What to Do About the Quillivant XR Shortage?

Does your child with ADHD take Quillivant XR?

quillivant-xr-shortage

Then you likely hopefully aware that there is a shortage of Quillivant XR because of a manufacturing delay.

What Is Quillivant XR?

Quillivant XR is another stimulant that is used to treat kids with ADHD.

Like many other ADHD medications, the main ingredient in Quillivant XR is methylphenidate – the main ingredient in Ritalin.

The big difference is that Quillivant XR is an oral suspension or liquid form of methylphenidate.

What to Do About the Quillivant XR Shortage?

So what do you do if you can’t get Quillivant XR for your child?

There are plenty of other ADHD medications

You will likely want to stay on something similar though, which will mean another long acting stimulant with methylphenidate, such as Aptensio XR, Concerta (Methylphenidate ER), Cotempla XR-ODT, Daytrana (patch), or Quillichew ER (chewable tablet). Metadate CD, Metadate ER, and Ritalin LA are other forms of methylphenidate, but they only last about 8 to 10 hours vs the 10 to 12 hours of all of those other long acting ADHD medications. Focalin XR (dexmethylphenidate) would likely be another alternative.

Unfortunately, there are no other liquid forms of methylphenidate. Except for Concerta and Metadate CD, you can open and sprinkle the contents of these capsules on applesauce if your child can’t/won’t swallow pills though.

You can also try and teach your child to swallow pills…

Best Alternatives To Quillivant XR

In reality, you probably don’t have that many options.

Your child is likely taking Quillivant XR because he couldn’t learn how to swallow pills, won’t take medications if you open and sprinkle them on things, and didn’t tolerate Daytrana (the methylphenidate patch).

That still leaves you with a couple of good options, including:

  • Quillichew ER – a chewable form of methylphenidate available in 20mg, 30mg, and 40mg chewable tablets (was under backorder, but that seems to have been resolved)
  • Cotempla XR-ODT – an oral disintegrating tablet form of methylphenidate available in 8.6mg, 17.3mg, and 25.9mg tablets

The main difference between all of the different forms of methylphenidate?

Surprisingly, it’s not only if it is a liquid, capsule, or pill. They all have different time release mechanisms that affect how your kids get the medication.

Quillivant XR, for example, uses a 20/80 time release delivery system. That means that your child gets 20% of the dose immediately and then 80% throughout the rest of the day. Ironically, because it is only available in a pill that can’t be crushed or opened, the closest medicine to that delivery system is Concerta, with its 22/78 system.

Cotempla XR-ODT is close, with a 25/75 delivery system.

Quillichew ER uses a 30/70 delivery system.

Aptensio XR uses a 40/60 system and some others, like Focalin XR use a 50/50 system.

Why does any of this matter?

If your child was doing great on Quillivant XR and you switched to another medicine using an equivalent dose of methylphenidate, they will be getting that dose delivered to them differently throughout the day. While that might be okay, it could also mean that your child is now starting the day off with either too much medicine (watch for side effects) or is getting too little medicine later (watch for decreased effectiveness). And that will mean some extra fine tuning of your child’s medication until Quillivant XR is available again.

Is your child due for a refill of his Quillivant XR? It’s probably time to look at your alternatives until the shortage is fixed.

What to Know About the Quillivant XR Shortage

Quillivant XR is a long acting form of methylphenidate that is available in a suspension form, so is easy for kids with ADHD to take if they can’t swallow pills, at least it is when there isn’t a shortage.

More About the Quillivant XR Shortage

How Long Are You Contagious When You Have the Flu?

Do your kids have the flu?

When their kids have the flu, one of the first questions most parents have, after all of the ones about how they can get them better as quickly as possible, is how long will they be contagious?

How Long Is the Flu Contagious?

Technically, when you have the flu, you are contagious for about a week after becoming sick.

And you become sick about one to four days after being exposed to someone else with the flu – that’s the incubation period.

“Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.”

CDC on Information for Schools

That’s why the flu spreads so easily and it is hard to control flu outbreaks and epidemics once they begin.

