Other Treatments for ADHD

In addition to stimulant and non-stimulant medications, behavior management therapy can help your child with ADHD.

So most people know that stimulant and non-stimulant medications are available as treatment for ADHD.

But what else is available?

Other Treatments for ADHD

Wait, why would you need to consider other treatments?

Well, believe it or not, some kids can’t tolerate stimulants.

And others either can’t tolerate non-stimulants either, or neither work for them.

So what’s left?

There’s behavior management therapy.

In fact, although it is often overlooked, it is important to remember that behavior management therapy should be the first treatment for younger, preschool children with ADHD.

“There are many forms of behavior therapy, but all have a common goal—to change the child’s physical and social environments to help the child improve his behavior.”

Behavior Therapy for Children with ADHD

And even though older kids are often treated with medication, they too might benefit from behavior management therapy.

“Under this approach, parents, teachers, and other caregivers learn better ways to work with and relate to the child with ADHD. You will learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. Your child will learn better ways to control his behavior as a result. You will learn how to be more consistent.”

Behavior Therapy for Children with ADHD

Typical behavior management therapy techniques might include positive reinforcement and allowing your child to earn rewards for desired behaviors and withdrawing privileges to try and decrease other behaviors.

You also want to help your child:

Some children with ADHD may also need social skills training and behavioral therapy for help controlling impulsive behavior.

Once you find a therapist, you can expect it to take time for your child to master the behavioral therapy techniques and better control his ADHD symptoms.
Once you find a therapist, you can expect it to take time for your child to master the behavioral therapy techniques and better control his ADHD symptoms.

And of course, accommodations at school (504 Plan vs IEP) can also be helpful so that your child has extra time to take tests if needed, modified instructions and assignments, and extra break time, etc.

What About Alternative ADHD Treatments?

What about all of those “other” treatments for ADHD that you might have heard about?

At those homeopathic dilutions, it is unlikely that there is any real active ingredient left in the Brillia pills. Remember, homeopathy works by the law of the minimum dose and  although it doesn't say it on the label, homeopathic medications only contain a "memory" of an active ingredient.
At those homeopathic dilutions, it is unlikely that there is any real active ingredient left in the Brillia pills. Remember, homeopathy works by the law of the minimum dose and although it doesn’t say it on the label, homeopathic medications only contain a “memory” of an active ingredient.

Restrictive diets, vitamins, minerals, brain training, and homeopathic remedies that are basically diluted to nothing…

Nutritional lithium, probiotics, and digestive enzymes…

You are actually trying to help your child with ADHD, right?

If all you have tried are alternative therapies to try and help your child with ADHD, then it's time to talk to your pediatrician about some real treatments.
If all you have tried are alternative therapies to try and help your child with ADHD, then it’s time to talk to your pediatrician about some real treatments.

Then try something that at least has a chance of working…

And if nothing works, keep in mind that your child might not actually have ADHD. Maybe something else is causing their symptoms or problems, like obstructive sleep apnea, depression, anxiety, or a learning disability, etc.

More on ADHD Treatments

Treating Hard to Control ADHD

Learn why ADHD can sometimes be hard to control and require more than just a quick prescription for Ritalin or Adderall, including adding behavior therapy, careful monitoring, and special accommodations at school.

ADHD is often much harder to treat than many people imagine.

It isn’t always just a matter of writing a script for Adderall or Ritalin and then have kids who had been failing suddenly jump to the ‘A’ Honor Roll.

ADHD Treatments

Whether your child’s ADHD symptoms include problems with inattention, hyperactivity and impulsivity, or both, the treatments are the same:

  • Stimulants – Adderall vs Ritalin based
  • Non-Stimulants – Intuniv (extended release guanfacine), Kapvay (extended release clonidine), Strattera
  • Behavior Management Therapy

Although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

ADHD Medications

Surprisingly, there is really no one best ADHD medicine. Those that aren’t yet generic (in bold) are going to be much more expensive than the others.

  • Short Acting Stimulants – Adderall, Focalin, Methylin (chewable), ProCentra (liquid), Ritalin
  • Intermediate Acting Stimulants – Dexedrine, Ritalin SR, Methylin ER
  • Long Acting Stimulants – Adderall XR, Adzenys XR-ODT, Concerta (Methylphenidate ER), Daytrana (patch), Focalin XR, Metadate CD, Metadate ER, Quillichew ER (chewable), Quillivant XR (liquid), Ritalin LA, Vyvanse
  • Non-Stimulants – Intuniv, Kapvay, Strattera

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

Treating Hard to Control ADHD

What do you do when your child’s ADHD treatments aren’t working?

