Urinary tract infections or bladder infections are common in childhood and adolescence. Symptoms in later childhood may be easy to spot but very confusing in the infant. Symptoms are : burning or pain while urinating, urgency or frequency in urinating, and back pain or fever, although back pain or fever are uncommon. These last symptoms may warn of kidney infections.

For infants, other symptoms may include : weight loss, vomiting, diarrhea, nausea, failure to gain weight or even jaundice. In early infancy, boys are three times more likely to have a urinary tract infection. This infection is carried to the bladder or kidneys from the blood. In childhood, bedwetting in a previously dry child, or abdominal pain may indicate a bladder infection. Treatment with any of several antibiotics works well. After treatment, I may suggest a follow-up test of the urine to insure no new infection has appeared.

Bacteria vs. Virus

Many parents are naturally confused about bacterial and viral illnesses. It is important to understand the difference between these two words because my treatment plan will be based on the type of infection I suspect.

Bacterial infections cause illnesses like : strep throat, ear infections, skin infections such as impetigo, pneumonia or meningitis. Each infection can range from less serious to life threatening. Although some bacterial infections will go away on their own, with the use of drugs like antibiotics, recovery is quicker and complications are reduced. For this reason, I use various methods (lab tests, physical examination, and your child’s history) to determine if your child could have a bacterial infection.

The use of antibiotics should not be taken lightly. Some children suffer reactions to antibiotics. While most side effects are annoying at worst, severe allergic reactions can be life threatening. Let me know if your child has allergies to any medications.

If I suggest and prescribe antibiotics it is critical that your child take them for the length of time I indicate.

Viral infections are extremely common. Most of us will get several viral infections every year. (See video on virus) The average child has 5 to 10 illnesses each year. Symptoms of viral illnesses can mimic bacterial illnesses. It can be difficult to separate and determine which infection your child has. Yet, viruses are less likely to cause serious complications.

Viruses are not affected by antibiotics. Certain medications can help some viral illnesses and several drugs are able to control and even kill some viruses. Even though most viral illnesses must run their course, I will probably be able to substantially reduce unpleasant symptoms and prevent complications from secondary bacterial infections.

If you suspect a bacterial infection, but your child is comfortable, I can examine your child during office hours. If there is a fever persisting more than 48 hours, difficulty breathing, pain, decrease in awareness of their surroundings, persist vomiting, or bloody diarrhea, you should call me or go to Children’s emergency room.

Last reviewed July 16, 2007

Hand, foot, and mouth disease

A possible complication is dehydration, because the oral ulcers can be severe and the discomfort will discourage fluid intake. This complication is unusual. Like most illnesses with rashes, your child is contagious for a couple of days before the rash appears until it fades.

Stomach flu or gastroenteritis

This viral infection should not be confused with “bacterial” food poisoning caused by improper food.handling. “Stomach flu” is a viral illness

so there are no antibiotic cures for the vomiting and diarrhea symptoms. Tylenol™ helps the pain from the cramping.

The important concepts to remember are concerning fluid replacement. Understanding which type of fluids and solids you can use will help in the treatment.

The goal of treatment is to avoid dehydration. Fortunately, few children have this complication. (See the section on Vomiting and Diarrhea...)

Start with small amounts of clear fluids. Avoid dairy products because they are not easily digested and can aggravate diarrhea. Even dilute fruit juices can stimulate the diarrhea and should be avoided. If clear fluids are tolerated in larger amounts over an 8 to 12 hour period, consider solid foods. The BRAT diet is an acronym for Bananas, Rice, Applesauce, and Toast. These are easily digested and help thicken the stools. Continue this diet until the stools approach normal for a couple of days.

Roseola (baby measles)

This is a contagious illness caused by a virus. The contagious period is just prior to and during the fever. It is treated the same as any febrile illness to provide symptomatic relief. Use aspirin-free fever relievers. Children with prolonged high fevers lasting more than two days should be examined. If fevers persist more than a few days, blood counts or similar laboratory examinations need to be performed. Occasionally some children will need to be hospitalized for observation to rule out serious infectious illnesses.