Most school closures are not to prevent the spread of the flu and clean the school, but simply because so many kids and staff are already out sick.
Most school closures are not to prevent the spread of the flu and clean the school, but simply because so many kids and staff are already out sick.

Another reason it spreads so easily is that most people are contagious the day before they even begin to develop flu symptoms!

And again, they then remain contagious for another five to seven days.

When Can You Return to School with the Flu?

Does that mean kids with the flu have to stay home for at least seven days?

Not usually, unless they have a fever for that long, or severe flu symptoms, which is definitely a possibility for some kids with the flu.

“Those who get flu-like symptoms at school should go home and stay home until at least 24 hours after they no longer have a fever or signs of a fever without the use of fever-reducing medicine.”

CDC on Information for Schools

In general, as with many other childhood illnesses, you can return to school or daycare once your child is feeling better and is fever free for at least 24 hours.

Keep in mind that even if they don’t have a fever, if your child still isn’t feeling well and isn’t going to be able to participate in typical activities, then they should probably still stay home.

But Are They Still Contagious?

Many childhood diseases have contagious periods that are far longer than most folks imagine. That’s because we continue to shed viral particles even as we are getting better, and sometimes, even once we no longer have symptoms.

Teach your kids proper cough etiquette to help keep cold and flu germs from spreading.
Teach your kids proper cough etiquette to help keep cold and flu germs from spreading.

For example, some infants with rotavirus are contagious for up to 10 days and some with RSV are contagious for as long as 4 weeks!

Like the child with flu that doesn’t have a fever, that doesn’t mean that these kids have to stay out of school or daycare for that whole time. But since they are still contagious, it does raise the issue of what to do about non-essential activities.

Should you keep going to playdates after your child had the flu? How about the daycare at church or the gym?

In general, you should probably avoid non-essential activities while your kids are still recovering from an illness, even if they feel better, because they are likely still contagious.

Most parents have the expectation that their own kids won’t be exposed to someone who is sick in these settings.

So you probably don’t want to bring your sick kid to a playdate or birthday party, etc., even if he is already back in school or daycare.

And whether they have a cold or the flu or another illness, teach your kids to decrease their chances of getting sick by washing their hands properly, not sharing drinks (bring a water bottle to school), and properly covering their own coughs and sneezes. They should also learn to avoid putting things in the mouth (fingers or their pencil, etc.) or rubbing their eyes, as that helps germs that could have made their way onto their hands get into their body and make them sick.

What to Know About Staying Home When You Have the Flu

Although your child may be contagious with the flu for up to a week, your child only has to stay home from school or day care until they are feeling better and are fever free for at least 24 hours.

More About Staying Home When You Have the Flu

 

Warning Signs of a Severe Case of the Flu

We all know the classic signs and symptoms of the flu.

They can include the sudden onset of:

  • fever
  • chills
  • cough and chest discomfort
  • headaches
  • fatigue
  • body aches
  • runny nose
  • sore throat

And these symptoms usually last a few days to a few weeks, with the worst of them lasting about five to seven days.

Warning Signs of a Severe Case of the Flu

But what if you don’t just have a classic case of the flu.

While many of the stories of this being the worst flu season are media hype, the flu is always dangerous and this is a severe flu season.

That makes it important to be able to recognize severe flu symptoms or signs that someone with the flu needs immediate medical attention, including:

  • having trouble breathing or fast breathing
  • being unable to eat and drink and getting dehydrated (dry mouth, urinating less, or fewer wet diapers, etc.)
  • not waking up easily
  • being inconsolable or so irritable that your child does not even want to be held
  • having chest pain
  • is suddenly dizzy
  • being confused
  • having seizures
  • having severe vomiting

You should also seek medical attention if your child was getting better, but then got worse again, especially if they again develop a fever and a worsening cough. Or if your child has a chronic health problem, like asthma or diabetes, and the flu is making it hard to control.

How will your child be treated? It depends, on treatments might include oxygen, IV fluids, antiviral medications, and antibiotics (if there is a secondary bacterial infection), etc.