While it is important to “initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity,” it is important to remember that not all kids with academic or behavioral problems have ADHD.

So the first thing you should do is confirm that your child really does have ADHD. Is it possible that your child was misdiagnosed and doesn’t have ADHD at all? Or could your child have ADHD and another co-morbid condition, including “emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions.”

Next, ask yourself these questions and discuss the answers with your pediatrician:

  • Is your child taking his medicine?
  • Does your child need behavior management therapy?
  • Are you not getting your child’s ADHD medicine because of how expensive it is? Ask your pediatrician about a lower cost generic ADHD medicine.
  • Has there been a sudden worsening of previously well controlled ADHD, which might indicate a problem with bullying, social changes at home, abuse, or depression, etc.?
  • Are you relying on restrictive diets or other alternative treatments for ADHD that have been proven to not usually work?
  • Does your child need a different dosage of his current stimulant, either a higher or lower dose?
  • Is your child’s medication wearing off too soon?
  • Does your child’s medication take too long to work?
  • Does your child need to switch to a different stimulant or to a stimulant with a different delivery method?
  • Does your child need to switch from a long-acting stimulant to a short-acting stimulant?
  • Does your child need to switch to a non-stimulant, keeping in mind that these are often used in combination with a stimulant and not by themselves.
  • Do you need to adjust your expectations for what kind of control you can get from even maximal treatment?
  • Does your pre-teen or teen with ADHD not want to take his medication anymore?
  • Are side effects keeping your child from taking his ADHD medicine everyday?
  • Does your child need 504 plan accommodations at school and/or an IEP?

And perhaps most importantly, what is making your child’s ADHD hard to control? Is he just still having some ADHD symptoms or are those lingering ADHD symptoms causing an impairment? If they aren’t causing an impairment, such as poor grades, problems with friends, or getting in trouble at school, etc., then your child’s ADHD may be under better control than you think.

What To Know About Treating Hard to Control ADHD

ADHD can sometimes be hard to control and require more than just a quick prescription for Ritalin or Adderall, including adding behavior therapy, careful monitoring, and special accommodations at school.

More Information About Treating Hard to Control ADHD

Pediatric Referral Guidelines

These referral guidelines can help you figure out when to refer a sick child to a specialist, how quickly you should get the child seen, and what to do as part of your pre-referral workup.

As much as we like to create a medical home for our kids, there are times when we have to refer them to specialists to help diagnose or manage an issue.

It is sometimes hard to know when that time is though.

Or what you can do before you start the referral process.

Do you know what to do as part of pre-referral workup for a child with short stature?
Do you know what to do as part of pre-referral workup for a child with short stature?

Reviewing our collection of pediatric referral guidelines can help to make sure that you send the right patient to the right specialist at the right time. And can help avoid unnecessary referrals and testing!

Pediatric Referral Guidelines

This is especially important because it can sometimes take time to get a pediatric patient in to see a specialist, so you don’t want a sick child to wait months only to discover that you could have or should have done something else.

Most importantly, these types of guidelines can help you figure out when to refer a sick child to a specialist, how quickly you should get the child seen, and what to do as part of your pre-referral workup.

Do the specialists you routinely refer to have their own guidelines you can look to before referring a patient?

If not, consider reviewing these referral guidelines for:

