Author: Vincent Iannelli, MD

Vincent Iannelli, MD

Treating Hard to Control Acne

After you get past getting your teen to use an acne medicine every day, there are many option for treating hard to control acne.

Does your teen or pre-teen have acne?

Does he want to get it under control? Will he actually follow a daily regimen your pediatrician prescribes?

Acne Treatments for Kids

While treating your child’s acne on you own with an over-the-counter product can be a good way to start, there are so many products, you do want to make sure you are using the right ones. In general, you should likely start with:

  • products with benzoyl peroxide (BP), which might include OTC 5-10% BP wash for your child’s back or chest
  • a gentle, soap free, pH-balanced cleanser to wash your child’s face twice a day or a salicylic acid cleanser
  • a facial toner, only if necessary to remove excess oil or makeup

When those regimens aren’t working, your pediatrician can prescribe stronger acne medicines, usually in a step-wise fashion, including:

  • a topical retinoid –  Tretinoin (Retin A), Adapalene (Differin), or Tazarotene (Tazorac)
  • a combination topical product – BP/clindamycin (BenzaClin), BP/adapalene (Epiduo), BP/erythromycin (Benzamycin),  tretinoin/clindamycin (Ziana)
  • oral antibiotics – doxycycline, monocycline, tetracycline

If your child isn’t tolerating these medicines, like if it is causing his skin to become dry, make sure he is also using a moisturizer and washing with a mild soap substitute, like Dove. Starting with the lowest strength medicine can also be helpful, perhaps even just using topical medicines every other day until your child gets used to them.

Treating Hard to Control Acne

What do you do if your child’s acne isn’t getting better?

Ask yourself these questions and discuss the answers with your pediatrician:

  • Has your child started puberty yet? If not, talk to your pediatrician or a pediatric endocrinologist to see why he or she has such bad acne.
  • Are you avoiding picking up an acne prescription because of the cost? Ask your pediatrician about lower cost alternatives.
  • Is your child really using his acne medicines each day?
  • Is your child correctly using his acne medicines each day, avoiding spot treating problem spots and using a pea-size amount of cream or ointment to cover his whole face? Teach her to use the 5-dot method of applying acne cream – with a small pea-size amount of cream, place dots of the cream on their forehead (1), cheeks (2, 3), nose (4), and chin (5). Rub the cream in until, keeping in mind that they are using too much if you can see or feel any left over cream.
  • What kind of acne does your child have? Comedonal (whiteheads and blackheads) and inflammatory acne (classic zits or pimples) are treated differently.
  • Does your child frequently touch or rub his face, which can make acne worse?
  • If using makeup, is it oil-free and noncomedogenic?
  • Is your child overdoing washing, using a harsh soap or astringent, thinking that dirt is making her acne worse?
  • Does your child use a non-comedogenic sunscreen, remembering that a sunburn will make her acne worse in the long run?
  • Does your child have severe acne, which should probably be treated with a combination of oral antibiotics plus topical retinoids with BP, with or without topical antibiotics?
  • Did you give the medicines enough time to work or have a relapse because you stopped them too soon? Acne often worsens before it gets better and oral antibiotics are often continued for months and months,  with a goal of being tapered and stopped after about three to six months.
  • Does your child need a step-up in therapy? Ask your pediatrician if you need to add on a new medicine, switch to a combination product, or move to a higher strength product.
  • Have you considered adding hormonal therapy (combination oral contraceptives) for your pubertal daughter with severe acne, such as Ortho-Tri-Cyclen, Estrostep, or Yaz?

Lastly, even with worry about possible side effects, oral isotretinoin (Accutane, Amnesteem, Sotret, and Claravis) is still a good option for teens with severe, refractory, and scarring acne. At this point, and perhaps even before, an evaluation by a dermatologist would be a good idea.

What To Know About Treating Hard to Control Acne

There are no quick fixes for acne, but your pediatrician can offer you a step-by-step regimen of topical and oral acne treatments.

More Information On Treating Hard to Control Acne

Treating Hard To Control Constipation in Kids

Learn how to treat kids with hard to control constipation.

Constipation is very common for kids.

