Treating Hard to Control Poison Ivy

Poison ivy growing on a tree, ready to give your kids a rash.
It is better to learn to avoid poison ivy than to get a rash and have to get it treated. Photo by Vincent Iannelli, MD

It is usually not hard to identify a child with a poison ivy rash, especially a classic case of poison ivy, which might include a child with a known exposure to poison ivy after a camping trip, hike in the woods, or day at the lake, who a few days later develops a red, itchy rash all over his body.

The problem is that many parents don’t remember the “known exposure,” especially if it is the child’s first poison ivy rash.

The Poison Ivy Rash

Aerial roots on the stems can help you identify poison ivy, and yes, they can trigger a rash too.
Aerial roots on the stems can help you identify poison ivy, and yes, they can trigger a rash too. Photo by Vincent Iannelli, MD

After exposure to the leaves, stems, or roots of a poison ivy plant, children develop symptoms of poison ivy within 8 hours to a week or so, including:

  • an intensely itchy rash
  • red bumps that often may be in a straight line or streaks, from where the poison ivy plant had contact with your child’s skin
  • a rash that appears to spread, mostly because the rash appears at different times depending on how big or small a dose of the urushiol oil that area of skin got, with the rash appearing first on the spots that got exposed the most
  • vesicles and blisters that are filled with fluid

Keep in mind that children exposed to poison sumac and poison oak, other members of the genus Rhus or Toxicodendron, can get these same symptoms that we generically refer to as poison ivy symptoms.

(Using medical terminology, these children develop rhus dermatitis or allergic contact dermatitis, an intensely pruritic, linear, erythematous, papulovesicular rash after exposure to the urushiol oil in poison ivy.)

Treating Poison Ivy

It seems like everyone has their favorite treatments for poison ivy.

These basic treatments for poison ivy are usually going to help control the itch, and might include:

  • oral antihistamines (Benadryl or Atarax)
  • modified Burow’s Solution
  • Calamine lotion
  • Aveeno oatmeal baths
  • over-the-counter or prescription topical steroid creams

Is that all you need?

While these treatments might provide temporary relief and might be enough for very mild reactions, those with more moderate or severe symptoms will likely require systemic steroids.

Does that mean a steroid shot?

That might be what your doctor suggests or what some parents request, but keep in mind that it might wear off too soon, leading your child’s poison ivy symptoms to flare up again (rebound rash). That’s why most experts recommend a longer, tapering course of oral steroids instead of a single shot. A steroid dose pack is also often avoided as treatment for poison ivy, as the dose might be too low and it typically doesn’t last long enough.

Since the poison ivy rash might not go away for as long as three weeks, getting treated with systemic steroids can be an especially good idea if you have a moderate or severe case.

Avoiding Poison Ivy

A classic poison ivy plant in the 'leaves of three, let it be' configuration.
A classic poison ivy plant in the ‘leaves of three, let it be’ configuration. Photo by Vincent Iannelli, MD

Since very few people are actually immune to poison ivy, it is best to learn to avoid getting exposed to it in the first place.

You can start with the old adage, ‘leaves of three, let it be,’ but you really have to look at a lot pictures of poison ivy to get good at avoiding it. And to be safe, learn to avoid the places where poison ivy grows – along tree lines, around lakes and ponds, along trails, and in wooden or wild areas, etc.

Or at least do your best to avoid the plants by wearing long pants, a shirt with long sleeves, and gloves, etc., to avoid skin contact even if you are around poison ivy while hiking, playing along a creek, or fishing near a lake.

What can you do if you have been exposed to poison ivy? If you can rinse the exposed area with rubbing alcohol, like within 10 minutes, then you might avoid a reaction. After that, the oil in poison ivy, urushiol, will likely be stuck and trigger a rash. Of course, you don’t want to be applying rubbing alcohol to a large area of your child’s skin though or allow your child to use it if they will be unsupervised. And be sure to wash it off afterwards.

Commercial products might be more useful (and safer) to help you avoid poison ivy reactions and  include:

  • Ivy Block – was an over-the-counter barrier lotion that was supposed to prevent poison ivy, but unfortunately, it isn’t being made anymore
  • Tecnu Original Outdoor Skin Cleanser
  • Tecnu Extreme Poison Ivy & Oak Scrub
  • Zanfel Poison Ivy Wash

Although it is best to use the products immediately, within 10 to 30 minutes after exposure to poison ivy, if used anytime before you get a rash, you might decrease your symptoms. And if you get lucky, you might not get any symptoms at all.

