Understanding Pediatric Diseases

This chapter is by no means meant to be a medical text. It simply describe in terms most people can understand what some of the common diseases little ones will come in contact with during their first two years. There will be multiple times your friends are going to tell you they think your little baby may have this or that and this is a resource to look up the disease and see if it truly sounds like what your baby’s symptoms are. You will also get little notes from daycare saying there is a certain disease in the classroom and using this chapter you will know what to look for as far as symptoms.

Chances are if you are referring to these chapters you are scared because your little one is sick. First, try to calm down; babies are going to get sick many times these first two years and they are tougher than we give them credit. Second, be glad we live in these modern times where most of these illnesses are treatable with modern medicine. Third, just remember as hard as it is to take care of your baby when they are sick, it is still easier than taking care of their daddy when he feels bad.

Chickenpox:

Everybody knows about chickenpox right? Probably not so much anymore as most adults have not seen a case since they were a child and most of the daycare workers have not seen a real case. Because of this pediatricians see bunches of rashes people are worried might be chickenpox. Chickenpox is rarely seen in babies less than six months old because antibodies they get from their mother while she was pregnant protect them. Most cases of natural chickenpox seen these days are seen in babies between the ages of six months and one year. At one year, babies get a vaccine against chickenpox and we do not see many cases after the vaccine. The symptoms of chickenpox are fever and cold like symptoms for the first day followed by the rash. The chickenpox rash starts off as a red spot then a clear blister in the middle and finally over the next several hours the clear fluid in the blisters turns white. The spots become very itchy and you have a very miserable, itchy baby. Besides the miserably itchy rash the most common problem with chickenpox is the spot getting infected from all the scratching. Natural chickenpox can last 7-21 days during which time they are contagious the whole time. People wonder why we vaccinate against chickenpox since we all used to get it and we turned out fine. But they do not realize about 100 children die every year from complications of chickenpox. When I was in medical school I was against the chickenpox vaccine and even gave a little presentation about why I thought it should not be given. After I had a little six-year-old die from an overwhelming infection from chickenpox and I changed my mind. It only takes one child’s death to make you realize how severe it can be.

Conjunctivitis:

Conjunctivitis is the inflammation of the conjunctiva and is commonly known as pinkeye. The conjunctiva is the lining of the inside of the eyelid and the outer surface of the eyeball. It can become inflamed due to irritation from an object scratching against it, chemical or environmental irritants, allergies, viral infections or bacterial infections. Most of the time, you are going to need to talk to your doctor’s office to figure out what the cause of your baby’s red eye might be. Some infections of the eye can be serious and can threaten vision. Here are some of the most common offenders causing irritation to your little one’s eyes:

Irritation by objects:

By far the most common irritant is going to be their finger or their nail. This could range from just a minor little poke to the eye to a corneal abrasion where they scratch the cornea of their eye. A corneal abrasion is very painful and will cause a very teary eye and a crying baby. It needs to be followed by a visit to the doctor for pain control and to make sure it heals properly. Other common objects are going to be eyelashes, dust, or anything small that might be knocked into the eye while they happen to be looking up.

Chemical or environmental irritants:

The first time you may encounter this type of irritation is in the hospital. The eye ointment place in baby’s eyes to prevent gonorrhea can cause irritation and a red eye in the newborn. Other irritants would be household cleaning supplies the toddler happens to get a hold of and pour into their eye. CALL POISON CONTROL ASAP FOR INSTRUCTIONS! Cigarette smoke is another very common irritant leading to red eyes in babies.

Allergic conjunctivitis:

Seasonal allergies can start in the first two years of life and can lead to red and puffy eyes. The red eyes will usually be accompanied by other allergy symptoms and will usually cause itchy eyes that tend to drain clear tears. If this becomes troublesome to your baby then give your doctor a call and ask what they recommend.

Viral conjunctivitis:

Many different viruses such as influenza, Respiratory Syncytial Virus (RSV), and the viruses causing upper respiratory infections (URI) can cause conjunctivitis. The eyes can be red, scratchy and drain clear to thick discharge that looks like snot. It is sometimes hard even for your doctor to tell the difference between viral and bacterial conjunctivitis. If it persists for longer than a couple of days and is getting worse it is time to see your doctor. The most worrisome of the viruses causing conjunctivitis is herpes type I and II. These can lead to scarring of the cornea if not properly treated. If there are blisters around the eye or if the baby or toddler is crying in pain they need to be seen right away.