Ringworm

Fortunately, it can be treated with readily available over-the-counter medications like Tinactin™, Micatin™, Lotramin™ or Lamasil™. I prefer Lamasil™ but there are many different medications available. Treatment consists of spreading the cream or ointment sparingly over the rash twice a day. There should be dramatic improvement over a weeks time. If the rash does not improve or it worsens, I should see the rash in my office to determine if an infection or if some other condition exists.

Chronic fatigue in children

A diagnosis of chronic fatigue has great appeal. It gives parents and children a socially accepted explanation for long-lasting complaints and some physicians a label for an otherwise baffling set of symptoms.

In part this is due to do with the nature of the Ebstein-Barr virus, the virus that causes mononucleosis. Most adults, and many infants and children have been infected with this virus at some point in their lives (90%). Assessing these patients is a difficult task. Most have normal physical examinations and laboratory tests, despite testing positive for the virus in the past. It is rapidly becoming apparent that most patients with “chronic fatigue syndrome” do not have an active case of the virus. We do know the Ebstein-Barr virus can cause many illnesses ranging from mononucleosis to a prolonged and intermittent infection can even cause death, in severe cases.

To diagnose severe, chronic EBV infection, I consider: a severe illness lasting more than six months; evidence of involvement of the bones, eyes, lymph glands, liver or lungs. Special laboratory tests may be helpful in confirming the diagnosis. A chronic fatigue syndrome that meets my specific criteria is uncommon in children and adolescents.

Complaints of prolonged fatigue are common among teenagers. Small children rarely complain of “feeling tired,” and even children with chronic disease rarely complain of fatigue. The concerned parent usually observes and reports that the child appears fatigued. Parents say things like, “He has no energy,” or “All she does is lay around the house.” They describe a child who prefers sedentary activities, looks tired or droopy, has no energy, seems bored, doesn’t want to play with friends, and generally shrinks from social contacts. Many children experience periods of lassitude from time to time. But, children who go through protracted and severe periods of chronic fatigue and withdrawal from usual activities may be suffering from a serious depression.

They will need special medical or psychiatric treatment.

Adolescents complain about being fatigued quite frequently. In fact, fatigue is among adolescents most common problems in pediatric practice and one that arouses much concern in parents, particularly in spring, when adolescents suffer from a combination of fatigue and mild depression. Springtime is the season of the greatest school-related stress, before final exams, grades, college acceptance, prom time, and graduation. These symptoms should definitely be called “spring fever.” All the uncertainties of adolescence including identity and sexual crisis, may create spring fever anytime of the year, with fatigue the major complaint. Many of the adolescence who come to my office with complaints of fatigue and no other problems have an emotionally based problem, usually a product of stress and anxiety.

This is a complex problem that may take time to work through. It should be discussed with both parents and child or adolescent.

Impetigo

Bacteria are growing in and below the crusts. Treatment involves clearing and cleaning the infected areas. Betadine™ ointment or solution is the best over-the-counter bactericidal agent. Other choices include Bacitracin™, Cortisporin™ and other over-the-counter creams and ointments. Oral antibiotics and prescription creams may be necessary for nonresponsive infections or infections covering many areas of the body at once.

These infections are very contagious. Your child may be required to stay home until the infection responds to treatment and clears up.

Influenza or Flu

Influenza or “true flu” is a viral disease

common in winter months. Adults use the term as a general description for many combinations of symptoms. I always ask parents to explain the symptoms. When “flu” appears, epidemic numbers of children and adults are affected. Type A virus is the most common strain, but during some years, Type B strain will occur. A second illness can occur in the same season, giving the false impression of a relapse. When ,in fact, the second illness is caused by a different strain of virus. H1N1 (Swine Flu) a new varient arrived in 2008 and has caused infection at times not typical for seasonal flu. There have been cases described in the Sprng and Summer which is not expected for normal seasonal type A influenza.

The virus takes about 2 to 3 days to develop before your children will show any symptoms. Older children can become ill quickly with fever, flushed face, chills, headache, muscle ache and fatigue. Temperature from 102° to 105° are common. Dry cough, runny nose and eyes appear early in the illness. You will notice sore throat and teary, burning, achy, light sensitive eyes. Up to 1/3 of children will have some diarrhea.