Since your kids will almost certainly become constipated, at least briefly, at some point in their lives, it is important to understand how to recognize the symptoms of constipation.

Symptoms of Constipation

How do you know if your child is constipated?

In addition to grunting and stomach pain, more traditional signs and symptoms of constipation include having:

  • fewer than two bowel movements in a week
  • bowel movements that are small, hard, and like little balls
  • bowel movements that are very big and hard and which may frequently clog the toilet

Most importantly, your constipated child will have bowel movements that are painful and difficult to pass. Very big bowel movements might also lead to small rectal tears and bleeding (usually some bright red blood on the toilet paper when wiping, not blood that fills the toilet bowl).

Not surprisingly, large painful bowel movements commonly lead kids to avoid going to the bathroom, creating a viscous cycle of worsening constipation that can become chronic. Your child with chronic constipation may eventually develop encopresis, having soiling accidents that you mistake for diarrhea. Or because they are holding their stool, they might also hold their urine and develop multiple urinary tract infections or just have urine accidents.

What about grunting and straining? If your baby grunts, strains and even cries briefly, but then passes a soft bowel movement each day, then she probably isn’t constipated (Infant Dyschezia).

Young Children with Constipation

It is often most obvious when young children get constipated, as you are still changing diapers or helping them use the potty.

Keep in mind that:

  • you should talk to your pediatrician if you think that your newborn baby is constipated (not pooping can be a sign that newborn babies aren’t eating enough) or if your child has had constipation problems since he was born (sign of Hirschsprung disease) or is constipated and isn’t gaining weight (Celiac disease)
  • exclusively breastfeeding infants, especially before they start solid foods, once they are gaining weight well, are unlikely to get constipated, but they may only have their soft bowel movements every few days or weeks
  • infants sometimes get constipated when they start rice cereal or other baby foods
  • toddlers sometimes get constipated when they start potty training – this is an especially important time to make sure your child doesn’t get or stay constipated, or it will interfere with potty training

Again, be aggressive if your child becomes constipated when potty training. It is easy to imagine that your toddler is not going to want to have regular bowel movements on the potty if he associated them with pain.

Children with Constipation

Although it is typically harder to recognize, because you likely don’t know how often they are going to the bathroom, constipation is common in older children too.

Common times to develop constipation might include:

  • when they start kindergarten, especially if they don’t feel comfortable going to the bathroom at school
  • after going to camp, on a trip, or any other situation where their diet and routine might have changed
  • after a brief illness, especially if they took or are taking a medication that might have constipation as a side effect
  • during a period of stress, such as starting a new school, moving to a new house, bullying, or social changes (divorce, death in the family, etc.) at home

It is so common, you might even want to watch for constipation at those times, especially if your child has had issues with constipation in the past.

Hard To Control Constipation

Most parents know how to treat simple constipation – more fluids, more fiber, stool softeners, and the occasional glycerin suppository or pediatric enema (the last treatments should likely only be used when nothing else is working and your child is uncomfortable).

But what do you do when that’s not enough?

To help treat kids with hard to control constipation, it usually helps to:

  • make long term changes to your child’s diet, including more fluids (especially water), less fat,  and more fiber, as kids with constipation may have a diet high in fat and low in fluids and fiber
  • make long term changes to your child’s behavior, encouraging him to sit and try to go to the bathroom after breakfast and dinner, but not making him sit until he goes
  • encourage your child to be physically active
  • continue your child’s daily maintenance constipation medicine (usually polyethylene glycol (PEG), lactulose, Milk of Magnesia (magnesium hydroxide), or mineral oil) until he is having a soft stool each day for several months and continues having a daily soft stool as you gradually decrease (over several months) and then stop the medicine (stopping a laxative as soon as kids begin having regular bowel movements is the biggest mistake that parents typically make when their kids are constipated)
  • consider a clean out regimen over a few days if your child is very constipated, using high dose polyethylene glycol or magnesium citrate, which unfortunately might cause some diarrhea as a side effect of getting a lot of hard stool out

What do you do if your child relapses? You usually just start over, especially if the relapse is because you stopped one or more of your child’s constipation treatments.