Bacterial conjunctivitis:

In the newborn period the bacteria we worry the most about are gonorrhea and Chlamydia. These are two very common sexually transmitted diseases infected mothers can pass to their babies via the birth canal. These need to be treated immediately to prevent vision problems and even blindness. Other bacteria acquired from the birth canal can also lead to conjunctivitis, but are not as serious. Outside of the newborn period the usual culprits are the bacteria living in the nose and throat. These are the same bacteria causing ear infections and sinus infections.

Croup:

Croup is a cold virus that is a little different from your average cold. It tends to be one of the first viruses of winter and is most commonly caused by a virus called parainfluenza. It has a very characteristic cough that sounds very hoarse and like a barking seal. It is usually worse at night between the hours of 9 p.m. and 5-6 a.m. This is when your body’s natural steroid is at its lowest point and swelling is at its highest point. The medical term for croup is laryngotracheobronchitis and the most important part of the name is the “laryngo” part. This is where the vocal cords are and the narrowest part of the airway. Swelling occurring at this level causes the hoarse “barky” cough and if the swelling gets severe enough it can lead to stridor. Stridor is a wheezing sound that happens when the baby breathes in. This means the baby is having a hard time getting the air in and as the air goes through the narrowing it makes a wheezing sound. If your baby has the barky cough or stridor the first thing you want to do is put a humidifier or vaporizer by their bed or you may want to steam up the bathroom with a hot shower and let them breathe the steam. This will often help but if it does not and they continue to have stridor or problems breathing you need to get to your doctor or the emergency room right away. The doctors can administer a special breathing treatment with a medicine known as racemic epinephrine and possibly give an oral or injectable steroid. Every once in a while, a baby will be bad enough they will need to be admitted to the hospital for more frequent steroids, breathing treatments or oxygen.

Ear Infection:

Ear infections are a common bacterial infection affecting little ones. Ear infections are usually secondary infections. This means they usually happen in the middle or end of another illness or condition like colds or allergies. Colds or allergies cause swelling of the lining of the nose and throat and can swell the tissues lining the tube connecting the middle ear to the throat closed and allow fluid to accumulate in the middle ear and get infected. The bacteria causing ear infections are commonly the infant’s own bacteria and normally found in their nose and throat. Ear infections will present with a baby who is fussy, has fever, a decreased appetite and pulling at their ear. Ear infections can be either viral or bacterial. When you suspect ear infections you should see your pediatrician. Your baby’s doctor will determine what the likelihood of the infection being bacterial is and treat with either an antibiotic or pain medication.

Fifth’s Disease:

Another one of those pesky little rash-causing baby viruses. It received its name because it was the fifth infectious rash causing viruses (funnily enough the others are not known by their number). It is caused by the human parvovirus B19. This little virus usually is mild and known mostly for its rash. It causes a bright red rash on the cheeks that looks like the little one has been slapped across the face (which is why it is known commonly as “Slapped Cheek Syndrome”). After the rash shows up on the cheeks they may get a little lacelike rash on their arms and legs. If the little person has a fever at all it will be very low and usually less than 101 degrees. They might have a slight runny nose and maybe a slightly sore throat but nothing else. By the time you see the bright red cheeks they are no longer contagious so there is no use keeping them out of daycare or school. There is no treatment to give or do at home. Pregnant women exposed to fifth’s disease need to notify their obstetrician immediately because of the risk of pregnancy complications.

Hand-Foot-Mouth Disease:

This name was originally called Hand-Hoofand Mouth Disease until the doctors agreed babies do not really have hooves and it might be better to refer to them as feet. This is a viral infection commonly caused by coxsackievirus, and is most common in the warmer months of the year. It is characterized by fever, blisters in the mouth that can be on the gums, tongue and roof of mouth, and a rash appearing as little red bumps or small blisters found anywhere on the body, but is different than most by being found on the palms of the hands and the soles of the feet. We try to encourage pushing fluids to prevent dehydration, giving meds like acetaminophen or ibuprofen for pain or fever. Check with your personal pediatrician to see if there are any other pain remedies they recommend.