And remember that children under the age of two to five years and those with chronic health conditions, such as asthma, diabetes, neurologic and neuromuscular conditions, and heart disease, etc., are most at risk for severe flu complications.

In four of the last deadliest flu seasons, at least half of the kids had no underlying medical conditions.
In four of the last deadliest flu seasons, at least half of the kids had no underlying medical conditions.

But you don’t have to be at high risk to develop flu complications.

Many of the kids who die with the flu each year don’t have any underlying health problems.

PedFluDeath_Characteristics-ages
And at least half of the kids who die with flu complications are school age children and teens.

Anyone, even previously healthy kids, can develop pneumonia, myocarditis, encephalitis, or septic shock, etc., so get help if you see any of the above signs and symptoms that your child with the flu is getting worse.

And get your kids vaccinated. Tragically, most kids who die with the flu each year didn’t have a flu shot.

What to Know About the Warning Signs of a Severe Case of the Flu

Seek medical attention if your child’s flu symptoms are getting worse, especially if it seemed they were getting better, but then got worse again, which can all be signs of complications of a severe flu case.

More on the Warning Signs of a Severe Case of the Flu

Sugar and Added Sugar

What do you think about when you think of sugar?

Candy and junk food?

It is important to remember that sugar is also naturally present in milk, including breastmilk and baby formula, and in fruits, and vegetables, etc.

That means that not all sugar is bad sugar.

Types of Sugar

Most of us have learned to limit or avoid certain types of sugar, like high fructose corn syrup, but you don’t have to avoid all sugar. In fact, if you eat fruits and vegetables, it would be awfully hard to avoid sugar.

You probably thought that sugar was sugar, right?

Nope.

There are many different types of sugar, with the most common types including:

  • glucose – found in many fruits and in corn syrup
  • fructose – fruit sugar
  • sucrose – sugar cane, sugar beets (a combination of glucose + fructose)
  • maltose – barley or malt sugar (a combination of two glucose molecules)
  • lactose – milk sugar (a combination of galactose + glucose)

Honey, a sweetener like sugar, is also made up of glucose and fructose, but they are not combined together. In general, honey contains much more fructose than glucose, which is why it is so sweet.

What about table sugar? That’s sucrose.

Still, like most other types of sugar, table sugar is broken down by enzymes in our body to glucose, with each gram of glucose providing four calories of energy. If you don’t need that energy at the time, that glucose gets converted into fat and is stored away.

Good Sugar vs Bad Sugar

While it’s become popular to worry about how bad sugar is for us, that’s not really what you should focus on. Instead,  learn more about the the differences between naturally occurring sugar and added sugars.

A large strawberry contains about 1 gram of natural sugar. They are low in sugar, unless you dip them in sugar before giving them to your kids.
A large strawberry contains about 1 gram of natural sugar. They are low in sugar, unless you dip them in sugar before giving them to your kids. Photo by Ken Hammond

If there is a bad sugar, it is the added sugars in foods that help us get too much sugar in our diets.

Also, when you eat or drink something with naturally occurring sugar, even though you are getting some sugar, you are also getting many other vitamins and minerals in your diet. For example, when you drink milk or eat an orange,  you get other nutritional benefits, unlike drinking a soda or eating a piece of candy.

So while you do get sugar from all of them, that’s all you get from the soda and candy.

That’s why it is often said that junk food is filled with empty calories.

Has someone got you shocked about the sugar content of your child’s lunch consisting of a PB&J sandwich, applesauce, and fruit punch? Then swap the applesauce for an apple and the fruit punch for low-fat milk or water.

Identifying Added Sugars

A new food label with added sugars is coming - by January 2020...
A new food label with added sugars is coming – by January 2020…

How do you know if the foods you are eating are high in sugar?

Just check the Nutrition Facts label and look at the amount of Sugars listed under Total Carbohydrates.

That can be misleading though, as it doesn’t differentiate between natural sugars and added sugars. At least not yet.