  • adolescent medicine – abnormal uterine bleeding, eating disorders
  • pediatric allergy & immunology – allergic rhinoconjunctivitis, anaphylaxis, asthma, atopic dermatitis, drug allergy, eosinophilic esophagitis, food allergy, immunodeficiency, insect hypersensitivity, sinusitis, urticaria/angiodema
  • back pain
  • pediatric cardiology – heart murmur, palpitations, arrhythmia, abnormal ECG, chest pain, syncope, hypertension, Kawasaki, genetic disorders, premature and term infants, hyperlipidemia
  • concussions
  • developmental-behavioral pediatrics – speech/language delay, delayed milestones, ADHD, preschool behavior disorder, autism
  • eating disorders – anorexia nervosa, bulimia, avoidant/restrictive food intake disorder
  • pediatric endocrinology – hypothyroidism, hyperthyroidism, goiter, thyroid nodule, diabetes, obesity, acanthosis nigricans, short stature, failure to thrive, precocious puberty, premature thelarche, premature adrenarche, delayed puberty
  • pediatric gastroenterology – abdominal pain, celiac disease, chron’s disease, diarrhea, hematochezia, food allergy, peptic ulcer disease, GER, vomiting, constipation, failure to thrive, eosinophilic esophagitis
  • GI conditions – abdominal pain, constipation, reflux, failure to thrive, vomiting, diarrhea, celiac disease, Crohn’s Disease / Ulcerative Colitis, Suspected Eosinophilic Esophagitis (EoE)
  • pediatric headaches
  • pediatric hematology – anemia, thrombocytopenia, neutropenia, coagulation defects (bruising and bleeding)
  • infectious diseases – recurring fevers, recurrent sinusitis, FUO, recurrent abscesses
  • metabolic disorders – developmental regression, hypotonia, stroke like episodes, recurrent seizures, failure to thrive, hypoglycemia, abnormal labs, positive newborn screen
  • menstrual irregularity
  • pediatric nephrology – microhematuria, gross hematuria, proteinuria, acidosis, cystic kidneys, hypertension
  • pediatric neurology – recurrent seizures, febrile seizure, first seizure, developmental delay, tics, autism, concussion, headaches
  • pediatric ophthalmology – visual acuity, ptosis, dacryostenosis, glaucoma, nystagmus, strabismus,
  • pediatric orthopaedics – flat feet, intoeing, chronic knee pain, acute knee pain, scoliosis
  • physical or occupational therapy/hand therapy
  • pediatric pulmonology – apnea, asthma, BPD, chronic cough, cystic fibrosis, recurrent pneumonia
  • psychiatry
  • pediatric rheumatology – arthralgias, joint swelling, weakness, back pain, malar rash, extremitiy color changes, positive ANA
  • umbilical hernia
  • pediatric urology – balanitis, bladder stones, dysfunctional voider, dysuria, frequency, hematuria, hernia, hidden penis, hydrocele, hydronephrosis, incontinence, kidney stoney, labial adhesions, meatal stenosis, paraphimosis, penile adhesions, phimosis, testicular pain, varicocele, vesicoureteral reflux
  • urology – undescended testicle, phimosis, UTI, hydronephrosis

And if you’re lucky, you might learn enough in the referral guidelines to save your patient a referral!

More on Pediatric Referral Guidelines

A Diet Plan for Teens

Need a diet plan to help your teen make healthier choices when they eat?

Have your teenagers picked up some bad eating habits and put on a little extra weight during the pandemic?

A Diet Plan for Teens

To get them back on track, in addition to encouraging them to be more active, it might help to teach them some healthy eating habits.

So no, this isn’t about putting your teen on a diet…

It’s about a diet plan that can lead to a lifetime of healthy eating, an active lifestyle, and a healthy weight.

It’s a diet plan that:

  • focuses on eating and drinking a variety of nutrient dense vegetables, fruits, grains (half should be whole grains), dairy products (can include fortified plant based alternatives to cow milk), protein foods, and oils
  • advises we stick within calorie limits and avoid oversized portions
  • limits added sugars (should be less than 10% of calories per day), saturated fat (should be less than 10% of calories per day), and sodium intake (should be less than 2,300mg per day)
  • goes along with an hour of more of daily moderate-to-vigorous physical activity for an hour or more with a mix of aerobic, muscle training, and bone-strengthening activities

Sounds easy, right?

It’s actually not that hard.

A customized MyPlate Plan will help you find your child’s food group targets so that you will both know what and how much your child should eat to stay within their calorie allowance each day.

Sound too easy?

Well, maybe it is… After all, we often already have some idea of what we should and shouldn’t be eating, that we need to be more active, and if we are eating too many things unhealthy things.

The real trick is getting motivated to eat healthier and be more active!

Need some easy things to start your path to a healthier lifestyle?