Myths and Facts About Poison Ivy

Would you recognize this is poison ivy? It will still trigger a rash...
Would you recognize this as poison ivy? It will still trigger a rash… Photo by Vincent Iannelli, MD

As common as poison ivy is, there are many myths and misconceptions about it, including that:

  • poison ivy is contagious (false) – scratching doesn’t spread poison ivy, although it may seem that way as the rash spreads to new areas over the days and weeks after being exposed. That’s only because some areas of a child’s skin that had less exposure to the poison ivy plant than others will get the rash later, not that they are continuing to spread it by scratching.
  • you can get poison ivy from your dog (true) – although not as common as direct contact with a plant, indirect contact, like if you touch the oil from poison ivy that got on your dog’s fur or on your clothing, could trigger a reaction
  • it is easy to spot poison ivy (false) – poison ivy plants are often found growing among other plants, can trigger reactions year round, even when they don’t have any leaves (the stems  and roots can trigger a reaction too), and even dead poison plants can trigger a reaction, which can make it extremely hard to simply use the ‘leaves of three, let it me’ advice to spot plants.
  • birds help spread poison ivy (true) – ever wonder why poison plants grow along tree lines? Birds and small mammals eat the poison ivy berries and then poop out the seeds, allowing new plants to grow wherever the birds commonly hang out, including tree lines, around lakes and ponds, and your garden.
  • it’s easy to get rid of poison ivy plants (false) – poison ivy plants are very persistent and can be hard to get rid of
  • goats like to eat poison ivy (true) – well, goats like to eat everything, but a goat in your yard will likely eat up all of the poison ivy plants.
  • it is easy to identify poison ivy (false) – many other plants mimic the ‘leaves of three, let it be’ pattern, like Virginia creeper and Boxelder
  • burning poison ivy plants is dangerous (true) – the oil that triggers the poison ivy rash can vaporize, meaning exposure to the smoke from a burning plant can cause severe reactions.

And remember that your pediatrician can be helpful if you think your child has poison ivy. (true)

What To Know About Hard to Control Poison Ivy

While poison ivy isn’t contagious, it can make you miserable if you don’t learn to avoid it and treat poison ivy rashes properly with anti-itch creams and steroids.

More About Hard to Control Poison Ivy

Don’t Skip Your Baby’s Vitamin K Shot

Most parents understand and expect that their baby will get a vitamin K shot when they are born and before they leave the hospital.

It helps prevent bleeding from vitamin K deficiency.

Vitamin K for Babies

Leave the formula samples at the hospital, but don't leave without your baby's vitamin K shot.
Leave the formula samples at the hospital, but don’t leave without your baby’s vitamin K shot.

Newborns have been routinely getting vitamin K shots since at least since 1961.

While it was well known that newborns could suffer from hemorrhagic disease of the newborn (the old name for vitamin K deficiency bleeding) since 1894 (thanks to Dr. Charles Townsend), it wasn’t until later that it was connected to a temporary lack of vitamin K in newborns and younger infants. This occurs because:

  • vitamin K doesn’t pass through the placenta well, so your baby doesn’t build up a good supply during pregnancy
  • breast milk is a poor source of vitamin K, even if the breastfeeding mother eats well and takes supplements, so your baby isn’t able to quickly build up a good supply after she is born
  • babies have a mostly sterile gut and are not born with the bacteria in their intestines that can make vitamin K
  • some clotting factors need vitamin K to work

Although vitamin K deficiency bleeding was never very common, before newborns began it get vitamin K shots, it did affect from 1.7% (classic onset disease) to 7 in 100,000 newborns (late onset disease).

Since many of these bleeds were fatal, even though they were rare, no one thought that there was a benefit to being low in vitamin K and getting a vitamin K shot wasn’t controversial. At least not until a 1992 paper suggested that vitamin K shots could be associated with childhood cancer. That soon led some parents to refuse their babies vitamin K shots for a short time, at least until the link was refuted.

In 1996, a student called for the ‘End of the Vitamin K Brouhaha:’

“Because hemorrhagic disease of the newborn can be life-threatening but preventable, the studies by von Kries et al and Ansell et al should allay our fears and doubts about the dangers of administering intramuscular vitamin K immediately after birth. It seems that hemorrhagic disease of the newborn can be completely eradicated without the threat of leukemia and childhood cancer as a side effect.”

And the vitamin K brouhaha did seem to end.

The Vitamin K Controversy

It came back though.

In addition to holistic and natural parenting groups, there are some who are against vaccines who are also against vitamin K shots.

This is surprising to many people, as those who oppose giving babies vitamin K are often the same folks who push many other types of vitamins, including megadoses of vitamin C, vitamin B12 shots, and extra vitamin D.

Vitamin K Misinformation

So why do some parents skip giving their new baby a vitamin K shot?

It is possible that in doing their research, they have been mislead by some of the misinformation about vitamin K that you commonly find on the internet.