For that, we have to check the ingredients list and look for clues that the food item contains added sugars, including that it contains things like:

Hidden Sugar on Ingredients List
agave nectar invert sugar
anhydrous dextrose lactose
beet sugar malt syrup
brown sugar maltose
confectioner’s powdered sugar maple syrup
corn syrup molasses
corn syrup solids nectars (e.g., peach nectar, pear nectar)
dextrose pancake syrup
fructose raw sugar
fruit juice concentrate sucrose
high-fructose corn syrup (HFCS) sugar
honey white granulated sugar

New rules from the FDA will hopefully soon make it easier to recognize added sugars on food labels, as they add information about the amounts of added sugars in foods.

Limiting Sugar in Your Diet

Although some people are concerned that sugar is an actual poison – it isn’t – the most common reason to avoid added sugar is to simply avoid extra calories.

Sugar itself doesn’t cause diabetes or ADHD or any number of other things it gets blamed for, except maybe getting cavities.

If you get too much sugar in your diet and you become overweight, then you could develop type II diabetes. Getting too much fat in your diet is also an easy way to become overweight though, especially if you don’t exercise everyday.

How much sugar is too much?

“Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”

WHO on Sugars intake for adults and children

In general, you don’t usually want to get more than 10% of your daily calories from free sugars. Unfortunately, most people get too many calories in their diet, and too many of those calories are from free sugars.

Other recommendations are a little more restrictive.

“The committee found that it is reasonable to recommend that children consume ≤25 g (100 cal or ≈6 teaspoons) of added sugars per day and to avoid added sugars for children <2 years of age.”

AHA on Added Sugars and Cardiovascular Disease Risk in Children

But remember, this is the sugar that you get from candy, cakes, fruit drinks, donuts, and soft drinks, etc.

A teaspoonful of sugar is equal to 4g of sugar or 16 calories.
A teaspoonful of sugar is equal to 4g of sugar or 16 calories. Photo by Samantha Celera (CC BY-ND 2.0)

In general, it is not the sugar that they get from whole fruits, plain yogurt, or milk.

For example, don’t be mislead by scary claims, like yogurt might have more sugar than a Twinkie. Unless it is a kid’s brand, with a lot of added flavorings, the sugar in yogurt is mostly from naturally occurring milk sugar and sugar from added whole fruit, while a Twinkie is almost all added sugars.

Once you start being more mindful of how much sugar your kids are getting and you limit sugary drinks and candy every day, it becomes easy to get under about 25g of added sugar each day.

Avoiding Added Sugars

To help your kids avoid added sugar, it can help to:

  • drink water
  • limit or avoid soda, fruit drinks, and other sugar-sweetened drinks, including sports drinks
  • drink low-fat white milk without extra flavorings
  • avoid sugary cereals
  • choose canned fruits with water over syrup when not eating fresh whole fruit
  • limit candy, cakes, cookies, ice cream, and other junk foods
  • choose plain yogurt without added sugars instead of a flavored yogurt and then add fresh fruit to it

Even 100% fruit juice should be limited, and avoided all together if your infant is under 12 months old.

And don’t make the mistake of limiting added sugar, but then turning to high fat foods!

Healthier alternatives can include more nutrient dense foods, including beans and peas, eggs, fat-free and low-fat milk and cheese, fruits, lean meats and poultry, seafood, unsalted nuts and seeds, vegetables, and whole grain foods.

Most importantly, learn to read food labels to look for added sugar in the foods your kids eat and then avoid those food and watch their portion sizes. When you do allow your kids to have a treat, don’t go overboard with a 24 ounce soda or letting them eat a pint of ice cream.

Learn to eat healthy.

Remember that it’s not all about sugar, fat, carbs, or any other one thing. A registered dietician can be helpful if you need more help planning what your family eats.

What to Know About Sugar and Added Sugar

Learn to avoid added sugar in your child’s diet as part of an overall healthy eating plan.

More About Sugar and Added Sugar

Why Have We Let High-Powered Magnets Be a Hazard to Our Kids for so Long?

We have been warning parents about high-powered magnets since 2007!

That’s when the first complaints started coming into the Consumer Product Safety Commission about kids swallowing small magnets that were falling out of toys or that were actually sold as toys to create patterns and build shapes.