Herpes Simplex:

Herpes simplex comes as type I and type II. Herpes simplex type II is commonly called genital herpes and type I is what is commonly referred to as a cold sore. Herpes simplex II can be transmitted to babies by an infected mother and can cause some very serious conditions for a newborn, but for this book we are going to discuss type I. First of all let me give you this warning: NEVER LET ANYONE KISS YOUR NEWBORN WHO HAS A COLD SORE! People don’t realize the virus in a cold sore can cause a life threatening illness in a baby that can affect their eyes, skin, and brain. Most people who are exposed to herpes simplex I will never know it and never break out in a cold sore. Some of the unfortunate little ones who are exposed to a cold sore will develop a condition known as herpetic gingivostomatitis (medical code for miserable little baby). This will cause symptoms such as a fever, a fussy baby who refuses to eat or drink, and probably drooling. When you look inside their mouth you see blisters on their tongue, lips, gums, or the back of their throat. I have seen babies with literally hundreds of blisters in their mouth. The main thing we worry about is a baby getting dehydrated from not drinking enough. Some babies will need I.V. fluids and if they are old enough your pediatrician may prescribe antiviral medicines, medicines to coat or soothe the sores and sometime even prescription pain medications. While they have the blisters, they are very contagious and should not be around other children, especially newborns.

Influenza:

This is what you hear called the flu. We need to start off clearing up a common misconception we all hear frequently. The flu has nothing to do with vomiting and diarrhea. The flu is a severe cold with coughing, fever, runny nose, sneezing, watery eyes, aching, and fatigue. The thing that makes the flu stand out from other cold viruses is the severity of all the symptoms. The fever is usually very high between 101-104 degrees Fahrenheit. The cough is very deep and productive and is usually worse on days 3-6. The congestion and runny nose make it hard to breathe. The flu causes intense myalgias which means your muscles hurt all over. It is not uncommon for little ones to feel so bad they moan in their sleep. They tend to look like you sucked half the life out of them and their little eyes are so watery it looks like they are crying even when they are not. The flu is notorious for leading to secondary infections like ear infections, sinus infections and pneumonia. There are medications to treat the flu and alter its normal course if caught early, so early diagnosis is a helpful thing. If you feel your little one has the flu watch closely for signs of worsening and secondary infections. If your baby is older than six months old we recommend yearly flu vaccines.

Meningitis:

Meningitis is an inflammation of the meninges. This is the most feared condition by your pediatrician and the one we dread hearing about and finding. Let’s start by describing what it is, what causes it, what meningitis does, and what can be done. The meninges are the lining of the brain and spinal cord. Meningitis just means this lining is upset and inflamed. This inflammation will cause symptoms such as fever, headache, neck stiffness, vomiting and make you feel like you are going to die. The problem with meningitis in a little baby is they will not always show the typical symptoms of meningitis until they are 18 months old. That is why your pediatrician is always thinking about and trying to rule out meningitis in their head when your baby comes into the office sick.

Meningitis can be caused by bacteria and viruses most commonly, but is also occasionally caused by tuberculosis and yeast in severely immunocompromised people. The symptoms will be the same regardless of the cause, but of course the treatments are going to be very different. The test for meningitis is one of the most feared and dreaded by parents and is called a spinal tap or lumbar puncture. Now many moms will have had an experience with a similar procedure because most of them will have had a spinal or epidural for pain during delivery. A lumbar puncture is technically much easier on a baby, but no easier on the parent of the baby. The spinal fluid is sent for some tests and cultures and from those it is determined what type of meningitis the baby has. All babies less than two months old with a fever are just assumed to have meningitis until the culture is negative and are put in the hospital for at least two days. All children less than two months with tests indicating the baby has a type of meningitis are going to be put in the hospital on antibiotics until the doctors make sure the infection is not caused by a bacteria. There are different bacteria and viruses that can cause meningitis, but this is really for the medical people to deal with. The bottom line for you as the parent is meningitis is bad and you do not want your baby to have it.

Pneumonia:

Pneumonia is an infection of the lungs and can be caused by bacteria, viruses, and fungi. Usually when people discuss pneumonia they are talking about bacterial pneumonia. Most pneumonia is a secondary infection, just like ear infections and sinus infections, and is largely caused by the same kinds of bacteria. Because the same kinds of bacteria are the cause, the types of antibiotics are similar as well. The symptoms of pneumonia usually occur in the middle or end of a cold when all of a sudden the little one gets a high fever usually over 101 degrees, their cough may or may not get worse, they may have decreased appetite, vomiting and look very sick. If you suspect pneumonia, you should always see your pediatrician as soon as possible. Your doctor may be able to hear the pneumonia with their stethoscope, but often the baby is screaming, crying and thrashing around so much they may just suspect pneumonia and order a chest x-ray. Your baby’s age, whether they are vomiting, how severe the pneumonia is, and how your baby looks will determine whether they treat them with antibiotics at home or put them in the hospital for a few days. Babies who get pneumonia over and over will need a work-up to find out why it is happening. Things the doctor will consider are immune problems, asthma, cystic fibrosis and aspirations (choking on food or milk and sucking it into the lungs).