“Flu” or influenza can be prevented by taking a series of one or two vaccine doses depending on age and history of previous vaccine, starting in early fall. I recommend flu vaccine for children between 6 months and 18 years, especially if there is a history of chronic illness like severe asthma, heart disease or diabetes.

A drug called amantadine hydrochloride or Symmetrel™ has been shown to help prevent influenza A and was also used to treat the illness. Unfortunately there is evidence that these medications are no longer very effective as a few years ago. Other medications are available like Tamiflu but have not been shown to prevent the disease, kill the virus or markedly reduce complications. Tamiflu may shorten the symptoms of the infections but often only shorten it 1-2 days. If you suspect your child has influenza and there is a worsening cough or persisting fever beyond 2-3 days, contact my office to schedule an appointment (School notes are only written when the patient is seen in the office). If your child has influenza, most will recover with home care without other medications. Antibiotics don't help unless there is evidence of a secondary infection. CDC recommendations for school return would be after 24 hours of fever free and markedly reduced cough or other symptoms.

Jaundice with hepatitis

This disease strikes terror in families because parents fear the worst outcome or have many misconceptions.

Hepatitis is an inflammation of the liver.

Most cases are not recognized because it is generally mild and symptoms are not severe. Its symptoms are nonspecific like fever, headache, general achiness, loss of appetite, or an itchy rash. After a few days, you will notice more nausea and vomiting, stomach ache, and in some cases jaundice (yellowness of the whites of the eyes and skin). Urine will be dark and stools will change to a tan or white color. The area of skin over the liver can be quite tender from the swelling of the liver.

Viruses cause inflammation of the liver including the virus of mononucleosis ( Ebstein-Barr virus ). Two common forms of hepatitis are infectious or “A” type and Serum or “B” type. Incubation period can vary from 1 month for infectious hepatitis to 6 months for serum hepatitis. Infectious hepatitis is spread from one person to another from intimate contact or from infected water or food. Serum hepatitis is spread by contact with contaminated blood which can occur when infected needles are used or shared or sexual contact.

There is no cure for the viral infection once it develops in the body.

Treatment focuses on meeting the nutritional needs of the infected child. Foods should be lower in fats and contain only mild to moderate amounts of proteins. Carbohydrates are easier to digest than fats or proteins, but all food types can be eaten.

If a member of the family is known to have infectious hepatitis, all family members may receive immune globulin to prevent or to minimize the severity of hepatitis. Once the disease is diagnosed, immune globulin will not stop the infected person’s disease. Some children and adults can have damage to the liver or chronic hepatitis. It is important to prevent cases of hepatitis, whenever possible. Fortunately, there will be complete recovery from infectious hepatitis in more than 90% of children.

Lyme disease

The first stage of the disease begins from 3 to 30 days after the tick bite. The characteristic rash can be flat or raised and red. There is a ringed border with a pale center. The size may be ¾ inch to 26 inches across. Later other rashes may appear accompanied by fatigue, fever and headache.

Stage two develops after a brief period of well being. Then the headache, stiff neck, nausea, vomiting , fatigue, memory loss and loss of concentration may occur. Facial nerve paralysis, irregular heart beat can also develop in this stage. In stage three, the last stage, weeks, months or years may pass before arthritis appears.

There are no accurate tests to detect Lyme disease in stage one. The combination of flu symptoms, rash and tick bite are necessary for diagnosis. The later stages can be more accurately tested. Treatment with common antibiotics is generally successful.

To prevent Lyme Disease wear light colored clothing so the tick may be easily seen. Wear long pants tucked into your socks. Remove ticks promptly. Use tick repellents containing 30% DEET or 0.5% Pyrethrins. Tick collars for pets are recommended. This tick is not native to our area so unless you have traveled to an area where it is common, you should not be concerned about Lyme Disease.

Tuberculosis

Children 3 to 15 years are likely to develop primary tuberculosis, if infected. This form of Tuberculosis is usually asymptomatic. There is no fever, cough, fatigue, or other symptoms. It is picked-up or diagnosed by the simple skin test that we do in the office. X-rays are often negative. Tests to cultures or examine the bacteria are difficult to obtain, because sputum is necessary to culture. Most small kids swallow their sputum so testing them is difficult.