  • avoid soda, fruit drinks, and other drinks with added sugar and little or no nutrition
  • get more exercise and physical activity than you have been, even if you start with just 15 minutes a day
  • eat smaller snacks and be more mindful of how many calories you are getting from your snacks
  • don’t skip meals
  • eat your meals at the table, avoiding mindless snacking while you are on a screen
  • decrease your screen time if you are frequently on a screen
  • avoid adding high-calorie, high-fat dressings and toppings to all of your food, some of which might have started out fairly healthy
  • eat more meals at home, which has likely gotten easier during the pandemic
  • take supplements if you aren’t confident that you are getting enough calcium, vitamin D, and iron from the foods you are eating each day
  • if you have been gaining too much weight, consider decreasing your portion sizes, as you are almost certainly getting too many calories each day

And then once you are on a healthier path, you can try to follow an age appropriate MyPlate Plan! Or if still need some reinforcement and more tips for healthy eating, read these articles:

And of course, your pediatrician and/or a registered dietician can also be a good source of help for your teen who needs a healthy eating plan.

More on Teen Healthy Eating Plan

Is Handwashing Drying Your Child’s Skin?

A rash on their hands might mean that you have to change how your kids wash their hands and not that they have to wash less often.

Do your kids get dry, red, and itchy hands, especially during the winter months when it gets cold?

Hand sanitizier and handwashing may be drying your child's skin.

Believe it or not, it’s probably because they are washing their hands very frequently, which is a good thing these days.

Is Handwashing Drying Your Child’s Skin?

Of course, many other things could be causing a rash on your child’s hands, but if the rash is on both hands, is worse each winter, and there are no other symptoms, then it is probably from handwashing.

Is it from excessive handwashing?

Not necessarily.

“The best way to prevent the spread of infections and decrease the risk of getting sick is by washing your hands with plain soap and water, advises the Centers for Disease Control and Prevention (CDC). Washing hands often with soap and water for at least 20 seconds is essential, especially after going to the bathroom; before eating; and after coughing, sneezing, or blowing one’s nose. There is currently no evidence that consumer antiseptic wash products (also known as antibacterial soaps) are any more effective at preventing illness than washing with plain soap and water. In fact, some data suggests that antibacterial ingredients could do more harm than good in the long-term and more research is needed.”

Q&A for Consumers | Hand Sanitizers and COVID-19

You might just need to change up how your child washes their hands, making sure that they:

  • use a moisturizing soap (Dove, Basis) or soap-free cleanser (Cetaphil, Vanicream Free & Clear), avoiding harsher, antibacterial soaps
  • apply moisturizers (Aquaphor, Vanicream, Cetaphil, Cerave, Eucerin) within a few minutes of washing, keeping in mind that greasy ointments typically are the best, followed by creams, and then lotions, although kids sometimes don’t like the feel of greasy ointments
  • avoid the frequent use of hand sanitizers, as they contain high concentrations of alcohol and can be drying, so limit the use of hand sanitizers to when soap and water isn’t available and even then, try to use a hand sanitizer with a moisturizer

But what if your child’s hands do get red and irritated? Simply applying a moisturizer probably isn’t going to be much help then, is it?

Probably not, so that’s when it’s time to also apply a steroid cream to calm the flare up. While you can start with over-the-counter hydrocortizone cream twice a day (don’t apply at same time as the moisturizers), you might need a medium strength prescription steroid cream for all but the mildest cases. In some cases, a more potent steroid might even be needed for a short time.

And of course, you should think about what else might be causing a rash on your child’s hands, especially if they aren’t quickly getting better with steroids and moisturizers:

  • does your child also have ulcers in their mouth or a rash on their feet, which might indicate Hand Foot and Mouth disease?
  • has your child recently been bitten by a tick?
  • does your child have a honey colored crusty rash on one hand, a sign of impetigo?
  • is your child working with new chemicals, solvents, wearing gloves, or doing anything else that could be triggering an allergic reaction or contact dermatitis on their hands?
  • do other people in the house have an itchy rash on their hands and arms, which could be a sign of scabies?

Fortunately, hand dermatitis from excessive hand washing and cold winter weather is typically easy to diagnosis and treat and isn’t often confused with other pediatric conditions.

More on Hand Dermatitis

Are Baby Foods Tainted With Dangerous Levels of Heavy Metals?

Review easy ways to reduce your child’s risk from heavy metals in baby food.

Why do some parents think that baby foods are tainted with dangerous levels of toxic metals?

A staff report from the US House of Representatives showed that "commercial baby foods are tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury."

It’s likely because they recently read articles and posts about a staff report from the US House of Representatives which showed that “commercial baby foods are tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury.”

A report that was prompted by a study last year, What’s in my baby’s food?, that found 95% of baby food tested contained lead, arsenic, mercury or cadmium.