If your child relapses even though you had been consistent and had been continuing all of his previous treatments that had been working well, you might consider:

  • switching to an alternative to cow’s milk, like almond or soy milk, as some people think constipation can be due to a cow’s milk protein allergy, plus they will likely be lower in fat than cow’s milk
  • increasing the dose of stool softeners and make sure that you don’t stop them too soon
  • avoiding treatments that have not been found to be helpful, including very high fiber diets, prebiotics or probiotics, biofeedback and other alternative treatments
  • avoiding suppositories and enemas, as oral constipation medicines are just as effective and will be better tolerated by your child

Your pediatrician and/or a pediatric gastroenterologist can be helpful if your child has hard to control constipation. In fact, up to 25% of the visits to a pediatric gastroenterologist are for constipation.

For More Information on Constipation

The Numbers Behind Keeping Food Safe

Learn the numbers behind food safety to help keep your kids safe from poisoning.

Learn the four basic steps to keep your food safe from germs.
Learn the four basic steps to keep your food safe from germs.

There is no safe food when it comes to food poisoning. Eggs, fruits, meats, vegetables and even organic sprouts can all become contaminated.

That makes it important to learn how to keep your food safe.

Although many things are being done to reduce contamination before food gets to us, it is just as important to prepare, cook and store food properly so that our kids don’t get sick.

Food Safety Numbers

There are some numbers related to food safety that you might be all too familiar with – about 48 million people get sick from food poisoning each year, sending 100,000 people to the hospital, and causing about 3,000 deaths

Reducing food poisoning is a “winnable battle” though, according to the federal Centers for Disease Control and Prevention. But of course, safe food doesn’t just happen. It takes a little work, starting with understanding some of the other numbers associated with food safety, such as:

  • 4 – the number of steps to proper food safety – clean, separate, cook, chill
  • 0˚F – the temperature to set your freezer (0˚F or below)
  • 40˚F – the temperature to set your refrigerator (between 40˚F and 32˚F)
  • 140˚F – the temperature you should keep food after cooking
  • 145˚F – the minimum internal temperature to cook pork, fresh ham, steaks, roasts, chops and other whole meats (cook to the right temperature)
  • 160˚F – the minimum internal temperature to cook egg dishes and ground meat (cook to the right temperature)
  • 165˚F – the minimum internal temperature to cook poultry and reheat leftovers (cook to the right temperature)
  • 3 minutes – the amount of “rest time” you should wait to make sure harmful germs are killed after cooking food, which is especially important after cooking steaks, roasts, chops, fresh pork and fresh ham. Don’t just heat and eat your food.
  • 2 hours – the maximum about of time that perishable food should be left out before you put it in the refrigerator
  • 90˚F – the outside temperature that should alert you that you need to refrigerate perishable food after just one hour, instead of the usual two hours
  • 20 seconds – how long you should wash your hands before, during and after preparing food and before eating.
  • 4 hours – the amount of time that a refrigerator will usually keep food cold if the power goes out and the refrigerator door is not opened. After that time, throw out perishable food that has been above 40˚F for two hours or more.
  • 3 to 4 days – how long most leftovers can be safely stored in the refrigerator
  • 15 to 20 – the number of Salmonella cells in undercooked food that can cause food poisoning
  • Less than 5 minutes – how long it takes to report a case of food poisoning to your local health department so that you can help to prevent a larger outbreak.

How can you tell the internal temperature of foods that you are cooking? Use a food thermometer, as you can’t tell when foods are safely cooked by simply looking at them.

And be on the alert for food recalls, to make sure that you don’t have contaminated foods in your home.

What To Know About Keeping Food Safe

Do all of these numbers sound too hard to do or keep up with, especially when you are trying to have fun at a cook out or family dinner?

Remember, it is better than the alternative, 2 to 10 days of vomiting and diarrhea because your family developed symptoms of food poisoning…

For More Information on Food Safety Numbers:

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Fire Ant Bites

Learn how to treat and avoid fire ant bites and stings.

A classic fire ant mound popping out of a nice green lawn. Photo by Bart Drees.

Are you worried about your kids getting bit by fire ants?

If not, then you don’t live in Alabama, Florida, Georgia, Louisiana, Mississippi, or Texas, where they have been around for a while.