This includes claims that:

  • there is mercury and other toxic ingredients in the vitamin K shots (the truth is that neither mercury or thimerosal nor any other heavy metals are used as a preservative in vitamin K shots and all of the other ingredients are safe too)
  • vitamin K shots cause cancer (the truth is that they don’t and an early study that suggested they did was later refuted many times)
  • babies don’t need extra vitamin K (the truth is that some do though and it is typically impossible to identify them, except maybe for babies born to mothers taking certain medications, mostly seizure medicines, that put them at extra risk of early vitamin K deficiency bleeding)
  • babies start making enough vitamin K when they are 8 days old (the truth is that some babies don’t, especially those with liver disease and other disorders that might interfere with the absorption of fat soluble vitamins)
  • babies did fine before we started giving them vitamin K shots (the truth is that some died, which is why we started giving vitamin K in the first place)
  • you can just give babies oral vitamin K instead of a vitamin K shot (the truth is that oral vitamin K doesn’t work to prevent all cases of late onset vitamin K deficiency, which is also deadly)
  • only boys who get a circumcision need vitamin K (the truth is that we don’t know why some infants with vitamin K deficiency bleeding develop bleeding in their brains, as it isn’t usually any kind of big trauma, so it doesn’t have to be something like a circumcision or a fall or whether you delivered vaginally or by C-section, etc. In fact, late onset bleeding can occur up to 12 weeks, and sometimes as long as 6 months, after a baby is born!)
  • there must be a benefit to having low vitamin K levels when we are born, otherwise God wouldn’t have made us this way (even if this were somehow true, it doesn’t negate the fact that some babies die from their low vitamin K levels…)

Just as with vaccine preventable diseases, since vitamin K deficiency is now rare (because most parents make sure their babies get a vitamin K shot), it is easy for parents to be misled by this type of misinformation.

Bad Advice about Vitamin K

According to the American Academy of Pediatrics, vitamin K deficiency bleeding “is most effectively prevented by parenteral administration of vitamin K.”

That’s the vitamin K shot.

While early (birth to 2 weeks) vitamin K deficiency bleeding can be prevented with either oral vitamin K or a vitamin K shot, late onset (2 to 12 weeks) vitamin K deficiency bleeding is best prevented with a vitamin K shot.

Some people didn’t get the message though, advising parents to skip the vitamin K shot against all standard medical advice:

  • Dr. Mercola still warns parents about the ‘jab with a syringe full of vitamin K.’
  • Sarah Pope at the Health Home Economist tells parents to ‘Skip that Newborn Vitamin K Shot’
  • 28 percent of parents who delivered at local private birthing centers in Tennessee had recently declined the vitamin K shot

So what are the consequences of this kind of non-standard, non-evidence based advice?

They are much as you would expect when dealing with a potentially life-threatening condition – a rise in vitamin K deficiency bleeding in newborns and infants.

Among the recent cases of early and late vitamin K deficiency bleeding include:

  • seven babies over eight months in  2013 at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, including three who required surgery to remove clots “out of their head” and who may “have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”
  • a 5-week-old in Florida with late onset vitamin K dependent bleeding. The youngest of 6 children, none of whom had been given vitamin K, the baby had a seizure and stopped breathing after developing two brain hemorrhages.
  • a 3-week-old in Indiana with late onset vitamin K dependent bleeding who was born in a birthing center and whose “parents signed a waiver to forego vaccination and prophylactic therapies,” and required an emergency craniotomy to evacuate braining bleeding, prolonged intubation, and difficult to control seizures
  • a 6-week-old in Illinois with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and developed brain bleeding and swelling, seizures, a DVT, and who was hospitalized for 10 days
  • a 6-week-old in South Texas with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and died after developing brain bleeding and seizures
  • an infant in Australia who had not been given a vitamin K shot as per her mother’s birth plan and  died of late vitamin K deficiency bleeding (at 33 days of life)
  • another infant in Australia who is in critical condition after his parents refused a vitamin K shot
  • infants in Germany, Switzerland, Denmark, and the Netherlands who have suffered from vitamin K deficiency bleeding while receiving oral vitamin K, often because their parents refused a vitamin K shot

Tragically, most parents who refuse vitamin K shots also refuse other potentially life-saving medical interventions, including getting a hepatitis B vaccine and even getting erythromycin eye ointment. And many go on to refuse all childhood vaccines.

On the bright side, the great majority of parents do allow their newborn babies to receive vitamin K when they are born. One study found that only 0.3% of parents refused vitamin K.

What To Know About Vitamin K Shots for Babies

The bottom line is that vitamin K shots are a safe way to prevent vitamin K deficiency bleeding. This is no good reason to skip this shot for your baby.

More Information About Vitamin K Shots for Babies

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Autism Acceptance vs Autism Awareness

Apple has added an autism acceptance page to their app store.
Apple has added an Autism Acceptance page to their app store.

April is traditionally recognized as Autism Awareness Month and April 2 as World or International Autism Awareness Day.

These awareness campaigns are supported and driven by Autism Speaks and their “light it up blue” drives.