Are Baby Foods Tainted With Dangerous Levels of Heavy Metals?

Wait, what?

Commercial baby foods really are “tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury?”

Yes, it seems that they are.

As compared to the maximum allowable levels in bottled water that are set by the FDA, the latest report found that baby foods and their ingredients tested at up to 91 times the arsenic level, up to 177 times the lead level, up to 69 times the cadmium level, and up to 5 times the mercury level.

How has this happened?

“FDA HAS FAILED TO CONFRONT THE RISKS OF TOXIC HEAVY METALS IN BABY FOOD. THE TRUMP ADMINISTRATION IGNORED A SECRET INDUSTRY PRESENTATION ABOUT HIGHER AMOUNTS OF TOXIC HEAVY METALS IN FINISHED BABY FOODS.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

We have been hearing about arsenic in rice and baby food for nearly 10 15 years, so it is hard to make this a Trump problem…

“In the context of arsenic in baby food, there are only two FDA regulations for specific products—an unenforceable draft guidance issued in July 2013, but never finalized, recommending an action level of 10 ppb for inorganic arsenic in single-strength (ready to drink) apple juice, and an August 2020 final guidance, setting an action level for inorganic arsenic in infant rice cereals at 100 ppb.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

How about we just look at it as a problem that needs to be fixed?

Do you want the FDA to add more regulations for baby foods, ensuring that they are all safe and free of heavy metals?

To understand why that wouldn’t be a quick fix, you have to understand how these baby foods likely became tainted with heavy metals. After all, it’s not like the baby food manufacturers are adding them as an ingredient…

The problem is that the rice, vegetables, and fruits that they use to make baby food are actually tainted with arsenic and other heavy metals!

“Step one to restoring that trust is for manufacturers to voluntarily and immediately reduce the levels of toxic heavy metals in their baby foods to as close to zero as possible. If that is impossible for foods containing certain ingredients, then those ingredients should not be included in baby foods.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

Yes, let’s hope that the companies stop making baby food that is contaminated with heavy metals and if they don’t, let’s set high FDA standards for baby food to make sure that they do.

Either way, we are going to need a food supply that isn’t tainted with heavy metals…

“On August 1, 2019, FDA received a secret slide presentation from Hain, the maker of Earth’s Best Organic baby food, which revealed that finished baby food products contain even higher levels of toxic heavy metals than estimates based on individual ingredient test results. One heavy metal in particular, inorganic arsenic, was repeatedly found to be present at 28-93% higher levels than estimated.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

And no, simply switching to organic foods isn’t the answer.

What Parents Should Know About Heavy Metals in Baby Foods

So what should parents do?

One obvious thing is to keep pressure on politicians and the companies that make baby food to fix this problem.

But that’s a long term fix…

Right now, you should understand that while baby foods do likely contain these heavy metals, it is not at toxic levels that will cause immediate harm.

And understand that many of the studies on exposure to heavy metals and risks for children were not necessarily specific to baby foods, but were often on general environmental exposure.

Children are exposed to heavy metals from many sources, including parents who smoke, lead in paint and water, and mercury in seafood, etc.
Children are exposed to heavy metals from many sources, including parents who smoke, lead in paint and water, and mercury in seafood, etc.

Still, you should work to decrease your child’s risk of exposure to heavy metals from food by:

  • avoiding apple juice, as like rice, apples can take up arsenic in the soil they are grown in, although keep in mind that infants shouldn’t be given any juice anyway
  • feeding your kids a variety of rices and grains, including oatmeal, barley, multi-grain rice, basmati rice, millet, and quinoa, etc. – remembering that iron-fortified cereals are a good source of iron, so typically shouldn’t be avoided all together
  • looking for rice-free baby snacks and limiting how many rice crackers and rice cakes your older kids eat
  • avoiding teething biscuits, as they are typically made with rice flour
  • offering your baby a variety of vegetables, understanding that carrots and sweet potatoes are often the ones that are most heavily contaminated with heavy metals, so continue to give since they are also high in nutrients, but mix in with a lot of other veggies
  • offering a variety of plant based milks if your older child has a milk allergy (giving breastmilk or an iron fortified infant formula until 12 months), so that they aren’t just drinking rice milk

What else can we do?

“Chemicals are part of our daily life. All living and inanimate matter is made up of chemicals and virtually every manufactured product involves the use of chemicals. Many chemicals can, when properly used, significantly contribute to the improvement of our quality of life, health and well-being. But other chemicals are highly hazardous and can negatively affect our health and environment when improperly managed.”