Fire Ants

Fire ants are thought to have been imported on ships into Mobile, Alabama from South America. They have continued to spread ever since, lately making it as far as eastern New Mexico, the southern half of Oklahoma, and parts of California.

Like imported killer bees, fire ants are more aggressive than native ants.

Many of us get annoyed when we see large fire ant mounds pop up in our yards after it rains, but it can be really concerning one or more fire ants bite or sting your child.

Symptoms of Fire Ant Bites

While many insects bite, it is the classic behavior of fire ants that can make their bites so much worse.

When disturbed, fire ants emerge aggressively, crawling up vertical surfaces, biting and stinging “all at once”.

Texas Imported Fire Ant Research and Management Project

In a typical situation, a toddler or preschooler steps on a fire ant mound in the yard, and before you know it, dozens of fire ants are covering their feet and legs. Or they fall onto the mound, with the fire ants all over their hands and arms.

As you scramble to move your child and get the ants off (quickly rub them off with a cloth or your own hand), they will likely all start stinging.

Multiple fire ant bites on a child’s hand. Photo by the Texas Department of Agriculture.

Fortunately, very few people are allergic to fire ant stings, which might trigger a whole body reaction, with dizziness, shortness of breath, and hives, etc.. The redness, swelling, and white-yellow pustule at the site of the bite are usually the normal symptoms of a local reaction to the fire ant venom.

The pustules go away over a few days to weeks. There is no need to pop or try to drain them. In fact, popping them might lead to their getting infected. It’s better to leave them alone.

After you are bit, it is going to hurt or burn for a few minutes too – that’s why they are called fire ants.

How do you treat fire ant bites?

After you remove the ants, basic first aid and treatment for fire ant bites might include washing the area with soap and then using a cool compress, oral antihistamines, and topical steroids to treat itching.

And of course, seek immediate medical attention if your child is having an allergic reaction to the bites or if it appears that the bites are later getting infected, with increased pain and swelling when you would think that they should be improving.

What To Know About Fire Ant Bites

Although fire ant bites are rarely dangerous or life-threatening, your best bet in protecting your kids is to get rid of any fire ants in your yard and in other places that they play. You might also encourage your kids to wear shoes (not sandals or Crocs) and socks when walking or playing outside.

For More Information on Fire Ant Bites

The Best Milk for Kids – Does It Still Come from a Cow?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut.

You wouldn’t think that the idea that kids should drink milk would be controversial.

Of course, it is…

The new joke seems to be that you can turn anything into “milk,” even peas.

The controversy is more over the type of milk now and not so much over the amounts though.

Few people disagree with the American Academy of Pediatrics 2014 clinical report on Optimizing Bone Health in Children and Adolescents, in which they recommended that “Children 4 through 8 years of age require 2 to 3 servings of  dairy products or equivalent per day. Adolescents require 4 servings per day.”

Which Kind of Milk You Got?

While you used to have to go to Whole Foods to get soy milk, nearly every grocery store now has every type of “milk” you can think of, and some you haven’t.

So in addition to raw milk and pasteurized cow’s milk, it is possible to buy:

  • almond milk
  • cashew milk
  • coconut milk
  • flax milk (flax seeds)
  • goat milk
  • hazelnut milk
  • hemp milk
  • lactose free milk (cow’s milk without lactose)
  • oat milk
  • potato milk (as powdered milk)
  • quinoa milk
  • rice milk
  • ripple milk (peas)
  • 7 grain milk (Oats, Brown Rice, Wheat, Barley, Triticale, Spelt and Millet)
  • soy milk
  • sprouted rice milk

Complicating matters even more, once you decide on the type of milk to give your kids, you will have a lot of other options to choose from – organic, hormone free, sweetened vs unsweeted, enriched vs original, and a long list of flavors, etc.

The question is no longer simply Got Milk?

Best Milk for Kids

So which milk is best for your kids?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and most importantly, which he is going to drink.

What about the idea or argument that cow’s milk is made for baby cows?

Following that logic, if you weren’t going to give your kids cow’s milk, then you probably wouldn’t give them most plant based milks, as they are commonly made from seeds. Almonds, peas, and soybeans, etc., aren’t “made” to make milk. They are produced to make more plants. But just like we pasteurize and fortify cow’s milk so that we can consume it, we have learned to use these other foods.