Many people will likely be surprised that there isn’t universal support for the “light it up blue” campaign of Autism Speaks to “shine a light on autism” on World Autism Awareness Day. Instead, in addition to the many people who think that April should be more about Autism Acceptance and less about autism awareness, there are many people who think that “Autism Speaks’ statements and actions do damage to that work and to the lives of autistic people and those with other disabilities” because they don’t listen to #AcuallyAutistic people and historically:

  • have not included an autistic person among their senior leadership
  • have advocated anti-vaccine ideas
  • use a very small amount of their budget to directly help autistic people pay for the services and supports that they need

Instead of Autism Speaks, the Thinking Person’s Guide to Autism suggests that people look for an autism group that focuses on support (not a cure), evidence based interventions, inclusiveness, and advocacy for the human and civil rights of all autistic people. And that the focus move to acceptance.

Similarly, Steve Silberman, the author of Neurotribes, explains why autism awareness is not enough.

Autism Advocacy Groups

As everyone because more aware of autism, they are also becoming more aware of the differences in all of the autism organizations out there. And that some provide bad autism information.

Consider the Chili’s public relations blunder, in which they were planning to donate 10% of sales on April 7, 2014 to the National Autism Association, an anti-vaccine autism organization. That situation highlighted how important it is to know the organization you are supporting and or visiting information and advice.

The organization in question, in addition to promoting unproven autism treatments, like chelation, clearly states that they believe that “vaccinations can trigger or exacerbate autism in some, if not many, children, especially those who are genetically predisposed to immune, autoimmune or inflammatory conditions.” They also state that “research to investigate, and reduce, adverse events in immunized individuals is currently nonexistent.”

The National Autism Association is the same organization that used anti-vaccine talking points to attack Dr. Paul Offit and his appearance on Dateline in an appearance with Matt Lauer that was critical of Andrew Wakefield. And it is the same organization that has tried to defend Andrew Wakefield’s fraud.

While many other autism organizations have distanced themselves from the idea that vaccines cause autism, this group is pressing on with the idea.

Why is that a problem? Keeping the focus on vaccines, after so many studies have shown that there is no link between vaccines and autism, diverts resources away from services and support for children and autistic adults.

Especially with the rise in vaccine-preventable diseases, including large measles outbreaks, it is very disappointing that Chili’s chose this organization to support.

Do you know how to find a reputable autism group that provides good autism information.

Reputable Autism Groups and Organizations

Among the most reputable autism groups and organization are the:

  • Autistic Self-Advocacy Network (ASAN) – Our projects seek to improve public understanding of autism, to involve the Autistic community in research that is relevant to the community’s needs, to empower Autistic people to take leading roles in advocacy, and to promote inclusion and self-determination.
  • Autism Society of America – Founded in 1965, the Autism Society helps over a million people each year through a grassroots nationwide network of local and state affiliates.
  • Autism Women’s Network (AWN) – a supportive community for Autistic women of all ages, our families, friends and allies.
  • National Autistic Society –  the leading UK charity for autistic people (including those with Asperger syndrome) and their families.
  • The Global and Regional Asperger Syndrome Partnership (GRASP) – works to improve and enrich the lives of adolescents and adults on the autism spectrum, and their families through, community advocacy & outreach, education, peer supports, programming and services.
  • The Arc and autism NOW – provides high quality resources and information in core areas across the lifespan to individuals with Autism Spectrum Disorders (ASD) and other developmental disabilities, their families, caregivers, and professional in the field.
  • Autism Science Foundation – supports autism research by providing funding and other assistance to scientists and organizations conducting, facilitating, publicizing and disseminating autism research.
  • Autistica – funds and campaigns for medical research to understand the causes of autism, improve diagnosis, and develop new treatments and interventions
  • NOS Magazine – a news and commentary source for thought and analysis about neurodiversity culture and representation.
  • Golden Hat Foundation – changing the way people on the autism spectrum are perceived, by shining a light on their abilities and emphasizing their great potential.
  • Simons Foundation Autism Research Foundation (SFARI) – sponsors research that promises to increase our scientific understanding of autism spectrum disorders, thereby benefiting individuals and families challenged by these disorders
  • Academic Autistic Spectrum Partnership In Research and Education (AASPIRE) – brings together the academic community and the autistic community to develop and perform research projects relevant to the needs of adults on the autism spectrum.

Are you still going to “light it up blue?”

How about checking out these other autism groups instead and learn more about autism acceptance. You might also be interested in these blogs by autistic people.

How to Clean Your Baby’s Umbilical Cord

It is very important that a baby’s umbilical cord is well cared for, as infections of the umbilical cord stump have historically been a major cause of disease and death in newborn babies.