Action is Needed On Chemicals of Major Public Health Concern

We can focus on real risks, instead of the never ending parade of things that we might be told to worry about, from pesticide residues and sunscreen ingredients to vaccines and GMOs.

Instead of allowing yourself to be overwhelmed and scared of made up risks, focus on things that really might affect your kids, like this news about heavy metals in baby foods.

But even then, understand that the risk isn’t so high that you have to throw out of the jars of baby food you just bought and start making your own. Just give your child a good variety of foods, so that they don’t get too many of the same foods that might contain heavy metals.

And no, you don’t have get your kids tested for heavy metals if your main concern is exposure to heavy metals in baby food…

More on Heavy Metals in Baby Foods

Returning to Sports After Having COVID-19

Review the guidelines on returning to youth sports during the COVID-19 pandemic.

While many of us are simply concerned about kids returning to school, there is an added concerned for other parents, whose kids play sports and have already had COVID-19.

Many kids are returning to playing sports as they return to school during the COVID-19 pandemic.
Many kids are returning to playing sports as they return to school during the COVID-19 pandemic.

When can they go back to playing sports?

Returning to Sports During the COVID-19 Pandemic

What are the issues with returning to sports during the COVID-19 pandemic?

Well obviously, there is the issue of a lot of kids getting together during practice and games and the risk that they could get each other sick.

“Sports that require frequent closeness between players may make it more difficult to maintain social distancing, compared to sports where players are not close to each other.”

COVID-19 and Considerations for Youth Sports

There is another issue though.

If kids have been inactive for a long time because we have been worried about them getting together and playing sports, then they might be out of shape and not ready to jump back in at their usual high level of activity.

“Implement a two-week ramp-up period for conditioning—aerobic, interval and strength training to decrease risk of injury—without scrimmages or games.”

Return to Youth Sports after COVID-19 Shutdown: Reference Guides

A graduated return to play program will be necessary until their conditioning improves again.

Returning to Sports After Having COVID-19

But what if your child has already had COVID-19?

When can they start playing sports again?

“Returning to sports participation after a COVID infection will be a significant question posed to pediatric providers in the coming months”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Wait, weren’t you aware that returning to sports after having COVID-19 was an issue?

Well, it is…

“Most pediatric patients will be able to be easily cleared for participation without extensive cardiac testing, but pediatric providers should ensure patients have fully recovered and have no evidence of myocardial injury.”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Or at should at least be something to think about.

“The question of returning to sports is significant because of the propensity for COVID-19 to cause cardiac damage and myocarditis. While the incidence of myocarditis is lower in the pediatric population compared to the adult population, myocarditis is known to be a cause of sudden death during exercise in the young athletic populations.”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Fortunately, kids often have mild or asymptomatic infections when they get COVID-19 and shouldn’t be at risk for heart problems. Even if these kids don’t need further testing, they should likely wait at least 14 days until their symptoms resolved (or after they tested positive if asymptomatic) before playing sports again.

Experts do recommend that older kids, over age 12 years who had more moderate symptoms, especially prolonged fevers or who required bed rest, have an ECG before doing high intensity, competitive sports or physical activity.

Those kids who had severe symptoms, especially if they were hospitalized, should see a pediatric cardiologist and follow the myocarditis return to play guidelines, which include an ECG, echocardiogram, and exercise restrictions, etc.

And all will likely need a graduated return to play program once they are ready to play sports again, as deconditioning will be an issue after weeks or months of being inactive, with further evaluation if they develop chest pain, an abnormal heart rate or rhythm, or fainting during exercise, etc.

More on Playing Sports and COVID-19

Why Can’t You Test Out of Your COVID-19 Quarantine?

You can’t test out of your 14 day COVID-19 quarantine after you have been exposed to someone with COVID-19.

Breaking News – new CDC guidelines do offer options for ending quarantine early. (see below)

Most people understand that they can’t test out of quarantine, right?

A quick reminder that close contacts of someone with COVID-19 need to quarantine for 14 days.
A quick reminder that close contacts of someone with COVID-19 need to quarantine for 14 days.

After all, if they are around others before their quarantine is over, they could end up exposing others to COVID-19!

Why Can’t You Test Out of Your COVID-19 Quarantine?

