses of pertussis vaccine (and the last dose within 3 years), or unless there is a compelling reason not to immunize them. Exposed teens 11-18 years old who have not already received a booster vaccine should receive one.

Related A-to-Z Information:

Airborne Transmission, Allergies (Allergic Rhinitis), Asthma,Bronchiolitis, Common Cold, Contact Transmission, Cough, Diphtheria, Droplet Transmission, Gastroesophageal Reflux, Influenza (Flu), Measles, Mumps, Pneumonia, Respiratory Distress, RSV Respiratory syncytial virus), Rubella (German measles), Sinusitis, Sleep Apnea, Sudden Infant Death Syndrome (SIDS), Tetanus, Tuberculosis, Wheezing

Related concepts:

Influenza

Introduction to the flu:

For many people, cold and flu have become an inseparable pair, like salt and pepper or New Year’s and weight loss. Walking down the “cold and flu” aisle of any drugstore, you will find stacks of bright boxes with bold claims of help for those suffering from a cold or the flu. Since the two illnesses share some similar symptoms, and both come during “cold and flu season,” the two often run together in people’s minds. We have a vague idea that they are different, but if pressed, have a hard time saying exactly how. The cold is much more common. The flu is much more serious.

What is the flu?

A single family of viruses – the influenza viruses – causes the flu.
Unlike with the common cold, both adults and children with the flu generally have a fever and feel sick all over. For the great majority of people, the illness is quite unpleasant but not dangerous.
However, the flu can be quite a serious illness. The most deadly recent worldwide outbreak was the flu epidemic at the beginning of the 20th century, which killed more than 20 million people.
Even today, more than 20,000 people in the United Sates die from the flu each year. This number is a small percentage of those who get the flu (much less than one percent). They are primarily those who are weak from advanced age or a major illness.
Still, about one percent of otherwise healthy children get sick enough from the flu to be hospitalized.

Who gets the flu?

Most people get the flu once every year or two or three – unless they are vaccinated. It can happen at any age, but is most common among school-aged children.
The flu is most common during the winter months.

What are the symptoms of the flu?

The flu can take many forms. It is not, primarily, a “tummy flu.”
Classically, the flu begins abruptly, with a fever in the 102 to 106 degree range, a flushed face, body aches, and marked lack of energy. Some people have other systemic symptoms such as dizziness or vomiting. The fever usually lasts for a day or two, but can last five days.
Somewhere between day 2 and day 4 of the illness, the “whole body” symptoms begin to subside, and respiratory symptoms begin to increase. The virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, and/or pneumonia.
The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore (red) throat and a headache. Nasal discharge and sneezing are not uncommon.
The initial symptoms of inhalational anthrax can be similar to those of the flu.

Is the flu contagious?

The flu is very contagious. It can be spread by airborne, droplet, or contact transmission and by fomites.

How long does the flu last?

Inhaling droplets from coughs or sneezes is the most common way to catch the flu. Symptoms appear 1 to 7 days later (usually 2 to 3 days). Symptoms (except the cough) usually disappear within 4 to 7 days. Sometimes there is a second wave of fever at this time. The cough and tiredness usually lasts for weeks after the rest of the illness is over.
The flu is airborne and quite contagious, and with its short incubation period, it often slams into a community all at once, creating a noticeable cluster of school and work absences. Within 2 or 3 weeks of its arrival, most of the classroom has had it.

How is the flu diagnosed?

The diagnosis is often based on the history and physical examination. Viral studies on nasal or throat swabs obtained during the first 72 hours of symptoms can verify the diagnosis if there is a question. Blood tests can make the diagnosis after the fact.
The initial symptoms of inhalational anthrax can be difficult to distinguish from the flu.

How is the flu treated?

Specific antiviral medications are available, and recommended for those with severe illness, those at high risk for complications, and children with social situations that would make treatment benefits outweigh the risks. If specific treatment is to be used, it should be started as early in the illness as possible.
Rest, fluids, and fever control are useful for most children. Other treatments are aimed at reducing specific symptoms.
Aspirin use in children with influenza increases the risk of Reye syndrome.

