Five Common Summer Rashes – What’s What and Proper Treatment

By Dr. Samuel Libber at Annapolis Pediatrics

Summertime is the season for a wide variety of activities that are a welcome change of pace for kids and parents alike. With that change, however, come some hazards that parents need to be on the lookout for. Many of these involve the skin, one of the body’s most vulnerable organs.

One that most parents will have dealt with is HEAT RASH (“prickly heat” or “miliaria”), a red blotchy or bumpy rash that often appears in skin creases after the child perspires. It is often itchy and responds well to cool compresses and relocation into a cooler environment. No topical medication is needed.

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Another summer skin condition, which we hope to see less and less of, is SUNBURN. This tends to occur when unprotected skin is exposed to the strong summer sun, most often between 10:00 AM and 4:00 PM. It tends to be most damaging in children with fair skin, fair hair, and light eyes but can lead to premature aging of the skin and skin cancers in anyone. Aggressive use of sunscreens with SPF values of at least 30 is recommended. Cool compresses, topical emollients, and oral and topical pain relievers can offer symptom relief.

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IMPETIGO is one of the more common skin infections that peaks in the warm weather months. It is usually due to a superficial bacterial infection and shows up as crusty or scabbed sores that sometimes seem to “weep”. The crust sometimes has a honey-like color. It is contagious and is treated with topical antibiotic ointments and occasionally with oral antibiotics.

rsz impetigo on arm

A very different sort of infection that we hear frequently about is HAND-FOOT-AND-MOUTH. This is caused by a virus in the Coxsackie family and is more prevalent in the warm weather months. It is also quite contagious and presents with fever, sore mouth/throat, sometimes vomiting or diarrhea, and scattered red spots or ulcers in the mouth and skin. The spots will sometimes blister and are most often seen on the hands, feet, and buttocks but can show up almost anywhere on a child’s skin. Treatment is supportive, with the main goal being to maintain hydration and provide comfort to the child. Symptoms are usually gone in 5-7 days.

rsz hand foot and mouth disease

Finally, one of the most common summer rashes is one that has an allergic basis. It is called “RHUS DERMATITIS”, typically due to POISON IVY in this part of the country. It is due to a plant oil called “urushiol” that causes an intensely itchy, blistery reaction on the skin of vulnerable children and adults who touch it. If exposed, a child should wash quickly with soapy water over the suspected sites.

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Should a rash develop, fingernails should be cut short to help prevent infection, and topical analgesics and steroids (such as hydrocortisone 1%) can be applied. If you are positive that your child has poison ivy, buy Zanfel cream and follow the directions. It washes away the urushiol and stops the allergic reaction. If facial or genital breakouts are noted, medical care is advised.

Enjoy the summertime, stay safe, and don’t forget to take precautions to reduce the risk of skin problems for your kids!

If your child is suspect to a summertime rash and you are not sure which one it is or how to treat it, take advantage of our walk-in hours at our Annapolis office location. Annapolis Pediatrics’ WALK-IN CLINIC is open Monday through Friday from 7:30 AM to 4:30 PM. No appointment is needed*. Just walk-in and see the next provider available. We will take a look at the rash and be able to provide quick comfort and assurance on the proper treatment.

*Walk-in service is only for Annapolis Pediatrics patients.

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About Annapolis Pediatrics:

For 70 years, Annapolis Pediatrics has provided superior healthcare to infants, children, adolescents, and young adults in Annapolis and the surrounding communities. In some cases, we have cared for three generations of families. We strive to provide high quality medical care, from excellent clinical care to a positive customer experience for our patients and their parents.

We have over 30 physicians and nurse practitioners in 5 locations: Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. We also offer Monday through Friday walk-in hours at our Annapolis office for short sick visits.

For more tips and information from your local pediatrician, visit us at:
Website: https://annapolispediatrics.com/
Facebook: https://www.facebook.com/AnnapolisPediatrics/
Twitter: https://twitter.com/AnnapPeds
Instagram: https://www.instagram.com/AnnapolisPediatrics/

Should Your Child Continue ADD/ADHD Medication During Summer Break?

By Dr. Sharon Richter at Annapolis Pediatrics

Often parents wonder if their children should continue medication for ADD/ADHD over summer break. This is something that families need to sit down and discuss with their child’s doctor. Some parents don’t think treatment is needed if there is no school. They may want to observe their child’s behavior for some time without medication or give them a break from the side effects. Other parents may say that their child could not do anything without medication due to extreme hyperactivity, impulsivity and distractibility. Whether or not to take medication over the summer depends on a variety of factors and should always be discussed with the child’s prescribing physician.