Remember Buckyballs and Buckycubes?

The CPSC issued their first safety alert about magnets in 2007, after a 20-month-old died.
The CPSC issued their first safety alert about magnets in 2007, after a 20-month-old died.

They issued another magnet safety alert in 2011, when they found that incidents of children ingesting these high-powered magnets were increasing each year, with reports of 22 incidents between 2007 and 2009, including 11 of which required surgical removal of the magnets.

Next, in 2012, we heard about a 3-year-old who required emergency surgery after swallowing 37 magnets!

High-Powered Magnet Dangers

Unfortunately, when kids swallow more than one of the small, 5mm magnets, they can attract each other through the walls of the child’s intestine. And this is what happened to the little girl who swallowed 37 Buckyballs. She required emergency surgery to repair perforations in her stomach and intestines.

Call poison control or seek immediate medical attention if your child swallows a magnet.
Call poison control or seek immediate medical attention if your child swallows a magnet.

This led to a recall of Buckyballs, but surprisingly, their importer, Maxfield & Oberton LLC, refused to participate in the recall, even though the CPSC “has received 54 reports of children and teens ingesting this product, with 53 of these requiring medical interventions.”

Another death, a 19-month-old girl and an estimated 2,900 emergency room-treated injuries between 2009 and 2013 led the CPSC to create a new safety rule for high-powered magnet sets.

Unfortunately, a Federal Court put aside that safety rule, so that you can still buy these dangerous high-powdered magnets.

And many of you likely did, as Christmas gifts.

And some of you have likely already been to the ER after a child in your home swallowed those high-powered magnets.

Be warned. If you have kids in the house, those “Mashable, Smashable, Rollable, Buildable Magnets” could end up in their mouth and getting swallowed.

Remember, as we have been warning folks for at least 10 years, even though they are sold as “Magnetic Toys,” these high-powered magnets are not good choices for kids.

What to Know About the Dangers of High-Powered Magnets

High-powered magnets don’t make good toys for kids. Understand the risks if you have them in your home and be sure to seek immediate medical attention if your child swallows a magnet.

More on the Dangers of High-Powered Magnets

New Report on Autism Rates

A new report on autism prevalence rates isn’t generating many headlines.

Why?

“There was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder from 2014 to 2016.”

Zablotsky et al on Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014–2016

While the rate seemed to increase on paper, from 2.24 to 2.76%, it was not a statistically significant change. If it had been a statistically significant change, then you could think autism rates really were increasing and the report would have made headlines beyond anti-vaccine websites.

“By trying to say that there is no significant increase, is the government hoping to reassure people that autism isn’t a significant problem? That the rising number of children with autism isn’t something that anyone has to worry about? Are they trying to avoid a panic?”

Dr. Bob Sears

As most people likely understand, the term significant is used in the report as a statistical term.

When something is found to be statistically significant, then you can be fairly confident that it wasn’t caused by chance alone.

“Significance is a statistical term that tells how sure you are that a difference or relationship exists.”

What does “statistical significance” really mean?

So by stating that “there was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder,” they were not “trying to avoid a panic.” There is no conspiracy.

Unlike Dr. Bob and some others, they were simply trying to not mislead people into thinking that the change from 2.24 to 2.76% meant something that it did not.

Reports About Autism Rates

Another thing to keep in mind as you think about this report – there are multiple reports about autism prevalence rates that come out every few years.

The latest report uses National Health Interview Survey data that was collected by the National Center for Health Statistics.

Unlike the autism prevalence reports from the Autism and Developmental Disabilities Monitoring (ADDM) Network that we are used to, which reported a rate of 1 in 68 children in 2016, the NCHS reports:

  • National Health Interview Survey question about autism.
    The National Health Interview Survey question about autism.

    rely on parent reports during a telephone survey – one of the questions that they are asked is if a health professional has ever told them that their child has autism, but that diagnosis is not confirmed by looking at medical or school records

  • are prone to recall bias – parents might not accurately recall what doctors have told them in the past about their child
  • have questions that have changed over the years, for example, when PDD was added in 2014, it was thought that it might have confused some parents who didn’t know that a pervasive developmental disorder is different than a developmental disorder
  • look at lifetime prevalence

And not surprisingly, over the years, the NHIS has typically reported higher autism rates than the Autism and Developmental Disabilities Monitoring Network.

autism-rates
The NCHS autism prevalence rate reports have traditionally been higher than others.

So what does this new report on autism prevalence mean?

It means the same thing that all of the other recent reports have been saying, that autism prevalence rates seem to be unchanged.

What to Know About Autism Rates

After increasing for several years, autism rates seem to be unchanged, but that hasn’t kept anti-vaccine folks from trying to get parents to panic about changes in prevalence rates that are not statistically significant.

More on Autism Rates

30 Uncommon Diseases Parents Should Learn to Recognize

Did you know that just because your younger child is pulling at their ears, it doesn’t automatically mean that they have an ear infection?

It could be teething, an over-tired infant or toddler, or a kid with a cold and their ears are popping because of congestion.

Understanding common, and some not so common symptoms of pediatric diseases can help make sure that your kids get diagnosed and treated quickly.

Symptoms of Classic Pediatric Diseases

Most parents are familiar with the more classic pediatric diseases and the signs and symptoms that accompany them, such as:

  • Appendicitis – classically, it starts with pain near the belly button, which quickly worsens and moves to the lower right side of your child’s abdomen. Appendicitis is not always classic though
  • Croup – often starts in the middle of the night with a seal bark cough, heavy breathing that sounds like wheezing, and a hoarse voice
  • Diabetes – type 1 diabetes is classically associated with polydipsia (drinking a lot), polyuria (frequently urinating large amounts), and weight loss
  • Ear infection – in addition to ear pain, fussiness, or tugging at their ears, kids with an ear infection will usually have cold symptoms, or at least might have had a recent cold, with a cough and runny nose
  • Fifth disease – red cheeks that appear to be slapped followed by a pink lacy rash on a child’s arms and legs that can linger for weeks
  • Hand, foot, and mouth disease – caused by the coxsackievirus A16 virus, kids with HFMD classically have ulcers in their mouth and little red blisters on their hands and feet. They might also have a fever and a rash on their buttocks and legs.
  • Hives – hives or whelps are raised, red or pink areas on your child’s skin that come and go, moving around over a period of three to four hours and are a sign of an allergic reaction. Unfortunately, unless your child is taking medicine or just eat something, it can be hard to find the allergic trigger. You often don’t need to though, as hives can also just be triggered by viral infections and might not come back.
  • Impetigo – honey colored crusted areas on your child’s skin that are a sign of a bacterial infection
  • Ringworm – a fungal infection that can appear on a child’s skin (tinea corporis), feet (tinea pedis), groin (tinea cruris), nails (tinea unguium), or scalp (tinea capitis)
  • Roseola – another viral infection, this one is caused by human herpesvirus 6 (HHV-6) and 7 and causes a high fever for three or four days, and then, as the fever breaks, your child breaks out in a pinkish rash. The rash starts on their trunk, spreads to their arms and legs, and is gone in a few days.
  • Swimmer’s ear – the tricky part about recognizing swimmer’s ear is that you can get it anytime you get water in your ear, not just after swimming, leading to pain of the outer ear, especially when you push or tug on it.

Symptoms of Uncommon Pediatric Diseases

Although not necessarily rare, it is often uncommon for the average parent, and some pediatricians, to be familiar with all of the following conditions unless they have already been affected by them.

Having dark, brown or Coca Cola-colored urine is a classic sign of acute post streptococcal glomerulonephritis.
Having dark, brown or Coca Cola-colored urine is a classic sign of acute post streptococcal glomerulonephritis. Photo by Vincent Iannelli, MD

Why should you know about them?

Some are medical emergencies. Missing them could lead to a delay in seeking treatment.

Others, while they might not be emergencies, often lead parents to seek treatment, but it might not necessarily be the right treatment if someone doesn’t recognize what is truly going on with your child.

  1. Acanthosis nigricans – dark thickened (velvety textured) skin often found on the back of an overweight teen’s neck, and sometimes in their armpits and other skin folds, and which can be a sign of type 2 diabetes
  2. Anaphylaxis – while a severe allergic reaction like anaphylaxis is not easy to miss, getting proper treatment is sometimes difficult. This life-threatening reaction requires an epinephrine injection as soon as possible, something that some parents and even some emergency rooms seem hesitant to do.
  3. Bell’s Palsy – children with Bell’s palsy develop a sudden weakness or paralysis of the muscles of one side of their face. Fortunately, the symptoms usually begin to resolve in a few weeks.
  4. Breath holding spells – a young child having a breath holding spell will actually pass out! While it sounds scary, since they follow a typical pattern, either the child is crying forcibly (cyanotic breath holding spell) or something painful happened suddenly (pallid breath holding spell), and they quickly wake up and are fine, you hopefully won’t panic if you ever see one.
  5. Cat scratch disease – after a bite or scratch from an infected cat or kitten, a child will develop a few lesions at the scratch site, but will also develop enlarged lymph nodes nearby – typically their armpit or neck if they were scratched on the arm.
  6. Cyclic vomiting syndrome – possibly related to migraines, children with cyclic vomiting syndrome have repeated episodes of intense nausea and vomiting, sometimes leading to dehydration, every few weeks or months
  7. Diabetes insipidus – like type 1 diabetes, kids with diabetes insipidus urinate a lot and drink a lot, but it has nothing to do with their blood sugar. It can follow a head injury or problem with their kidneys.
  8. Encopresis – kids with encopresis have soiling accidents, sometimes leading parents to think that they have diarrhea. Instead, they are severely constipated and have small amounts of liquidy stool  involuntarily leaking into their underwear after getting passed large amounts of impacted stool.
  9. Erythema multiforme minor – triggered by infections and sometimes medications, kids with EM have a rash that looks like hives, but instead of going away, they just keep getting more spots, some of which look like target lesions. The severe form of EM, erythema multiforme major is fortunately rare.
  10. Geographic tongue – a curiosity more than a condition, children with geographic tongue have bald areas on their tongue where the papilla have been lost (temporarily). The name comes from the fact that the shapes of the bald areas vary in size and shape and they move around. They are not painful, although parents typically don’t notice them until they look in their child’s mouth when they complain of a sore throat or other problem.
  11. Henoch-Schonlein Purpura (HSP) – episodes of HSP typically follow an upper respiratory tract infection, when kids develop a rash (palpable pururpa), stomach aches, arthritis (joint swelling and pain), and more rarely, kidney problems. The rash is distinctive – red dots (petechiae) and a hive-like rash that looks like bruises.
  12. Hemolytic Uremic Syndrome (HUS) – follows a diarrheal illness with E. coli, in which toxin from the bacteria causes bleeding (from low platelets) and anemia (destruction of red blood cells) and can lead to kidney damage.
  13. Intussusception – colicky abdominal pain (severe pain that comes and goes) and loose stools that are filled with blood and mucous (red currant jelly stools) in young kids, typically between the ages of three months and three years
  14. Kawasaki disease – it is important to recognize when a child might have Kawasaki disease, because early treatment might help prevent serious heart complications from developing. The initial signs and symptoms of Kawasaki disease can include a prolonged fever (more than five days), swollen lymph glands, pink eye (without discharge), rash, strawberry tongue, irritability, swelling of hands and feet, red and cracked lips, and as the fever goes away, skin peeling.
  15. Nephrotic syndrome – kids with nephrotic syndrome have swelling (edema), around their eyes, on their legs, and even their belly. All of the swelling causes them to quickly gain weight. Because, at first, the swelling is worse in the morning and gets better as your child is up and about, it might be mistaken for other things that cause swelling, like eye allergies. Nephrotic syndrome won’t get better with eye drops though.
  16. Night terrors – most common in preschoolers and younger school age children, kids with night terrors ‘wake up’ in the early part of the night screaming and are confused and impossible to console, because they are really still asleep. The episodes are not remembered the next morning and are often triggered when kids are off their schedule or under extra stress.
  17. Nursemaid’s elbow – you are walking with your toddler and all of a sudden he gets mad, drops to the ground while you are holding his hand, and then he refuses to move his arm or bend his elbow. Did you break his arm? It’s probably a radial head subluxation, which your pediatrician can usually easily reduce.
  18. Obstructive sleep apnea – although many kids might snore normally, with obstructive sleep apnea, the snoring will be loud, with pauses, gasps, and snorts that might wake your child up or at least disturb their sleep.
  19. PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections is characterized by OCD and/or tics that appear or suddenly worsen after a strep infection.
  20. Peritonsillar abscess – a complication of tonsillitis, it can cause fever, severe throat pain, drooling, a muffled voice (hot potato voice), and swelling on the side of one tonsil, pushing the uvula towards the other side
  21. Pica – while many younger kids put things in their mouth, kids with pica crave and eat all of those non-food things. Since it can be a sign of iron-deficiency, talk to your pediatrician if you think that your child might have pica.
  22. Pityriasis rosea – kids with pityriasis rosea have a rash that starts with a herald patch (looks like a ringworm) and is then followed by a lot of small, oval shaped red or pink patches with scale on their trunk. The rash, which may be a little itchy, can last for up to 6-12 weeks.
  23. POTS – teens with Postural Orthostatic Tachycardia Syndrome have dizziness, fatigue, headaches, nausea, difficulty concentrating and other symptoms related to alterations or dysfunction in the autonomic nervous system (dysautonomia).
  24. Pyloric stenosis – since so many infants spit up, it is not uncommon for the parents and pediatricians to sometimes delay thinking about pyloric stenosis when a baby has it. Unlike reflux or a stomach virus, with pyloric stenosis, because their pylorus muscle becomes enlarged, no food or liquid is able to leave their stomach and they eventually have projectile vomiting of everything they try to eat or drink. It is most common in babies who are about three to five weeks old.
  25. Scalded skin syndrome – unlike typical bacterial skin infections, with scalded skin syndrome, exotoxins that certain Staphylococcus aureus bacteria cause the skin to blister and appear burned, with eventual skin peeling
  26. Stevens-Johnson Syndrome – a rare skin reaction that can be triggered by medications, beginning with flu like symptoms, but then progressing to a blistering rash that includes their mouth and eyes.
  27. Testicular torsion – if one of the testicles twists around the spermatic cord, it can cut off blood flow and quickly lead to permanent damage. Sudden, severe pain and swelling often make it easy to recognize this medical emergency, but sometimes the pain comes on more slowly or the pain is dismissed as happening from trauma, epididymitis, or torsion of the appendix testis.
  28. Toxic synovitis – typically following a viral infection, kids with toxic synovitis have hip pain and limping for a few days, but otherwise seem well, without high fever or other symptoms
  29. Vocal cord dysfunction – often misdiagnosed as asthma, especially exercise induced asthma, and other things, kids with vocal cord dysfunction often have episodes of repeated shortness of breath, chest tightness, wheezing, and coughing – just like asthma. They don’t improve though, even as more asthma medicines are added, which should be a red flag that they don’t have asthma and could have vocal cord dysfunction instead.
  30. Volvulus – a volvulus occurs when the intestines twists on itself, cutting off blood blow. In addition to severe abdominal pain, these kids often having vomiting – typically of a green, bile looking material (bilious vomiting). Green vomitus can also be a sign of other intestinal obstructions, but all would be a medical emergency.

Is knowing about these conditions always helpful?

No, especially if you don’t know what a ‘seal bark’ or ‘hot potato voice’ sounds like or what ‘red currant jelly’ looks like, but it likely shouldn’t hurt to get a little more educated about the diseases that could be causing your child’s symptoms.

What to Know About Recognizing Symptoms of Pediatric Disease

Having the internet and access to Google doesn’t make you a doctor. Get real medical advice if you think that your child is sick and has symptoms that have you concerned. It does help to know which symptoms to be concerned about though.

More on Recognizing Symptoms of Pediatric Disease