Children have been getting lice for centuries.Peter Power/The Globe and Mail
School is just around the corner, I can hardly believe it. My "big kid" is heading into senior kindergarten, and our middle son into nursery this year. I don't fret about them meeting new friends or loving their new teachers. But I do worry about what they will be exposed to daily. As a pediatrician I am all too familiar with the different germs that will prevent them from going to the place they love.
There are a handful of common infections that we doctors count on seeing each fall. Here are the top infections to look out for:
HAND, FOOT AND MOUTH DISEASE
Despite the scary name, hand, foot and mouth disease (HFMD) is a generally benign viral infection that goes away on its own without the need for antibiotics. HFMD is also known as herpangina, typically affecting children during the fall and summer months. Though it usually affects young children, it can occur in older kids and even adults.
What does it look like?
Hand, foot and mouth disease causes rashes in the mouth, hands, feet and sometimes the rest of the body. Symptoms include: small pimple-like lesions in the throat and mouth (vesicles), ulcers on the tongue and in the mouth, small blister-like rashes on the palms and soles, groin and diaper-area rash, fever, decreased appetite and fussiness.
What causes it?
A virus called coxsackie causes HFMD. It is very contagious and is spread through coughing and contact with saliva.
What can I do?
Since it is a virus, antibiotics will not help. Fortunately, it will go away in approximately a week or so (about as long as the common cold). If your child experiences a decreased appetite, likely because his or her mouth may be sore, you'll find that cold, bland and non-acidic foods and drinks can help (e.g. yogurt, Popsicles and ice cream). For the pain, I recommend ibuprofen or acetaminophen. Viscous lidocaine mouthwash, available by prescription, can also help sooth the ulcers in the mouth if your child can swish and spit. Ensure you see your pediatrician or family doctor if your child is not drinking enough.
STOMACH FLU (GASTROENTERITIS)
Most of us have been there; stuck in the washroom with diarrhea and/or vomiting. It is miserable. This is the stomach flu.
What does it look like?
Symptoms include: watery diarrhea, nausea, decreased appetite, vomiting, headache, muscle aches, fever and abdominal cramps
What causes it?
Gastroenteritis is typically causes by viruses, such as rotavirus and norovirus. Unfortunately, the viruses that cause stomach flu are prevalent in schools, as children are sometimes not so effective at cleaning their hands after using the washroom. Some bacteria cause gastroenteristis including E. coli and salmonella, though these are often associated with bloody diarrhea. Parasite infections can cause diarrhea as well.
What can I do?
As most of these infections are viral, antibiotics do not help clear the infection. With time, the virus will leave the body. Ensuring hydration is paramount. Your child can drink small amounts of fluid often, such as 10-15 ml every 20-30 minutes. If needed, I recommend using a syringe if your child will not drink on his or her own. A solution with water, salt and sugar is required to prevent dehydration, so consider breast milk, formula or an electrolyte solution such as Pedialyte. Intravenous fluid is rarely needed. See your doctor if your child is dehydrated, having bloody diarrhea, vomiting, or you have recently travelled (and are therefore more at risk of a bacterial or parasitic infection).
EAR INFECTIONS
Ear infections are one of the most common illnesses I see. Many kids present with fever and irritability, others have obvious ear pain and are pulling or rubbing their ears.
What does it look like?
Rubbing or pulling the ears, fever, irritability, decreased appetite, trouble hearing, fluid or blood coming from the ear
What causes it?
Most ear infections are viral in nature, stemming from fluid accumulation behind the eardrum. This fluid causes pressure and inflammation. Occasionally, bacteria grows in this fluid, leading to persistent symptoms which require treatment.
What can I do?
As most ear infections are viral, we take a watch-and-wait approach. Children older than six months can wait on using antibiotics for two to three days. If the infection persists, antibiotics can be used.
LICE
Many of us remember lice infections from when we were in school. These infections have been around for centuries, wreaking havoc on our kids' (and sometimes our) heads!