But why can’t you just test out of your COVID-19 quarantine?

Basically, if you have a negative COVID-19 test early in your quarantine period, it doesn’t mean that you can’t develop symptoms or test positive later on.

“If you are tested and the test is negative, do you still have to be quarantined?
Yes. Someone exposed to a person with COVID-19 needs a 14-day quarantine regardless of test results. This is because COVID-19 can develop between two and 14 days after an exposure.”

Coronavirus Questions and Answers

Testing negative doesn’t get you out of quarantine.

A negative test simply means that you don’t have an active infection. It doesn’t mean that the SARS-CoV-2 virus isn’t still incubating inside you. And no, we can’t test for that.

So why get tested?

“If you do not have symptoms, it is best to get tested between 5-7 days after you’ve been in a high-risk situation.  If your test is negative, get tested again around 12 days after the event. It can take 2-14 days for COVID-19 to develop, so even if you test negative once, you could still develop COVID-19 later and spread it unknowingly.”

Symptoms and Testing: COVID-19

Getting tested can be helpful because some people can test positive even if they don’t have symptoms, they can still be contagious, and this can help with contact tracing and can help you warn others that you exposed them to COVID-19.

Ideally, since you are in quarantine, you would not have exposed anyone else though…

And if you test positive?

Well, technically that does get you out of quarantine, but only to move you to a period of isolation, which is basically a stricter form of quarantine and lasts at least 10 days.

New Options to Test Out of Quarantine Early

And although it is not without risk, the CDC has suggested some alternatives to the traditional 14 quarantine after being exposed to someone with COVID-19.

This includes ending quarantine after day 7 if you have tested negative within 48 hours and you have no symptoms, understanding that you will have to continue to monitor yourself for symptoms each day and that this strategy has a 5-12% risk of failure (you might still develop COVID-19).

Or even ending quarantine after day 10 without testing if you have no symptoms, understanding that you will have to continue to monitor yourself for symptoms each day and that this strategy has a 1-10% risk of failure (you might still develop COVID-19).

“Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.”

Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing

For most people, 14 days of quarantine will likely still be the safest option.

More on Testing out of Quarantine

The Latest COVID-19 Treatment Regimens

The latest COVID-19 treatment regimens do not include zinc, vitamin C, vitamin D, CBD oil, azithromycin, or hydroxychloroquine.

As cases surge once again, let’s do an update on COVID-19 treatment regimens, after all, you have likely been hearing about cures and treatments for months now, right?

This doc also has a daily "immune booster" regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.
This doc also has a daily “immune booster” regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.

Unfortunately, despite the “treatments” that some folks are pushing, there still isn’t a cure and there aren’t any treatments that are very effective for COVID-19.

Sure, the FDA has granted emergency use authorization (EUA) for some treatments, including monoclonal antibodies, convalescent plasma, remdesivir, bamlanivimab, baricitinib, and casirivimab and imdevimab, but most are either for patients with severe COVID-19 or who are progressing to severe COVID-19.

The Latest COVID-19 Treatment Regimens

But why wouldn’t you take over a dozen medicines if someone on the Internet tells you they read a bunch of well designed studies, he has the support of “America’s Frontline Doctors,” and he has his own statistics proving they work?

Take home point - don't trust a health care provider who says that masks and lockdowns do nothing.
Take home point – don’t trust a health care provider who says that masks and lockdowns do nothing.

Because it all quickly falls apart if you really take a close look at what he is doing.

Consider Dr. Procter’s comparison of “death rates”…

He is trying to talk about the case fatality rate, but fails to mention any of the things that would cause his practice to have lower rates than the rest of the world, especially younger patients without many co-morbid conditions who aren’t yet hospitalized.

How many of Dr. Procter's patients are over age 65?
How many of Dr. Procter’s patients are over age 65?

And the bias in his data aside, there is evidence that shows his recommended treatments don’t work.

Some are even dangerous.

“The results of an observational study suggest that delayed viral clearance may be a concern in patients with non-severe COVID-19 who are receiving corticosteroids without antiviral drugs. Corticosteroids have also been associated with delayed viral clearance and/or worse clinical outcomes in patients with other viral respiratory infections.”

Therapeutic Management of Patients with COVID-19

So you should likely avoid these medications and unless you have a vitamin deficiency (zinc and vitamin C deficiency are very uncommon in developed countries), there is likely no good reason to take extra or high doses of vitamins to try and prevent or treat COVID-19.