ADD/ADHD is a disorder that is diagnosed when symptoms (for example inattention, distractibility, hyperactivity, or impulsivity) are present in “several settings”, not just in school. For some children, these symptoms cause the most interference in the school setting. However, for many other children, these symptoms are present and cause interference in other situations, such as at home and with peers. Even when there is no school, there is still a need for children to get along with family members and friends. Difficulties from symptoms of ADHD may affect the parent-child relationship, impact the child’s self-esteem or cause difficulties in social relationships. A continuing conversation with the prescribing physician needs to occur on a regular basis to determine if the risks and benefits of the medication are outweighing any risks from not treating the symptoms of ADD/ADHD.

Some questions to consider regarding whether to continue medication for ADD/ADHD over the summer include asking if there will be any significant interference without treatment based on what he or she will be doing. Will symptoms interfere with participation in camp activities or playing with other kids? Will behaviors interfere with family activities including any travel plans? Can your child focus to do summer reading, reinforce math facts, practice writing or keyboarding skills? Without medication, will your child be in trouble frequently, be yelled at, put in “time out” or told to change his or her behavior constantly?

Medication to treat ADD/ADHD is used so children can be successful in their endeavors, not to make things easier for the adults around them. Sometimes, medication may be needed over the summer, but at a lower dose or for a shorter duration of action than during the school year. These options can also be explored when discussing the medication plan for the summer. Although most medications used for ADD/ADHD can be stopped and re-started when needed, there are some that need to be slowly discontinued or re-started over a few weeks. If the summer medication plan differs from the school year plan, it may be advisable to return to the school year plan before the first day of school. This way, there are not two big changes on the same day. Before making any changes in your child’s medication plan, always discuss medication concerns with your child’s prescribing physician.

About Annapolis Pediatrics:
For almost 70 years, Annapolis Pediatrics has provided superior healthcare to infants, children, adolescents, and young adults in Annapolis and the surrounding communities. In some cases, we have cared for three generations of families. We strive to provide high quality medical care, from excellent clinical care to a positive customer experience for our patients and their parents.

We have over 30 physicians and nurse practitioners in 5 locations: Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. We also offer Monday through Friday walk-in hours at our Annapolis office for short sick visits.

For more tips and information from your local pediatrician, visit us at:
Website: https://annapolispediatrics.com/
Facebook: https://www.facebook.com/AnnapolisPediatrics/
Twitter: https://twitter.com/AnnapPeds
Instagram: https://www.instagram.com/AnnapolisPediatrics/

 

Progression of Illness: When It’s Not What You Thought It Was

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Since I’ve started this digital gig, I’ve had the opportunity to read a lot of healthcare patient feedback: reviews of doctors, physician assistants, and nurse practitioners, commentary on urgent care offices and hospitals, and opinions on nurses and reception staff. Lots of people report on things like cleanliness of surroundings and wait times and throughput. There are a fair number of comments about staff attitudes and “tone”. But I’m not going to talk about those aspects in particular today. Believe it or not, many of those topics I’ve just named are fairly straightforward to address: people can be given feedback to pay more attention to their behavior and to improve communication skills, and the facilities issues are mostly easily rectified. Billing disputes are typically solved after varying degrees of investigation.

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I also read occasional comments about “missed diagnoses” in the acute care setting.

Every now and again I’ll read a frustrated review from someone who sought medical care one day and was given a diagnosis, only to obtain a different one the next from another physician. Or an upset parent who got the news that his child had an ear infection a day after they were seen elsewhere and told that the ears looked clear. These situations require a more complex dissection, and each and every one of them must be reviewed and analyzed in detail to search for any discrepancy of standard of medical care. And they do happen, as we all know. Medicine is far from perfect. I’m sure that the term frustration doesn’t even BEGIN to describe how this must feel on the patient/family side of things. I can vouch for this personally.

What I DO want to highlight in these few paragraphs is the concept of “progression of illness”

and how that causes a lot of tough breaks and is at the heart of many negative reviews and bad feelings about various healthcare encounters, though I’m not sure it should be. I know it sounds obvious to state that “things change,” but clinical scenarios do. Diseases evolve, big and small. It’s really true that on a Tuesday night a child’s ears could look clear as day and by Wednesday they are red and fluid-filled. Or that the lungs sound great on Friday but by Sunday morning there’s an audible pneumonia. So progression of illness is the term we use when a disease takes its typical course. Kind of like a timeline. And on that timeline there’s an early, middle and late phase. The hard part about snapshot diagnostics, when clinicians only see patients once and briefly at that, is that if you catch someone on the early phase of a disease timeline, there’s a chance that an accurate diagnosis will be missed. Thankfully this doesn’t happen all that often.

There are several reasons to be careful about pulling the definitive diagnostic trigger too soon in the early phase of an illness.

For example, in the case of possible infection, incorrectly calling it “bacterial” and thus prescribing antibiotics too early can actually do more harm than good if the infection turns out to be a simple self-resolving virus. It won’t help a person get better any quicker, can potentially have some unpleasant side effects, and fosters the growth of antibiotic resistant superbugs. A little bit of “expectant observation” often allows for better accuracy, even if it means taking time out of busy schedules for another healthcare check. I understand the potential financial impact of this, which must be weighed into the equation, but I still stand behind the belief that doing the right thing medically should take precedence.

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Another example is the decision whether or not to give intravenous (IV) fluids to a child with the stomach flu. Nearly everyone who gets the stomach flu has some degree of dehydration, and I’ve seen situations where an IV is expected yet not necessarily indicated. Dehydration is a spectrum, and it’s nearly always better to use the stomach to rehydrate if at all possible, meaning to hydrate by drinking in frequent small sips or sucking on an ice cube. This can be slower and often takes more work than rapidly infusing some saline into someone’s veins, but in the end it avoids a needle-stick and helps keep the intestines at work. The tricky part in this scenario is being able to guarantee that a person will be successful at rehydrating by mouth: it’s impossible to predict. Sometimes that queasy feeling subsides sooner rather than later and tolerating fluids goes better, but sometimes not. Regardless of direction, there has been progression of illness, and as a result of that progression, a different therapeutic direction may need to be taken. No one’s fault, it just is.

I bring up the topic of progression of illness today because it’s what I ask myself every time I read a review or post or commentary or survey response that includes details about a delayed or missed diagnosis. “Could this have been simply part of the progression of illness?” is a worthwhile question, and I hope by bringing it up today it’s a question that you’ll ask too as you come across reviews and posts in the digital space.

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What can YOU do?

1. Ask your provider the question about progression of illness. Know what to expect in general, recognizing that every situation is slightly different.

2. Establish a plan of action at your first medical visit for what to do if things seem to be worsening. Are there specific signs to watch out for?

3. Know what else your clinician is thinking about in regards to your specific case. What other diagnoses are on the list? How will the determination be made, and does it matter (i.e. will it affect treatment)?

4. Don’t be afraid to call your provider if you have questions after your visit. He/she may tell you to come back in for evaluation or may be able to direct you right at home. Speaking from experience, we always want to help to provide the best care possible.

I’m not trying to make excuses for medical care that doesn’t measure up, or make light of the fact that it is often difficult, usually time-intensive, and frequently expensive to have more than one medical visit for an acute issue, but what I am trying to say is that progression of illness is always at play and sometimes the clinical care dictates some step by step management with observation and evolution in between. Being mindful of this amidst the plethora of commentary by understandably stressed and concerned people when considering various healthcare environments is important in the spirit of fostering the most positive clinician-patient relationships possible.

And THAT, I know, is good for everyone’s health.

Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics and author of the blog, Dear Dr. Christina. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.

Dr.ChristinaJohns

Follow Dr. Christina online for everyday health tips, insightful articles and more.
Blog: https://www.pmpediatrics.com/dear-dr-christina/
Facebook: https://www.facebook.com/DrChristinaJohns/
Instagram: https://www.instagram.com/deardrchristina/
Twitter: https://twitter.com/DrCJohns
Pinterest: https://www.pinterest.com/deardrchristina/

Visit PM Pediatrics in Annapolis
Festival at Riva Shopping Center
Phone: 410-266-6767

PM Pediatrics is the specialized urgent care just for kids from cradle through college. Open every day until midnight, the practice’s kid-friendly themed offices are staffed by Pediatric Emergency Specialists and feature on-site digital X-ray and lab. PM Pediatrics treats a broad array of illnesses and injuries – from earaches, fevers, infections and abdominal pain to dehydration, asthma, fractures and wounds requiring stitches. The result is the highest quality after-hours pediatric care, delivered with comfort and convenience to both patients and their parents. To learn more about PM Pediatrics’ services and locations, visit pmpediatrics.com.

 

Breastfeeding and Returning to Work

By Kendra Nagey, CPNP, IBCLC at Annapolis Pediatrics

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Returning to work after maternity leave can be very difficult – it’s emotional for some, a logistical dilemma for others, and yet another big life change for everyone. For those mothers who are returning to work and also hope to continue breastfeeding their babies, pumping while you are away from your baby presents another complication.

As a Certified Pediatric Nurse Practitioner (CPNP) and an International Board Certified Lactation Consultant (IBCLC), I frequently encounter mothers who have questions about HOW breastfeeding after maternity leave actually works. I am often asked questions such as, “When do I pump?”, “How much should I pump?”, “What do I need to pump?” and “What do I do with pump parts when I’m at work?”

First, let’s review the goal of pumping. There are many reasons that mothers pump; however, the main reasons are usually to maintain your milk supply when you are away from your baby and to ensure that your baby continues to receive expressed breast milk while under the care of others.

Schedule: It’s important to think about pumping a few weeks before you actually return to work. Specifically ask yourself, what kind of flexibility will you have in your schedule? Where will you be able to pump, i.e. is there a private office available? Do you need to leave your desk to go to a lactation room or mothers’ lounge? If you have a flexible schedule and are able to pump whenever your baby typically feeds, transitioning from breastfeeding to pumping can be fairly straightforward. Unfortunately, this is not the case for everyone. Teachers, for example, may need to pump during their planning periods or lunch. Other professions might need to schedule meetings around their pumping time. Ideally, nursing mothers should be pumping every three hours while they are away from their baby.

Volume: Duration of these pumping sessions will vary from mother to mother; however, you should anticipate that pumping to empty your breasts will take fifteen to twenty-five minutes. The volume pumped during this time will also vary from mother to mother. A general rule of thumb is that your baby will require one ounce of expressed breast milk (EBM) for every hour that you are away from him or her. So, if between your commute and your work day, you are away from your baby for 9 hours, it can be expected that your baby will need 9 ounces of EBM.

Supplies: I highly recommend use of a double-electric breast pump. If you do not have a pump already, call your insurance company to inquire about which pumps are available to you through your policy. A good pumping bra makes things a lot easier (I tend to recommend the bras that actually attach to your nursing bra/camisole as opposed to the separate garments). Another consideration is how to clean your pumping parts between pumping sessions. As per the CDC, it is NO LONGER advised to put used pump parts in the refrigerator until their next usage. Instead, pump parts should be cleaned with soap and hot water and air dried between each use. If this will be difficult for you, it might be worth investing in addition assemblies for pumping. Finally, consider how you will be able to store your EBM until your return home. You might have a refrigerator available to you or you might need to bring a portable cooler with you to work. Please see the CDC website for up-to-date guidelines regarding the proper storage of EBM (https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm).

Mindset: Like anything else, sometimes it takes a little trial and error to get into a good rhythm with routines – pumping is no different! Pumping can be frustrating, annoying, and sometimes emotional, but it can also be very rewarding. Remember, the point of pumping is to help you meet your individual nursing goals! For some mothers, getting into the right state of mind can actually benefit their pumping. For example, instead of catching up on email while you pump, can you take a minute to look at pictures or videos of your baby? Can you call their caregiver to check in? The release of breastmilk is, in part, mediated by oxytocin – our “love hormone.” Taking a moment to foster the release of this hormone may help you meet your pumping goals.

Hopefully, this basic introduction to pumping at work is helpful. If you have additional questions or concerns, please contact your primary care provider or an IBCLC.

About Annapolis Pediatrics:
For almost 70 years, Annapolis Pediatrics has provided superior healthcare to infants, children, adolescents, and young adults in Annapolis and the surrounding communities. In some cases, we have cared for three generations of families. We strive to provide high quality medical care, from excellent clinical care to a positive customer experience for our patients and their parents.

We have over 30 physicians and nurse practitioners in 5 locations: Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. We also offer Monday through Friday walk-in hours at our Annapolis office for short sick visits.