What does it look like?
Lice cause the scalp to be itchy.
What causes it?
Lice are tiny insects that live on the skin and feed on blood. Once on the surface of the skin they cause itching due to irritation from their saliva. Lice lay their eggs on the surface of the hair; these are called nits. Lice spread by hair contact. Children who share their brushes, hats or pillows are at risk of getting infested. Lice are unable to jump or fly and require direct contact to cause infection.
What can I do?
Treatment for lice regularly involves using medications applied to the hair and scalp. These medications have to be applied twice, seven to 10 days apart to kill off the lice and nits that are in different stages of the life cycle. I recommend washing brushes, hats, bedding, clothes and toys in hot soapy water or placing these items in a tight plastic bag for two weeks. Ask your doctor which medication to use, as some are not recommended in younger children. Services that provide manual removal of lice and nits may be helpful. Many parents try to apply oils, vinegar or even mayonnaise to "kill" the lice. Unfortunately, these "remedies" have not been proven to be useful.
PINK EYE (CONJUNCTIVITIS)
We've all seen it: red, sticky and irritated eyes. Pinkeye, or conjunctivitis, is inflammation of the membrane (conjunctiva) that covers the white part (sclera) of the eye.
What does it look like?
Inner eye and eyelid redness, itchy eyes, clear, yellow or green eye discharge, limited eyelid swelling, which may be accompanied by a stye.
What causes it?
Pink eye is most often caused by a virus, though bacterial infections, allergic or chemical irritation can also cause conjunctivitis. Conjunctivitis is very contagious. Even brief contact with the virus or bacteria, and then touching the eyes can lead to conjunctivitis.
What can I do?
Viral conjunctivitis Viral pink eye usually lasts one to two weeks and does not require treatment. It will resolve on its own. Some children get relief from using warm compresses or saline eye drops.
Bacterial conjunctivitis See your physician if you think your child has bacterial pink eye. This will improve with antibiotic eye drops or ointment. Symptoms usually improve within one to two days.
Allergic conjunctivitis Saline drops, allergy eye drops or oral antihistamines can help resolve your child's allergic pink eye.
So, how do I prevent these infections from ruining our back-to-school season? We focus a lot on hand hygiene in our house. When my kids get home, they immediately head to the washroom to wash their hands. We take sanitizer wipes with us to the park and play dates. My kids know to keep their hands off their faces to prevent pesky bugs from entering.
Reality is, kids are kids and will get sick sometimes. But we can aim to prevent a few illnesses a year if we are lucky.
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Take action against illness
Thankfully, there are some preventive measures you can take to avoid bringing these illnesses into your home.
Keep hands clean
I know you've heard it a million times, but washing your hands with soap and water – and doing it often – or using a sanitizing gel or spray really does decrease the risk of getting viral and bacterial infections. Always wash your hands and your child's hands before eating. Teach your children to wash for 20 seconds or more (as long as it takes to sing Happy Birthday twice) and model this same healthy behaviour to them. They will be more likely to follow suit.
Hands off the face!
Teach your children to avoid touching their nose, mouth, and eyes whenever possible. This is how bacteria and viruses take hold, by entering your body through these areas.
Keep surfaces germ-free
Viruses and bacteria can live on surfaces for hours or even days. Public areas such as playgrounds, washrooms and door handles are likely covered in illness-causing germs. You can't count on everyone to be as diligent as you are at washing. Consider cleaning these surfaces often (and encourage others to do the same), or keep hand sanitizers close by and ready to use after you use public places. Antiseptic wipes are great to keep on hand when you are out with your children.
Exercise regularly
Making sure you and your children are getting your heart rates up every day
(ideally for at least 60 min) can help stave off illness. Your hearts will become stronger and your immune systems will be better able to fight infection if you are healthy and active.
Dr. Dina Kulik is a pediatrician in Toronto and provides child health information to parents and the public through television, radio, print media and her blog. Follow her on Facebook and Twitter.