How can the flu be prevented?

People are most contagious beginning 24 hours before they develop symptoms (and up to 7 days afterwards), making it difficult to prevent the flu by avoiding sick individuals.
The flu vaccine is a specific and effective way to prevent the flu. It is available for children over 6 months old. Children under 9 years old need two doses of the vaccine the first year they get it.
Yearly flu vaccine is especially important for children with asthma, cystic fibrosis, bronchopulmonary dysplasia (BPD), heart disease, HIV, sickle cell anemia, juvenile rheumatoid arthritis, diabetes, and a number of other chronic childhood conditions.

Related A-to-Z Information:

Arthritis (Juvenile rheumatoid arthritis, JRA), Asthma, Bronchiolitis, Congenital Heart Disease, Contact Transmission, Cough, Croup, Cystic Fibrosis, Droplet Transmission, Ear Infection, Fomites, Headache, HIV, Nosebleeds (Epistaxis), Otitis Media with Effusion (OME), Pneumonia, Reye Syndrome, Sickle Cell Anemia, Strep Throat, Tonsillitis, Type I Diabetes, Wheezing

Introduction to cough:

Your home calms at night, the children are tucked into bed – but then loud coughing replaces the silence. It’s impressive that a body so small can cough so loud.

What is a cough?

Coughing is an important part of the body’s defense system. It forcefully propels unwanted invaders up and out of the body.

A cough signals some irritation in your child’s air passages. This irritation may be in the throat, the lungs, or in the passageways connecting them.

A cough often accompanies infections of the upper or lower respiratory tract, such as colds, flu, sinus infections, croup, bronchitis, bronchiolitis, measles, or pneumonia. Sometimes the cough will linger once the infection has cleared.

Hair cells, called cilia, normally move mucus along the respiratory tract to keep the area clean and moist. If these cilia are damaged during an infection, the body may use coughing to move this mucus along – even after the invading germs are gone. Thus, the cough sensors tend to be hypersensitive following an infection.

Whenever a child has a recurrent or persistent cough, it is important to consider a diagnosis of asthma. Many children with asthma have cough as their primary symptom. The diagnosis is often delayed in these children, and they fail to get the preventive medicines they need.

Other important causes of chronic cough include allergies, inhaled foreign bodies, GE reflux, pertussis, chronic sinusitis, tuberculosis, inhaled irritants (smoke or fumes), pressure on the respiratory tract from the outside (perhaps from lymph nodes or blood vessels), or habit.

Occasionally a cough can be caused by swimmer’s ear, which can trigger cough sensors in the ear canal.

Who gets a cough?

All children will cough occasionally as a part of their bodies’ way to fight infections and irritation. Nevertheless, cough is a symptom that deserves attention. While sneezing in a newborn is usually normal, a cough usually indicates that something needs to be addressed. In older children as well, the cough is a sign of irritation and it is important to discover the cause.

What are the symptoms of a cough?

The sound of the cough often depends on the location of the irritation. If an infection is in the voice box (croup), the cough may sound like a barking seal. If it is deeper in the bronchi (bronchitis), the cough will sound deeper as well.

A chronic nighttime cough might signal asthma, nasal allergies, or a chronic sinus infection. A habit cough disappears with sleep. A cough that is at its worst when your child first awakens might signal bronchitis.

The cystic fibrosis cough is also usually worse in the morning. It tends to be productive, and may come in spasms.

A productive cough might also signal bronchitis or pneumonia.

Coughing spasms may be a sign of pertussis or of an inhaled foreign body. Spasms of coughing accompanied by vomiting or a whooping noise may also indicate pertussis.

Is a cough contagious?

People are a little more likely to cough when they hear someone else cough, but a cough is not truly contagious. The infection that causes a cough is often contagious, however.

How long does a cough last?