These infections can include funisitis (foul smelling, purulent discharge from the umbilical cord stump), omphalitis (infection of the umbilical cord stump), omphalitis with necrotizing fasciitis (more severe infection with sepsis and shock), and neonatal tetanus.

History of Umbilical Cord Care

Over the years, many things have been used to try and keep a newborn baby’s umbilical cord free of bacterial colonization until it falls off.

“To achieve the goal of preventing omphalitis worldwide, deliveries must be clean and umbilical cord care must be hygienic.”

AAP Umbilical Cord Care in the Newborn Infant – 2016

These substances include:

  • triple dye
  • isopropyl alcohol  or rubbing alcohol
  • povidone-iodine or iodopovidone (Betadine)
  • chlorhexidine
  • hexachlorophane
  • antimicrobial ointments, such as neomycin and bacitracin

Remember when your baby came home from the nursery with his or her cord covered in purple dye? That was triple dye. It is rarely used anymore.

Umbilical Cord Care Recommendations

So what is used now that we don’t use triple dye?

Although many parents are still tempted to use alcohol, the main advice is now to ‘do nothing’ and just let the cord fall off.

That is not a universal recommendation though.

“Ensuring optimal cord care at birth and during the first week of life, including use of chlorhexidine, especially in settings having poor hygiene, is a crucial strategy to prevent life-threatening sepsis and cord infections and avert preventable neonatal deaths.”

Chlorhexidine Working Group

Why the different recommendations?

Because, in some countries, 10 to 20% of live births are still complicated by umbilical cord infections.

But if antiseptics can help keep the umbilical cord stump free of infections, why not just use them?

It is thought that using these antiseptics when they aren’t necessary, like when a baby is born in a hospital under hygienic conditions in a “high-resource country,” then they may:

  • lead to the development of resistance and selection of “more virulent bacterial strains”
  • cause the cord to take longer to fall off – especially if you applied alcohol to the stump at each diaper change
  • waste money and resources

That’s why, when appropriate, it is now recommended that we practice dry cord care. And that’s great news, as it still seems like most parents don’t want to ever touch their baby’s umbilical cord stump!

Dry Cord Care

Give your baby sponge baths until the umbilical cord comes off to help it stay dry.
Give your baby sponge baths until the umbilical cord comes off to help it stay dry.

With dry cord care, you simply:

  • keep the umbilical cord stump clean and dry (sponge baths only until the cord comes off)
  • leave the umbilical cord stump exposed to air or loosely covered by a clean cloth (fold your baby’s diaper down, which will also help prevent the cord from getting soaked with urine)
  • clean the umbilical cord stump with soap and sterile water if it does get soiled
  • watch for signs and symptoms of omphalitis, including a foul smelling discharge, red skin around the umbilical cord, or if the cord or skin around it becomes tender

Keep in mind that dry cord care is likely not appropriate if your baby was born at home, was born in a “resource limited country” or community, or if you are putting any non-sterile products on the cord to ‘help’ it come off more quickly.

These natural products to avoid include clay, cord care powders, dried herbs, honey, and oils.

When should your baby’s cord come off? While the average time is about two weeks, it is usually not considered delayed unless it hasn’t fallen off by the time your baby is three or four weeks old.

What To Know About Umbilical Cord Care

Taking care of your baby’s umbilical cord stump is now easier than ever for most parents. Just keep it clean and dry and watch for signs of infection until it falls off.

More Information on Umbilical Cord Care

Understanding the Risks and Benefits of Drinking Raw Milk

Understand the many risks of drinking raw milk and don't be fooled by propaganda, such as that 'raw milk heals.'
Understand the many risks of drinking raw milk and don’t be fooled by propaganda, such as that ‘raw milk heals.’ (CC BY 2.0)

Surprisingly, more and more people are starting to drink raw, unpasteurized cow’s milk.

Or maybe that shouldn’t be too surprising as most people associate things that are raw or natural as being safer and healthier for them, often without understand the consequences.

Unfortunately, drinking raw milk can be dangerous, especially for young children.

There are plenty of risks and no real health benefits.

Drinking Raw Milk

Just as you would have thought, is basically “straight from the cow,” and hasn’t been processed or pasteurized.

Although most experts consider pasteurization to be one of the most important health advances of the last century, some people think that it removes nutrients and kills beneficial bacteria. They also claim that raw milk can taste better than pasteurized milk, which if you believe it, is really the only possible benefit of drinking raw milk.

It’s not even a good way to avoid growth hormones in milk, as most milk is now growth hormone free anyway and is labeled rBST-free.

Is raw milk healthier than pasteurized milk? There is no research to support that raw milk is healthier or, according to the FDA, that there is a “meaningful difference between the nutrient content of pasteurized and unpasteurized milk.”

In fact, the American Academy of Pediatrics states that “substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections.”