Best Milk for Kids with Food Allergies

While the wide availability of so many different types of milk is confusing for many parents, it has been great for pediatricians and parents of kids with food allergies and intolerances. Having more of a variety has also been helpful for vegan families.

In general, you should breastfeed or give your infant an iron fortified formula until they are at least 12 months old, avoiding milk or other allergy foods as indicated if you are breastfeeding and your child develops an allergy to that food, or switching to a hypoallergenic or elemental formula if your child develops a formula allergy.

And then, after your toddler is old enough to wean from breastmilk or formula, you:

  • should avoid cow’s milk, lactose-free cow’s milk, and goat milk if your child has a milk protein allergy
  • should avoid almond, cashew, coconut, and hazelnut milk if your child has a nut allergy (yes, even though almonds and coconuts are really stone fruits and not true nuts, they have been rarely known to cross react and trigger allergic reactions)
  • should avoid soy milk if your child has a soy allergy
  • should make sure your child’s milk is fortified with calcium and vitamin D

Most importantly, talk to your pediatrician and/or a pediatric allergist before switching to a plant based milk if your child has food allergies and before trying to switch back to cow’s milk after you think they have outgrown their allergy.

Other Things to Know About Kids Drinking Milk

Kids don’t necessarily need to drink any kind of milk.

They do need the nutrients that you commonly get from milk, including fat, protein, calcium, and vitamin D, etc.

You should also know that:

  • the American Academy of Pediatrics recommends that most toddlers drink whole milk until they are two years old, when they should switch to reduced fat milk.
  • switching to reduced fat milk can be appropriate for some toddlers who are already overweight or if their pediatrician is concerned about their becoming overweight or about their cholesterol, etc.
  • most cow’s milk that you buy in your grocery store doesn’t have any added growth hormone (labeled rBST-free), even if it isn’t organic
  • the AAP, in a report on Organic Foods: Health and Environmental Advantages and Disadvantages, states that “there is no evidence of clinically relevant differences in organic and conventional milk”
  • if a company makes more than one type of non-dairy milk, such as rice, almond, and soy, then cross-contamination could be a problem for your child with food allergies
  • most kids with a lactose intolerance can tolerate some lactose in their diet, so may be able to drink some cow’s milk and eat cheese, yogurt, and ice cream, even if they can’t tolerate a lot of regular cow’s milk
  • while plant based milks are lactose free and some are unsweetened, others might have added sugar, including cane sugar or cane syrup
  • reduced-calorie and no added sugar flavored cow’s milk often use artificial sweeteners
  • unlike cow’s milk, most plant based milks are very low in protein, so look to give other protein rich foods to make up for it, like eggs, peanut butter, beans, tofu, and of course meats
  • although they aren’t labeled as 1% or 2%, plant based milks typically have less fat than whole milk, so look to give other foods with healthy fats to make up for it, like avocados, hummus (provides protein and fat!), peanut butter, some fish (salmon), and use olive oil, coconut oil, and real butter when possible
  • phytoestrogens in soy milk are a concern for some people
  • most milk, even oat milk, is gluten-free, with the exception of 7 grain milk, which obviously contains wheat
  • UHT milk undergoes ultra-high temperature processing or ultra-pasteurization to allow it have a longer shelf life, even if not refrigerated, at least until the carton is opened
  • although some experts warn about cross reactivity, like between peanuts and green peas, the Food Allergy Research & Education website states that “If you are allergic to peanuts, you do not have a greater chance of being allergic to another legume (including soy) than you would to any other food.”
  • raw cow’s milk, in addition to being a risk for bacterial contamination and outbreaks of Escherichia coli, Campylobacter, and Salmonella, is very low in vitamin D and has no proven health benefits over pasteurized milk
  • some brands of almond milk contain only about 2% of almonds, which leads some critics to say that you should just eat a few almonds to get even more nutritional benefits

But don’t forget about cost. Plant based milk can be at least two to four times more expensive than cow’s milk.

So again, remember that while each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut, etc.

For More Information On The Best Milk For Kids:

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What Does Polio-Like Mean?