The latest NIH recommendations for treating COVID-19 in hospitalized patients.
The latest NIH recommendations for treating COVID-19 in hospitalized patients.

You should certainly make sure you are getting plenty of all of these important nutrients, especially vitamin D, but there are no treatments for COVID-19 if you aren’t hospitalized. And understand that no treatments that will keep you from requiring hospitalization.

Mostly understand that the kind of multi-drug COVID-19 treatment regimens you might see some doctors pushing are not proven, are not recommended, and likely won’t help you get better any faster.

And again, some are harmful!

So why do some people think they work?

“Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.”

Coronavirus disease (COVID-19) advice for the public: Mythbusters

Probably the same reason that some folks think that eating garlic works against COVID-19 – it is a highly variable disease and some people have very mild symptoms and get better quickly. If you are lucky enough to be one of these people and you tried some alternative treatment, you will likely associate your quick recovery with that treatment, even if it was just a coincidence.

“New symptoms are usually due to the virus rather than side effects of medications.”

Brian Procter, MD

And if you are really lucky when following one of these treatment regimens, you won’t suffer any side effects as you try to recover from your COVID-19 symptoms. Especially if you are being treated by a doctor who might ignore those side effects…

More on COVID-19 Treatment Regimens

What is the COVID-19 Multi-System Inflammatory State?

Are kids with COVID-19 developing symptoms of Kawasaki disease?

Breaking News – The CDC reports at least 1,000 confirmed cases of MIS-C and 20 deaths in the United States. (see below)

Kids aren’t supposed to get serious COVID-19 symptoms, right?

As we are learning more and more about SARS-CoV-2, that seems to be holding true most of the time.

That doesn’t mean that kids are unaffected though.

Remember, it is still thought that kids get asymptomatic infections that they can spread to everyone else. And tragically, they sometimes get life-threatening infections.

What is the COVID-19 Multi-System Inflammatory State?

What else are we seeing when kids get SARS-CoV-2?

As they reassure parents that “serious illness as a result of COVID 19 still appears to be a very rare event in children,” the Paediatric Intensive Care Society issued a statement discussing an NHS England email alert about kids presenting with a type of multi-system inflammatory disease.

“The alert indicated ‘the cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation’.”

PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease

This statement followed the release of a study in Hospital Pediatrics, COVID-19 and Kawasaki Disease: Novel Virus and Novel Case, that discussed a similar case.

“We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease (KD), who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And an alert of more frequent cases of Kawasaki disease in France and Italy.

“In several Italian centers, where the incidence of Covid-19 was higher – Professor Ravelli told ANSA – more frequent cases of Kawasaki disease have occurred than we have observed before the arrival of the coronavirus.”

Coronavirus: Prof. Ravelli, investigation of Kawasaki disease report (google translated)

And New York.

“The NYC Health Department contacted PICUs in NYC during April 29-May 3, 2020 and identified 15 patients aged 2-15 years who had been hospitalized from April 17-May 1,2020 with illnesses compatible with this syndrome (i.e., typical Kawasaki disease, incomplete Kawasaki disease, and/or shock).”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Following a report of 15 cases in New York City, the New York State Department of Health issued an advisory to healthcare providers about 64 potential cases throughout the state.

As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.
As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.

And next came an alert from the CDC on what they are calling multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).

MIS-C case definition

Most people will find the MIS-C case definition more helpful than the new name.

Also helpful is a recommendation to “report suspected cases to their local, state, or territorial health department.”

“This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.”

Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated With Coronavirus Disease (Covid-19) in Children

So what does this mean?

It may means that we can add SARS-CoV-2 to the list of possible viruses that can trigger Kawasaki disease.

“Various studies have described an association between viral respiratory infections and KD, ranging from 9% to as high as 42% of patients with KD testing positive for a respiratory viral infection in the 30-days leading up to diagnosis of KD.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And continue to be reassured that “serious illness as a result of COVID-19 still appears to be a very rare event in children.”

“If the above-described inflammatory syndrome is suspected, pediatricians should immediately refer patients to a specialist in pediatric infectious disease, rheumatology, and/or critical care,as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Patients meeting criteria for Kawasaki disease should be treated with intravenous immunoglobulin and aspirin”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Still, everyone should be on the alert for MIS-C, especially as COVID-19 cases once again surge.

More on COVID-19 in Kids