The length of a cough depends on the underlying cause. Any cough that lasts for weeks or months should be considered a persistent or chronic cough, and evaluated accordingly.

How is a cough diagnosed?

The underlying cause of a cough may often be diagnosed based on the history and physical exam. Sometimes additional tests, such as a chest x-ray, TB skin test, blood test, pulmonary function test, or even bronchoscopy, may be needed.

Diagnosing the cough is very important if the cough makes it difficult for your child to breathe, if you suspect your child may have inhaled some food or other object, if there are intense spasms of coughing, if your child otherwise seems ill (as with a high fever), or if the cough is not improved within two weeks.

Any cough in a newborn or young infant should be evaluated.

How is a cough treated?

Identifying and treating the underlying cause is they key. If the cough is from reflux, the reflux should be treated. If it is from tuberculosis, TB meds are needed.

Asthma coughs should be treated with asthma medicines, not with cough suppressants.

Although over-the-counter cough suppressants are readily available, they are not always helpful – even if the cause is not asthma — and even if they seem to work. The cough is often helping your child clear mucous and debris from the airways and lungs. Sleep may help your child more, though, so discuss treating the cough at night with your child’s pediatrician. Elevating the head at night may help, and sometimes a cough syrup at night is a real boon. However, over-the-counter cough suppressants should not be used in children less than 6 years of age without discussing their use with your pediatrician. Studies have not proven that over-the-counter cough suppressants are effective in this age group, and the potential for serious side effects are greater in young children.

Extra fluids to drink, and a humidifier for the room will help many kinds of cough.

There is some evidence that two teaspoons of dark honey (such as buckwheat honey) may be effective for nighttime cough, and it is safe to use for children over 12 months of age (Arch Pediatr Adolesc Med, 2007 Dec; 161(12):1140-46).

How can a cough be prevented?

Childhood immunizations can prevent significant cough illnesses, including measles, pertussis, Haemophilus influenzae (Hib), and pneumococcal pneumonias. The flu can also be prevented by vaccine.

Breastfeedingis protective against many of the infectious and allergic causes of cough. Other efforts at prevention are aimed at preventing the individual underlying causes.

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Asthma, Bronchiolitis, Croup, Cystic fibrosis, Haemophilus influenzae (H flu, Hib), Influenza (Flu), Measles, Pertussis (Whooping cough), Pneumonia, Gastroesophageal reflux, Respiratory Distress, RSV (Respiratory syncytial virus), Sinusitis, Swimmer’s ear (External otitis), Tuberculosis, Wheezing

Related concepts:

Laryngotracheobronchitis, Infectious croup, Spasmodic croup.

Introduction to croup:

Picture this scene: A couple is spending a quiet evening at home with their one-year-old daughter, who has had a bit of a cold. At about 8 o’clock she begins coughing — an unusually loud, resonant cough. Over the next few hours, the sporadic cough becomes increasingly frequent. She gets a fever.

At 11 o’clock (when all the After Hours Clinics have closed, and her doctor is in bed), her breathing becomes noisy and labored. Each breath now makes a worrisome crowing noise unlike anything the parents have ever heard. Concerned, they bundle her up and take her to the local emergency room.

As they are pulling into the ER driveway, they notice that the child seems much, much better. After some heated debate (during which the little girl falls asleep peacefully), they decide to head home without being seen. An hour later, at home, the little girl is woken up by the loud cough, and her breathing is even more difficult…

What is croup?

Croup, bronchiolitis, bronchitis, and pneumonia are all words that denote the location in the body of a problem. Bronchiolitis refers to inflammation in the bronchioles, the smaller airways that branch off from the main bronchi or breathing tubes. Bronchitis is inflammation in these larger, main breathing tubes. Pneumonia refers to inflammation of the lungs themselves.

The word croup comes from an old Germanic word for the voice box. Today, croup, or laryngotracheobronchitis, refers to swelling centered at the larynx or vocal cords. Infection, allergy, or an inhaled foreign body can cause croup. GE reflux can trigger croup.