Learn why at least 350 children have developed acute flaccid myelitis since 2014.

Breaking News – 90 cases of AFM in 27 states have been confirmed so far this year, and are among 252 cases that are under investigation.

Polio has been in the news a lot lately.

Well, not exactly polio.

The term “polio-like” has been in the news.

This follows a large outbreak of enterovirus D68 (EV-D68) respiratory infections in 2014, some of which seemed to be associated with the development of acute flaccid myelitis (AFM).

While there were no reports of EV-D68 infections in 2015, there have been “limited sporadic EV-D68 detections in the U.S. in 2016.”

And 2017.

And 2018.

But after we saw 149 cases in 39 states in 2016, there were only 33 cases in 16 states in 2017.

And there have been about 38 cases in 16 states in 2018, coming out of the peak season for AFM cases – August to October.

Polio-Like Syndromes

Similar to coxsackievirus, which causes hand, foot, and mouth disease, EV-D68 is a non-polio enterovirus. On the other hand, the virus that actually causes polio is just a different type of enterovirus.

Because they are all enteroviruses, some get differentiated as being non-polio.

To make it even more confusing, some non-polio enteroviruses can cause a polio-like syndrome.

And both polio and non-polio enteroviruses can cause acute flaccid myelitis.

It is important to note that only some, but not all, of the kids with AFM have been positive for enterovirus D68. In Colorado this year, 9 of 14 cases were linked to EV-A71 infections.

Acute Flaccid Myelitis

What is acute flaccid myelitis?

AFM is a syndrome characterized by sudden onset of limb weakness, sometimes accompanied by cranial nerve dysfunction (such as facial drooping or difficulty speaking). In many cases, distinctive lesions in the gray matter (nerve cells) of the spinal cord may be seen on neuroimaging.

CDC definition

Acute flaccid myelitis caused by the polio virus can usually be recognized because it is associated with an unvaccinated person who traveled to an area that still has cases of polio and who has “one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss. Paralysis usually begins in the arm or leg on one side of the body (asymmetric) and then moves towards the end of the arm or leg (progresses to involve distal muscle groups).”

Since 2014, at least 350 children have developed acute flaccid myelitis. Most had some improvement in function and a small number had a complete recovery, just as a small number had no improvement.

And of course, none of them had polio. In fact, the last polio outbreak in the United States was in 1979.

So maybe we should stop saying “polio-like,” as it likely just confuses people, few people likely know what “polio-like” symptoms actually are, and these cases have nothing to do with the polio virus.

Unfortunately, “despite extensive testing, CDC does not yet know the cause of the AFM cases.”

AFM isn’t caused by vaccines though…

Still, the CDC recommends standard precautions to try and avoid AFM, including handwashing, avoiding other people who are sick, getting vaccinated (to avoid polio), and protecting your kids from mosquitoes (West Nile virus can cause AFM too).

For More Information on Polio-Like Syndromes

Updated November 13, 2018

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What to Know About Fifth Disease

Fifth disease is a common viral infection that causes a characteristic rash on a child’s cheeks, arms, and legs that can linger for weeks.

Fifth disease, also called erythema infectiosum, is a very common viral infection that most kids get in early childhood.

It got its name because it was the fifth disease that was known to cause a fever and rash.

Measles was the first.

Symptoms of Fifth Disease

Fifth disease can cause a child to look like they have slapped cheeks. Photo by Dr. Philip S. Brachman

It is caused by parvovirus B19.

Symptoms start with a red rash on your child’s cheek, giving them the appearance that they have been slapped. And that’s where fifth disease’s other name comes from – slapped cheek disease.

This slapped cheek rash is often subtle, so that many parents might think that the rash is from the sun or wind. They often don’t even consider that their child might be ‘sick’ until a few days later, when they get a pink, lacy rash on their arms and legs. Even then, they might mistake the rash for hives, poison ivy, or any number of other common childhood rashes.

Diagnosis of Fifth Disease

Unless you understand that the fifth rash can come and go, being more obvious when your child is overheated, it can be easy to see why it isn’t quickly recognized by some people. It can also be confusing because the rash could also appear on a child’s back, chest, and leg – it doesn’t have to be limited to the cheeks and arms.