Dangers of Drinking Raw Milk

According to the FDA, raw milk can be contaminated with bacteria, including:

  • Brucella species
  • Campylobacter jejuni
  • Coxiella Burnetii
  • Escherichia coli
  • Enterotoxigenic Staphylococcus aureus
  • Listeria monocytogenes
  • Mycobacterium bovis
  • Mycobacterium tuberculosis
  • Salmonella species
  • Yersinia enterocolitica

These bacteria can cause people to get sick, leading to symptoms such as diarrhea, vomiting, fever, stomach cramps, and headaches. The Centers for Disease Control and Prevention reports that about 200 to 300 people get sick each year from drinking raw milk or eating cheese made from raw milk.

Another big danger of drinking raw milk that some people may overlook is that raw milk is very low in vitamin D. In addition to being pasteurized, processed milk that you routinely buy in a store is typically fortified with vitamin D, which is important to keep your bones strong.

Since young children are at big risk for getting sick from any bacteria that may be in raw milk and they need vitamin D, it is important that you not give your child raw, unpasteurized cow’s milk. In fact, the American Academy of Pediatrics states that “children should not consume unpasteurized milk or products made from unpasteurized milk, such as cheese and butter, from species including cows, sheep, and goats.”

We will have to add unpasteurized camel milk to the list, as that seems to be a thing now too.

Keep in mind that kids should also avoid unpasteurized fruit juices, including unpasteurized apple juice and apple cider.

Lastly, raw milk is about the same as whole milk in terms of fat content and calories. Experts recommend that children start drinking reduced fat milk, which has less fat and calories than whole milk, beginning at age two, you won’t be able to do that if your kids are drinking raw milk.

What To Know About Drinking Raw Milk

If you are still thinking of giving your child raw milk, keep in mind that “the AAP strongly supports the position of the FDA and other national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants, and children.”

And remember that you are basically giving raw milk to your kids because you think it tastes better, as it certainly isn’t better for them, is missing key nutrients, and it could be contaminated with dangerous bacteria.

More Information on Drinking Raw Milk:

Understanding Strep and Why Your Kids Keep Getting Strep Throat

Tonsillitis caused by group A streptococcus bacteria.
Tonsillitis caused by group A streptococcus bacteria. Photo courtesy of the CDC.

Does your child get strep throat so often that you are thinking about getting his tonsils out?

While it is not uncommon for kids to get strep throat a few times a year once they are in school, it is even more common to get viral sore throats.

Strep throat, which can be treated with antibiotics, is caused by the group A Streptococcus (GAS) bacteria. And while a fast or rapid test can help determine if your child has strep throat or a virus, false positive (the test is positive, but the strep bacteria isn’t really making your child sick) results can sometimes confuse the picture.

Understanding Strep Throat

Before you can begin to understand why your child might be getting strep throat over and over again, you first have to understand strep throat and the current guidelines for diagnosing and treating strep.

“Diagnostic studies for GAS pharyngitis are not indicated for children less than 3 years old because acute rheumatic fever is rare in children less than 3 years old and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group.”

Infectious Diseases Society of America Guidelines

Strep throat is most common in children and teens between the ages of 5 and 15 years. While it might be possible for younger and older folks to get strep, especially if someone else in the house is sick with strep throat, since they aren’t considered to be at risk for acute rheumatic fever, it isn’t typically necessary to diagnose or treat them. It may surprise you, but strep throat does go away on its own – the main reason it is treated is so you don’t later develop rheumatic fever.

“Testing for GAS pharyngitis usually is not recommended for children or adults with acute pharyngitis with clinical and epidemiological features that strongly suggest a viral etiology (eg, cough, rhinorrhea, hoarseness, and oral ulcers).”

Infectious Diseases Society of America Guidelines

The classic symptoms of strep throat can include the sudden onset of a sore throat, fever, red and swollen tonsils (tonsillitis), possibly with white patches (exudate) and small, red spots (petechiae) on the roof of the child’s mouth, and tender, swollen lymph glands in their neck.

Kids with strep throat might also have nausea, vomiting, stomach pain, a headache, and a rash (scarlet fever).

Kids with strep throat will not usually have a cough, runny nose, hoarse voice, mouth ulcers, or pink eye with their sore throat. Those are symptoms that suggest a virus is causing the sore throat and they should not usually be tested for strep. This helps to avoid an unnecessary antibiotic prescription if your child tests positive, but really has a virus.

So basically, try to avoid over-testing for strep. But if your child does have strep throat symptoms and has a positive test, get an antibiotic that will clear the strep bacteria and finish all of your child’s prescription.

Avoiding Strep and Other Infections

Can you avoid getting strep?