Croup is usually (75 percent of the time) caused by parainfluenza viruses, but RSV, measles, adenovirus, and influenza can all cause croup.

Before the era of immunizations and antibiotics, croup was a dreaded and deadly disease, usually caused by the diphtheria bacteria. Today, most cases of croup are mild. Nevertheless, it can still be a dangerous disease.

Who gets croup?

Croup tends to appear in children between 3 months and five years old, but it can happen at any age. Some children are prone to croup and may get it several times.

In the Northern hemisphere, it is most common between October and March, but can occur at any time of the year.

What are the symptoms of croup?

Croup is characterized by a brassy cough that sounds rather like a seal barking. Most children have what appears to be a mild cold for several days before one evening when the barking cough becomes evident. As the cough gets more frequent, the child may have stridor (a harsh, crowing noise made during inspiration).

Croup is typically much worse at night. Cool air or steam can briefly decrease the swelling in the larynx and improve the symptoms.

Is croup contagious?

Croup caused by an infection is contagious. Croup caused by allergies or foreign bodies is not.

How long does croup last?
Croup often lasts 5 or 6 nights, but the first night or two are usually the most severe. Rarely, croup can last for weeks. Croup that lasts longer than a week or that recurs frequently should be discussed again with your doctor to determine the cause.

How is croup diagnosed?

Children with croup are usually diagnosed based on the history and physical exam. Sometimes a doctor will even identify croup by listening to a child cough over the phone. Occasionally other studies, such as x-rays, are needed.

How is croup treated?

Most cases of croup can be safely managed at home, but you will want to call your physician for guidance, even in the middle of the night.

Acetaminophen can make the child more comfortable and lower any fever, lessening his or her respiratory needs. Avoid cough medicines especially in children under 6 years old unless you discuss them with your doctor first.

You may want your child to be seen. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated aerosol treatments, if necessary, are also powerful.

If your child is not responding to home treatment, or is struggling to breathe, has stridor at rest, retractions (tugging-in between the ribs with inspiration), dusky lips, drooling, or is very tired or agitated, she should be seen immediately. If you suspect a foreign body or an insect sting as the cause of croup, she should be also seen immediately. Some children with croup require hospitalization for a few days.

How can croup be prevented?

Most causes of croup are spread by direct contact, droplet transmission, and by fomites. Careful hand washing and other appropriate precautions can decrease the spread of these viruses.

The diphtheria, Haemophilus influenzae (Hib), and measles vaccines protect children from the most dangerous forms of croup and infectious airway obstruction.

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Bronchiolitis, Common Cold, Contact Transmission, Diphtheria, Droplet Transmission, Fomites, Food Allergies, Gastroesophageal Reflux, Influenza (Flu), Measles, Peanut Allergy, Respiratory Distress, RSV (Respiratory syncytial virus), Wheezing

Many of the most common and most dangerous infections spread via germs on the hands that make their way into the mouth, nose, or eyes. How best to keep our children’s hands clean? The Centers for Disease Control and Prevention (CDC) issued October 25, 2002 guidelines for hand hygiene in healthcare settings, where spread of infection is an even more serious problem.

What do they recommend for doctors, nurses, and other healthcare workers? When hands are visibly dirty or soiled, wash them with soap and water. Otherwise, use an alcohol-based hand rub to keep the hands clean (or soap and water as an alternative). The alcohol-based hand rubs are so effective that, used after brief washing with soap and water, they can replace the traditional surgical scrub!

To get healthcare workers to use these hand rubs, containers should be placed at every important location, such as every patient room. Individual pocket-size containers should also be given to healthcare workers.

For our children, the most important times for clean hands are after toileting, before eating, and after playing with germ-laden objects (shopping cart handles?). Kids often enjoy alcohol-based hand rubs. It makes sense to strategically place containers in restrooms, kitchens, glove compartments, purses, and pockets.

Clean hands are a powerful tool toward healthy bodies.