And the rash, which can be itchy, can linger for weeks or even months.

While a blood test can be done, it is this pattern of symptoms that makes the diagnosis.

Most importantly, understand that fifth disease eventually does goes away without treatment. While not usually necessary, anti-itch treatments may be tried.

Can your kids go to school with fifth disease?

Fortunately, kids are not contagious while they have this rash, so they can go to school and participate in other activities. You might need a note from your pediatrician to convince folks though. They were contagious during the week before they developed the rash though, so it can be a good idea to tell people, so they can look for symptoms too.

Facts About Fifth Disease

Other things to know about fifth disease include that:

  • Fifth disease is caused by the parvovirus B19 virus and is most common during the spring and school outbreaks are no uncommon.
  • The incubation period for fifth disease is very long – up to 4 to 21 days. That means you can get this virus about 4 to 21 days after being exposed to someone else that had it, especially if you were exposed to their respiratory secretions (coughing and sneezing) just before they developed their rash.
  • Prodromal symptoms of fifth disease, which can start 7 to 10 days before the rash, might include a few days of mild fever, muscle aches, headache and decreased activity.
  • In addition to a rash, adults with fifth disease can also have joint pain and arthritis.

It is also important to know that like roseola, fifth disease can be more serious for those with immune system problems. It can also be serious for pregnant women who aren’t immune and for those with hemolytic anemia and sickle cell disease.

What to Know About Fifth Disease

Fifth disease is a very common viral infection that causes a characteristic rash on a child’s cheeks, arms, and legs that can linger for weeks.

More Information About Fifth Disease

Pediatrics Health Library

An A to Z guide to pediatrics and parenting.

From acne to zika, we will get you the information you need to keep your kids safe and healthy:

Please check back often as we get all of these topics updated.

Updated September 26, 2017

Roseola

Roseola is a common viral infection that most kids get in early childhood.

Roseola is a very common childhood infection.

It was first described in the journal Pediatrics in 1910 by J. Zahorsky.

Also called roseola infantum or exanthem subitum (sixth disease), it is caused by human herpes virus type 6 and 7. That fact wasn’t discovered until 1986 though.

Roseola is best known for causing a high fever for about three to five days, but even more characteristically, roseola often causes a rose-pink or red rash on your child’s trunk once the fever breaks.

Infections can also be asymptomatic.

There are no treatments and it rarely causes complications. Even febrile seizures that can be triggered by roseola, which happens commonly, are not thought to be serious.

Roseola, even reactivation of an old infection, can be a serious for children or adults with immune system problems though, especially those who have had a stem cell transplant.

What To Know About Roseola

Roseola is a common viral infection that most kids get in early childhood. The biggest problem when having roseola is that by the time you get diagnosed, because the fever is gone and your child has a rash, it is basically over.

For more information:

Vaccine Preventable Diseases

Kids routinely get 13 vaccines that protect them against 16 vaccine preventable diseases.

There are over 25 vaccine-preventable diseases, including:

  • Anthrax – military use only
  • Adenovirus – military use only
  • Cervical Cancer (HPV)
  • Cholera
  • Diphtheria (DTaP)
  • Hepatitis A
  • Hepatitis B
  • Hepatitis E
  • Haemophilus influenzae type b (Hib)
  • Influenza (Seasonal Flu)
  • Japanese Encephalitis (JE) – travel
  • Measles (MMR)
  • Meningococcal disease (MCV4 and MenB)
  • Mumps (MMR)
  • Pertussis (DTaP)
  • Pneumococcal disease (Prevnar 13 and Pneumovax 23)
  • Poliomyelitis (IPV)
  • Rabies – after bites
  • Rotavirus
  • Rubella (MMR)
  • Shingles (Herpes Zoster) – for seniors only
  • Smallpox – eradicated
  • Tetanus (Tdap)
  • Tick-borne encephalitis
  • Tuberculosis (BCG)
  • Typhoid Fever – travel
  • Varicella (Chickenpox)
  • Yellow Fever – travel

Of course, kids don’t actually get vaccinated against all of these diseases.

They do routinely get 13 vaccines (bolded above) that protect them against 16 vaccine preventable diseases.

For more information:

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