As with other infections, the best way to avoid strep throat is to teach your kids to:

  • wash their hands properly
  • avoid close contact with people that are sick (for strep, that means until they have been on their antibiotic for at least 24 hours)
  • avoid drinking out of other people’s cups or glasses
  • consider taking a water bottle to school instead of drinking out of the water fountains
  • not touch their eyes or put objects (fingers, pencils, clothing, etc.) in their mouth, as that helps germs get in their body
  • cover their coughs and sneezes to avoid getting others sick

Most importantly, don’t wait until someone is sick in your home or lots of kids are getting sick at school to encourage your kids to avoid getting sick. By then, it will likely be too late.

Is Your Child a Strep Carrier?

If your child continues to get strep, especially if their strep test is always positive, it is likely time to consider that they may be a strep carrier.

“We recommend that clinicians caring for patients with recurrent episodes of pharyngitis associated with laboratory evidence of GAS pharyngitis consider that they may be experiencing >1 episode of bona fide streptococcal pharyngitis at close intervals, but they should also be alert to the possibility that the patient may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infections.”

Infectious Diseases Society of America Guidelines

What does it mean to be a strep carrier?

It simply means that the strep bacteria are living or ‘hanging out’ in the back of your child’s throat. While that sounds bad, these strep bacteria aren’t causing any problems. They aren’t making your child sick, causing any symptoms, and don’t even make your child contagious.

“…the recovery of GAS does not establish causality. The tests do not distinguish carriage of GAS in a child with pharyngitis attributable to another cause from an acute infection caused by GAS.”

“Group A Streptococci Among School-Aged Children: Clinical Characteristics and the Carrier State” Pediatrics. 2004 Nov;114(5):1212-9.

The big problem with being a strep carrier is that whenever you have a strep test, these strep carrier bacteria will make the test positive, even if they aren’t what is causing your child’s symptoms.

This is often why people get diagnosed with strep and flu or strep and mono at the same time.

If you still don’t understand strep carriers, consider that if you go to almost any school and test every child, up to 20 to 25% of the kids will test positive for strep, even though they aren’t sick and have no symptoms. They are likely just strep carriers.

“We recommend that GAS carriers do not ordinarily justify efforts to identify them nor do they generally require antimicrobial therapy because GAS carriers are unlikely to spread GAS pharyngitis to their close contacts and are at little or no risk for developing suppurative or nonsuppurative complications (eg, acute rheumatic fever).”

Infectious Diseases Society of America Guidelines

What kind of efforts are they talking about? We sometimes hear about doctors ordering antibody tests, doing rapid strep tests and cultures on kids after they finish their antibiotics, testing everyone who lives in the house, or even testing the family dog.

None of this is usually necessary.

One thing that can be helpful is that if your pediatrician thinks that your child is a strep carrier, then instead of the more typical penicillin or amoxil antibiotics, they might treat your child with a stronger antibiotic, like clindamycin. This can help ‘knock out’ the carrier bacteria.

And then learn to be much more selective about getting strep tests, avoiding them if your child has more classic viral symptoms, like a cough and runny nose.

In addition to the idea of being a chronic carrier, there are other theories about why kids get recurrent strep throat infections, including:

  • antibiotic resistance – although this is thought to be rare or non-existent when it comes to the GAS bacteria and penicillin, amoxicillin, and cephalosporins. There is some resistance between azithromycin and strep, which is why it should only be prescribed if your child is allergic to the other antibiotics that are used to treat strep throat.
  • noncompliance – not finishing your antibiotic or not taking it as prescribed
  • influence of other bacteria – there are theories that other bacteria may be inactivating penicillin or amoxicillin (so you need a stronger antibiotic) or even that other beneficial bacteria help to kill the GAS bacteria, but may be gone if your child is frequently on antibiotics
  • you are starting antibiotics too quickly – some people think that if you don’t wait a few days and let the body start to fight the strep infection on its own, then it is more likely to come back

Or if your child had true strep throat symptoms, got well quickly after being on an antibiotic, but then got strep (with classic strep symptoms) again quickly, it is possible that it is just a new infection.

“We do not recommend tonsillectomy solely to reduce the frequency of GAS pharyngitis.”

Infectious Diseases Society of America Guidelines

If it is happening over and over again, consider the possibility that your child is a strep carrier and teach him or her how to avoid getting sick as much as possible.

Why not just get your child’s tonsils out? The problem is that many studies have shown that while this might help for a year or so, after that, these kids start getting strep just as much as they did before. So unless your child also has sleep apnea or has had complications of strep infections, like a peritonsillar abscess, you probably shouldn’t rush into a tonsillectomy.

What To Know About Recurrent Strep Throat Infections

Some other fast facts to know include that:

  • having tonsillitis does not automatically mean that your child has strep. Remember that viruses are an even more common cause of sore throats.
  • you can’t tell if someone has strep just by looking at their tonsils. Even having pus (white stuff) on their tonsils doesn’t automatically mean strep. Viruses can do that too. That’s why a rapid strep test, with a backup culture for negative tests, is important to make the diagnosis.
  • throwing out your child’s tooth brush every time they have strep isn’t necessary, after all, you don’t do that after they have other infections, do you? Instead, encourage your kids to routinely rinse their toothbrush after each use and replace it every 3 to 4 months.

Hopefully you have a better understanding of strep throat now.

Sore throat infections, including strep throat, are common, but remember to look for other answers besides just getting your child’s tonsils out if they get strep over and over.

More Information About Strep Throat

What is Causing your Child’s Diarrhea?

Often described as the "cruise ship virus," you can get norovirus infections in daycare centers, schools, or after eating at a restaurant.
Often described as the “cruise ship virus,” you can get norovirus infections in daycare centers, schools, or after eating at a restaurant. (CC BY-SA 2.0)

Why does your child have diarrhea?

Could it be the “stomach flu,” food poisoning, or just an intolerance to something your child eat?

Common Causes of Diarrhea

While parents often quickly jump to the idea of “food poisoning,”  infections are typically the most common cause of diarrhea in kids.

These include:

  • viruses – rotavirus (a vaccine preventable disease), adenovirus, and norovirus
  • bacteria – C. diff, Salmonella, Shigella, E. coli, Campylobacter jejuni, Bacillus cereus, Listeria, Cholera
  • parasites – Cryptosporidium, Giardia, Cyclospora

Not all diarrhea is caused by infections though. If the diarrhea lingers for more than a few weeks or keeps coming and going, then you might consider that your child might have a lactose intolerance, irritable bowel syndrome, Celiac disease,  or other non-infectious cause.

Hints of Diarrhea Causes and Risk Factors

To help figure out what might be causing your child’s diarrhea, consider these questions and share the answers with your pediatrician:

  • Does your child have bloody diarrhea (sometimes a sign of a bacterial infection)?
  • Is your child getting dehydrated? While that doesn’t tell you want is causing the diarrhea, it is a good sign that you need to seek medical attention.
  • Does your younger child (under age 2 to 4 years) have bloody diarrhea that is becoming jelly-like and episodes of severe, colicky abdominal pain (sign of intussusception)?
  • Is your child in daycare? Has anyone else recently been sick with diarrhea or vomiting?
  • Has your child recently been on antibiotics (a risk for C. diff)?
  • Does your toddler with diarrhea drink a lot of juice (Toddler’s diarrhea)?
  • Have you recently traveled out of the country (Traveler’s diarrhea)? Did your child get sick a few days later (could be a bacterial or viral cause) or a few weeks later (parasites have longer incubation periods)?
  • Has your child recently spent time on a lake or river and possibly drank untreated water (risk for Giardia infection)?
  • Do you have any high risk pets, including turtles, snakes, lizards (or other reptiles); frogs, salamanders, newts (or other amphibians); chicks, chickens, ducklings, ducks, geese, and turkeys (or other poultry); mice, rats, hamsters, and guinea pigs (or other rodents); or farm animals (all can be a risk for Salmonella)?
  • Have you recently visited a farm or petting zoo (risk for Salmonella and E. coli)?
  • Has your child recently visited a water park or public swimming pool (risk for Cryptosporidium)?
  • Does your child drink raw milk, unpasteurized juice, raw or undercooked eggs, or undercooked beef, pork, and poultry (risk for food poisoning)?
  • Has your child recently eaten leftover food that had been unrefrigerated for more than two hours (risk for food poisoning)?
  • Is the diarrhea worse after your child drinks a lot of milk or eats a lot of dairy (a sign of lactose intolerance)?
  • Does your child have alternating episodes of constipation and diarrhea (irritable bowel syndrome)?
  • In addition to chronic diarrhea, is your child irritable, with poor weight gain and other symptoms (a sign of Celiac disease)?
  • Does your child also have abdominal pain or just diarrhea?
  • Is your child taking any medications that might cause diarrhea as a side effect?

Once you have narrowed down the possibilities, blood and stool tests, including stool culture tests for bacteria, parasites, and viruses can sometimes help to figure out what is causing your child’s diarrhea. Keep in mind that these are usually reserved for diarrhea symptoms that are severe (bloody diarrhea, fever, weight loss, etc.)  or lingering for more than a few weeks.

And remember that the most common causes of diarrhea, including food poisoning and viral infections, typically go away on their own without treatment. In fact, you can make things worse if you treat some causes of diarrhea with antibiotics, including some Salmonella, Shigella, E. coli infections.

Still don’t know what is causing your child’s diarrhea? In addition to your pediatrician, a pediatric gastroenterologist can be helpful when your child has diarrhea.

What To Know About Diarrhea

While diarrhea is common in kids and we often don’t figure out the specific cause before it goes away on its own, there are clues that can help you figure out if your child’s diarrhea is caused by a virus, bacteria, parasite, or other condition.

For More Information on Diarrhea