The American Academy of Pediatrics (AAP) just released new guidelines for the diagnosis and treatment of acute otitis media (AOM) which is doctor speak for an ear infection.
An ear infection is one of the most common infections of early childhood and is also one of the most common reasons that antibiotics are prescribed. Guidelines from 2004 recommended that pediatricians use watchful waiting before prescribing antibiotics for an ear infection in some children.
The new guidelines for treating an ear infection with oral antibiotics are even more specific than those in 2004, and further clarify who are the best children to observe and those that should be treated right away. This will reduce the number of unnecessary antibiotics that are prescribed, which in turn may help prevent antibiotic resistant bacteria.
Many parents worry that their child may develop an ear infection after having a cold, but for a child between 6 months and 12 years of age, a mild ear infection found during a visit to their pediatrician may now be observed for 72 hours.
According to the new AAP guidelines, children need to receive immediate antibiotics if they have a severe ear infection (with a fever of 102.2 degrees or higher or significant pain), have a ruptured ear drum with drainage or an ear infection in both ears in a 2 year old or under. This will really change current treatment and the number of antibiotics prescribed.
As both pediatricians and parents know, there are all sorts of things that cause ear pain: an erupting new molar, a cold, or a sore throat can all result in ear pain and a cranky child. But if the
Mosquitoes are out in full force and while we are seeing higher than normal cases of West Nile Virus (WNV) in many states, we pediatricians are more often diagnosing impetigo secondary to bug bites, than a case of WNV (thank goodness!).
Those pesky mosquito bites, or any other type of insect bite (hopefully you are applying bug spray to your kids as well) just scream for a child to scratch them. With scratching comes abrasion to the surface of the skin and those little fingers (even if washed) harbor bacteria that can penetrate the breaks in the skin and set up an infection. Once those fingers go on to scratch yet another bite the infection can be moved from place to place (the name for the spread of the infection by the fingers is auto-inoculation) and before you know it you see several to many little inflamed, honey crusted, weeping lesions on the skin surface. This is classic impetigo (not INFANTIGO as some like to call it).
Impetigo is typically caused by the bacteria staph or strep and even frequently washed hands harbor bacteria. If you notice one or two bites that are looking inflamed and weepy it may just take a prescription antibiotic ointment to treat the infection.
In some cases the area of infection involves multiple areas on the face, arms, legs, and buttocks (where kids typically pick and scratch) and your doctor may want to prescribe an oral antibiotic to treat the infection.
The best treatment is always prevention, so continue to use insect repellant appropriately, trim those fingernails, discourage scratching and picking and use an antibacterial soap for bathing. If you see an area looking like it is getting infected treat it early and you may be able to avoid taking an oral antibiotic.
It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions.
The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks. This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed.
Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that baby fat reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites.
Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer.
Severe local reactions are called sweeter syndrome and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.
Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito