Village Pediatrics
Fall Newsletter
September  2012- Vol 4, Issue 3
In This Issue
Colic
Nose Bleeds
Coughing and colds
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Facts About the West Nile Virus
mosquito Summer is carrying over in our area in the form of mosquitos, which seem to be as ubiquitous as backpacks and yellow school buses this September.  Several towns have reported mosquitos positive for the West Nile virus, which sounds scary, but is actually, for the majority of children, a very mild illness.  In fact, about 80% of people who contract the virus are assymptomatic.  Since WN is a virus, the main treatment is supportive therapy such as fever reducers and fluids.  For more information on the prevention of mosquito bites, and details on West Nile Virus, click here.
New Infant Acetaminophen Dosing
Infant acetaminophen drops, formerly concentrated (80 mg/0.8 ml), are now acetaminophenbeing made in the same concentration as the older child liquid formula (160 mg/5 ml).  This means that infant's acetaminophen is now THE SAME as children's, only the measuring device differs (dropper versus a measuring cup.) 

If you are unsure of your child's dosage, please consult our website for directions based on your child's weight and the concentration listed on the medication bottle.
The Period of Purple Crying

New parents take notice: there is a new phrase in town, "The Period of PURPLE Crying®."  This describes the time in a baby's life when they cry more than any other time. This period of increased crying is often described as colic, but there have been many misunderstandings about what "colic" really is.  While a very small percentage of infants have an identifiable cause of their crying (milk allergy, reflux) the majority of infants are healthy and normal. 

 

baby crying
The Period of PURPLE Crying is a new way to help parents understand this time in their baby's life, which is a normal part of every infant's development .  The acronym PURPLE stands for: P- Peak of crying (starts around 3 weeks, peaks at 2 months, abates around 3-4 months), U- Unexpected (crying comes and goes for no apparent reason),  R- Resists soothing, P- Pain-like face (babies appear to be in great pain, even when they are not), L-Long lasting (as much as 5 or more hours a day),  E- Evening (late afternoons and evenings are often the worst time of day, exactly when parents are also often most fatigued.)


We encourage ALL new parents to take a look at this website, which covers all aspects of crying from infant sleep recommendations to soothing methods and sources of support. The pediatricians at Village Pediatrics recognize that this can be an extremely stressful period of your infants life, and encourage you to talk with us if you are having trouble coping with your infant's fussing. 
 Nosebleeds (Epistaxis)
nosebleeds

What causes nosebleeds?  The purpose of the nose is to warm and humidify the air that we breathe in. The nose is lined with many blood vessels that lie close to the surface where they can be injured and bleed. Once a vessel starts to bleed, the bleeding tends to recur since the clot or scab is easily dislodged. Nosebleeds, called epistaxis, can be messy and even scary, but often look worse than they are. Many can be treated at home, but some do require medical care.
 

Most nosebleeds occur in the lower, inner, anterior portion of the nose (the nasal septum) where multiple blood vessels meet to form the Kiesselbach's plexus (see picture.)  Common causes of nosebleeds in children include:

  • Dry, heated, indoor air, which dries out the nasal membranes and causes them to become cracked or crusted and bleed when rubbed or picked or when blowing the nose (more common in winter months)
  • Dry, hot, low-humidity climates, which can dry out the mucus membranes
  • Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and nose blowing
  • Vigorous nose blowing or nose picking
  • The insertion of a foreign object into the nose (we have seen legos, crayons, peas...)
  • Injury to the nose and/or face
  • Allergic and non-allergic rhinitis (inflammation of the nasal lining)
  • Tumors or inherited bleeding disorders (rare)

How are nosebleeds stopped?

Follow these steps to treat a nosebleed:

  • Have your child sit with her head slightly forward. This will keep the blood from running down the throat, which can cause nausea and vomiting. Do NOT have your child lay flat or put her head between her legs.)
  • Have your child breath through her mouth.
  • Use a tissue or damp washcloth to catch the blood.
  • Use your thumb and index finger to pinch together the soft part of the nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop bleeding.
  • Keep pinching the nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If the nose is still bleeding, continue squeezing for another 10 minutes.
  • You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then hold apply pressure to the nose as described above. WARNING: These topical decongestant sprays should not be used for more than 2-3 days.)
  • For several days after a nosebleed (or on a regular basis if your child tends to have nosebleeds frequently) apply Vaseline with a cotton swab to the inner, lower third of each nostril to help protect the mucosa from drying out and rebleeding.

When should your child be seen for nosebleeds?

  • Bleeding persists after more than 15 to 20 minutes of applying direct pressure.
  • Repeated episodes of bleeding.
  • The bleeding is rapid or the blood loss is large (exceeds a coffee cupful).
  • The bleeding was caused by an injury, such as a fall or other blow to the nose or face, and is not easily stopped.
  • The blood goes down the back of your child's throat rather than out front through the nose even though she is sitting down with body and head leaning slightly forward. (This may indicate the rarer, but more serious, "posterior nosebleed," which almost always requires a physician's care. This condition occurs more frequently in older people).
  • Nosebleeds accompanied by unusual bruising all over the body, or other types of bleeding (heavy periods, frequent bleeding with toothbrushing, etc.)

How to prevent nosebleeds:

  • Use a saline nasal spray or saline nose drops two to three times a day in each nostril. These products can be purchased over-the-counter or made at home. (To make the saline solution at home: mix 1 teaspoon of salt into 1 quart of tap water. Boil water for 20 minutes, cool until lukewarm.)
  • Add a humidifier to your furnace or run a humidifier in your child's bedroom at night.
  • Place water-soluble nasal gels or ointments in your nostrils with a cotton swab. Bacitracin®, Vaseline®, or Ayr Gel® are examples of over-the-counter ointments that you can use. These gels and ointments can be purchased in most pharmacies.
  • Teach your child to sneeze through an open mouth (into the crook of the arm.)
  • Teach your child not to put anything into their nose, including fingers and cotton applicators.
  • If nosebleeds seem to worsen with allergen exposure (pollens, molds, animal dander) your child may need a prescription nasal spray- please call for an appointment.

 

 

How to Treat a "Hack Attack"

 

coughWith fall and winter quickly approaching, the dry cough seems to be coming along for the ride.  This pesky symptom is often the result of a post nasal drip or irritated throat, and can be the cause of many school and nighttime disruptions.  Here are a few simple things you can try at home:

 

1) An extra pillow (under the mattress if your child is still in a crib).

2) Try steaming up the bathroom and bathing your child in the warm, moist air.

3) Sipping warm soothing liquids(ie: decaffeinated teas) throughout the day.

4) A teaspoon of honey for children over the age of 1.

5) Nonmedicated cough drops for older children only.

 

Note that over the counter cough medications have not been scientifically shown to actually help with cough symptoms in children.  We strongly discourage the use of such medications in younger patients.   Children 6 and older may benefit from a single ingredient cough medicine with dextromethorphan if non-medical interventions are not working.

 

If none of these offer any relief or your child has other symptoms such as fever or difficulty breathing then please give our office a call.  

 

For more information on the symptoms and treatment of the common cold visit our website article

 
 
Influenza Vaccine Now Available

We now have in stock both injectable and nasal mist (FluMist) 2012 Influenza Vaccine for everyone.  We are administering the vaccine at either regularly scheduled physical exam appointments, or during one of several flu clinics we will have throughout the season.

The Academy of Pediatrics (AAP) recommends that all children receive the influenza vaccine yearly.  This vaccine is effective for at least one year, so get your children immunized early while we still have ample supply.

Children under the age of 2, or those with moderate to severe asthma or other chronic immunosuppressive medical condition, should receive the injectable flu vaccine.

Healthy children ages 2 and older can receive the nasal spray form of vaccine (FluMist.)

Children less than 9 years of age who have only had one or no previous flu vaccinations before need two doses this year, spaced at least 1 month apart.

Healthy adults may also receive vaccine at our office.  There will be a cash charge of $45 for the vaccine and its administration.  If you are 49 years of age or younger, you can get FluMist.  If you are on immunosuppressive therapy, have asthma or other chronic medical condition, you must get the injectable form of the vaccine.

Wishing you a healthy autumn..

Dr. Jenn, Dr. Nikki & Dr. Robin
Village Pediatrics LLC

 

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Village Pediatrics | 156 Kings Highway North | Westport | CT | 06880