For more tips and information from your local pediatrician, visit us at:
Website: https://annapolispediatrics.com/
Facebook: https://www.facebook.com/AnnapolisPediatrics/
Twitter: https://twitter.com/AnnapPeds
Instagram: https://www.instagram.com/AnnapolisPediatrics/

Bedwetters Anonymous

You know what’s great? That my 8 year old is not totally stressed out that she is still an occasional bed wetter. It happens to her about once every six months, and the way I’ve explained it to her is that she gets into such a deep sleep that she doesn’t even realize that it is happening until it does. She’ll tell me by saying, “Mom, I was in a really deep sleep last night....” And I know what’s coming.

Benign bed wetting is fairly common and can make kids quite anxious and avoid sleepovers and other situations where this might happen. When talking to patients & parents about this topic I think it’s important to get out of the way IMMEDIATELY actual physical causes of bedwetting—like urinary tract infections. Medical causes do happen, as do psychological ones—like a significant life change for a child— a new sibling, parent divorce, move, or other transition. And these are all important. But once these causes have been considered, then you’re back to my 8 year old, a random, occasional bedwetter.

Some kids wet the bed very regularly and there are some strategies that can be really helpful to aid in decreasing the number of sheets washed per week, such as:
• Limiting fluids by mouth after 6pm
• Waking them up for a bathroom trip once in the middle of the night
• Even trying out one of those bedwetting alarms can help make families’ lives much easier when they are dealing with this.

Older kids do NOT want to sleep in a pull up so I really recommending trial and error of some of the other strategies to help kids manage. One pediatrician colleague told me “kids won’t go to college as bedwetters” and I’ve repeated this over and over to try and reassure people far and wide that it’s simply a matter of time before it’ll all be in the rear view mirror.

Occasional bed wetting does seem to run in families, and most kids totally outgrow it by the time they are teenagers. For the “rare” or “occasional” crowd, I generally suggest NOT MAKING A BIG DEAL ABOUT IT. At all. I can guarantee that kids are never happy that it happens so there’s really no need to pile on here. The less anxiety, the better.

If you’re reading this and have experience in this area, I hope you’ll comment and share what you know; what has worked and what hasn’t. If you’re new to this gig I really suggest trying the “deep sleep” explanation: it shifts any and all blame from the child and puts it into some perspective for them. I’ve known kids who wet their beds up until 12 or 13 years old. They’re in college now, and you know what? They’re fine. And sleeping in a dry bed each night.

Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.

Dr.ChristinaJohns

Follow Dr. Christina online for everyday health tips, insightful articles and more.
Blog: https://www.pmpediatrics.com/dear-dr-christina/
Facebook: https://www.facebook.com/DrChristinaJohns/
Instagram: https://www.instagram.com/deardrchristina/
Twitter: https://twitter.com/DrCJohns
Pinterest: https://www.pinterest.com/deardrchristina/ 

PM Pediatrics: Now Open in Annapolis
Festival at Riva Shopping Center
410-698-6918

PM Pediatrics is the specialized urgent care just for kids from cradle through college. Open every day until midnight, the practice’s kid-friendly themed offices are staffed by Pediatric Emergency Specialists and feature on-site digital X-ray and lab. PM Pediatrics treats a broad array of illnesses and injuries – from earaches, fevers, infections and abdominal pain to dehydration, asthma, fractures and wounds requiring stitches. The result is the highest quality after-hours pediatric care, delivered with comfort and convenience to both patients and their parents. To learn more about PM Pediatrics’ services, visit pmpediatrics.com.

 

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Upcoming Events Inside Pages

Thu Jun 21, 2018 @12:00AM
Columbia Festival of the Arts
Thu Jun 21, 2018 @ 9:30AM
World's Largest Swim Lesson, Chesapeake Beach
Thu Jun 21, 2018 @10:00AM
Public Archaeology Day
Thu Jun 21, 2018 @ 6:30PM
Twilight Thursdays on the Row, Owings Mills
Thu Jun 21, 2018 @ 7:00PM
Tides and Tunes: Summer Concert Series
Fri Jun 22, 2018 @12:00AM
Columbia Festival of the Arts
Fri Jun 22, 2018 @ 4:00PM
Summer Fridays, National Harbor
Fri Jun 22, 2018 @ 6:00PM
Chocolate Making Class, Washington
Fri Jun 22, 2018 @ 7:00PM
Friday Night Summer Concert Series, Annapolis
Sat Jun 23, 2018 @12:00AM
Columbia Festival of the Arts