Because tuberculosis requires large amounts of infected particles to be coughed up and spread, it is very unusual to contract TB from a casual exposure. It is also unusual for a child to spread it to another child. The classic exposure is from an older adult with long established disease to another person after prolonged exposure.

Treatment is by drug therapy. Up to a year of drug therapy is necessary to eliminate the infection.

Skin infections

The skin might not be the only location for the spread of viruses, bacteria, or fungi. Some infections invade deeply advancing into the blood system, spreading throughout the body or adjacent organs.

The skin is naturally dry. The first locations for infectious overgrowth will be in areas where moisture is increased. The groin, underarms, around the neck, and feet are frequent sites for infections to grow or spread.

There are many common types of bacterial infections found. Here is a brief list of the those I see: impetigo, folliculitis, furuncles, carbuncles (boils), paronychia, and cellulitis.

Infections are first noted on the outermost areas of the skin. Impetigo is one of the most common skin infections in children. It can start as a simple small red bump or flat area. It progresses to form a small white head or larger collection of pus. Drainage can occur on its own with crusting. This crusting is generally honey-colored. Bacteria grow in the collection of crusts and continue to reinfect the skin.

As the parent you can help to control the infection by removing the crusts with medicated ointments, crèmes, or lotions. This will reduce the reinfection of the skin. Over-the-counter Neosporin, bacitracin, or Betadine are just a few examples of possible medications.

Other forms of impetigo appear as large pus-filled blisters. This is more common in the diaper area and between the thighs. This is called bullous impetigo and needs antibiotic treatment with oral medications.

Deeper infections can produce pain and fever. In most cases these infection called cellulitis start as a simple pimple but grow involving deeper zones of the skin, muscle, and bone. The skin might be red, tender, and swollen.

These are definitely more serious and require my care. Close doctor follow-up is necessary to avoid progression of the infection into the body organs or the blood system.

Some infections start at the hair follicle and cause redness, irritation, pain, and sometimes a discharge of watery, yellow, or bloody fluids. Soaking these with water might be your first option. It will help if you keep the area clean with soap and water and then dry well.

On occasion small areas of infection group and form an abscess which will require minor surgical drainage. I recall a recent patient account where a well-meaning parent tried to clean and drain an infection around a nail by lancing it with a needle. After repeated attempts at draining the area, the infection grew. It invaded the bone in the finger. The destruction of the bone infection eroded the end of the finger bone, leaving his finger tip shortened by about an inch. Don’t try to drain an abscess at home with a needle. Very serious complications can result.

A form of skin infection called Methacillin Resistent Staph Aureus (MRSA) is now appearing that is resistant to common antibiotics. There are two forms. One is a community acquired form which is less serious and can be treated in the office. It can reoccur. The other form is acquired in the hospital with patients that often have chronic illnesses and their form requires care from an infectious disease specialist.

Last reviewed July 16, 2007

Pinworms

Symptoms caused by pinworms are usually confined to the areas surrounding the rectum, although in girls the worms can cause symptoms in the vagina. There may be itching and pain or restlessness at night. Many children grind their teeth.

You may be able to see the worms migrating at night near the rectum. Take a flashlight at night while your child is sleeping.

A chewable prescription medication kills the worms. If more than one person in the family is infected, I will treat the whole family at the same time.

Valley Fever

There may be a fine red round rash or hives might appear within a day or so. The rash might last a few days only or appear as tender bumps. At the same time you might notice an arthritis or conjunctivitis.

Signs of pneumonia can appear. It is usually minor but can be quite severe.

The diagnosis of Valley Fever can be made by skin test but a negative test does not rule out Valley fever so I will order a complete cocci blood test. This will be more accurate and gives dependable results.

There is no treatment recommend for primary, uncomplicated Valley Fever. Rest is helpful, but not is not required. You can only contract the disease by breathing the infectious spores and will not be contagious to others will the disease is active. One infection should establish immunity for future infections. There is no effective vaccine for this disease.