Roseola:

You got to love roseola because once you know the diagnosis the illness is done. This is a viral infection most babies will have had by the time they are three years of age. Its only symptom in the beginning is fever and fussiness. The fever can be fairly high and with no other symptoms. Many babies will end up having a lot of lab work done to make sure they do not have any serious illness. After about the third day of illness the fever goes away and the baby breaks out in a red poke-a-dot rash all over their body and the disease is done. The baby is contagious while they have the fever, but not after they break out in the rash. The rash can last 2-5 days and then goes away. The rash tends to get brighter when the baby gets warm like after baths or playing.

Rotavirus:

Rotavirus is a virus that typically happens in late winter or early spring. This virus causes severe vomiting and diarrhea. I like to call it rotarooter virus because it cleans everything out of the plumbing. It causes very watery, foul smelling, green diarrhea that shoots out of their little bottom like a fountain. By definition, diarrhea is more than six stools per day and it is not uncommon for little babies to have as many as 20 dirty diapers per day. The danger of rotavirus is severe dehydration. The good news is we now have vaccines for rotavirus, which are making a huge impact on how severe this illness is. See Chapter 20 for the signs of dehydration and if you suspect dehydration see your doctor or the emergency room immediately. To treat rotavirus we routinely get you to stop all dairy in the baby’s diet for a few days and go to a lacto-free formula. If eating solid foods, things like toast, cereal, applesauce, and potatoes will help slow stools down. If you are worried always give your pediatrician a call for more advice.

Respiratory Syncytial Virus (RSV):

RSV in pediatrics is three letters causing about as much fear as the letters IRS does to accountants. RSV is a cold virus, which likes to attack the smallest airways of the lungs. Think of a tree and its system of branches and consider that if it were hollow the bronchioles would be the branch holding the leaves on the tree. RSV attacks the lining of the bronchioles. I like to describe it as like peeling sunburn and the dead skin then gets in and blocks the airway (it’s a little more complicated than that, but it makes for a good visual). With all that stuff in the way you can imagine how it would be hard to breathe and if you were trying to cough it up you may get an idea of how terrible the cough would sound. I like to describe their breathing as sounding like a broken washing machine. This disease tends to show up in the winter months with a peak from November to February. It is much worse the smaller the baby, with the premature babies being the hardest hit. Many babies are admitted to hospitals every year because of respiratory distress secondary to RSV. Most pediatric offices will be able to test for this virus in their office by doing a simple nasal swab. They will get the answer from the swab in about 10 minutes. Treatments at home mostly consist of sucking out the baby’s nose, running a vaporizer or humidifier in their room, pushing fluids, and lots of love. When babies start to work very hard to breathe by having retractions (pulling dents in their skin between the ribs, or under the ribcage), or breathing very fast, it is time to go to your doctor’s office or an emergency room. The doctor may give your baby different types of breathing treatments, some better nasal suction, or give your baby oxygen if needed.

All children will get RSV eventually with about 80 percent getting an infection by the time they are three years old. You will hear people say RSV causes asthma, which is not true. It is true that if you were meant to develop asthma you may start to have problems while infected with RSV. This virus is most scary for babies less than six months old, but is not fun for any babies less than two years old.

Sepsis:

Sepsis is a medical term that means an overwhelming bacterial infection of the body, which leads to important body functions to shut down. As a parent you are going to hear this term most frequently when your doctor uses the term “rule out sepsis work-up”. This usually means your baby has a fever and looks sick, but no reason for this has been found in their examination. This makes your doctor worry there is a bacteria infecting an area that is not as easy to look at such as a urinary tract infection, bacteria in the blood (called bacteremia), or bacteria in the fluid around the brain and spinal cord (called meningitis). A “rule-out-sepsis” work-up includes blood work, urinalysis and often a spinal tap. Most of these babies will be started on antibiotics either by a shot or by an I.V. and put in the hospital until they know what is going on.

Sinusitis:

Sinusitis is something parents think their baby has every time they have a cold and their snot turns yellow or green. Yellow or green snot does not mean anything except their snot has some color to it. The signs of a sinus infection in a baby are a cough that lasts longer than 10 days that happens only when they lie down or first get up. They usually have little to no fever. Every time your baby has a cough lasting longer than 10 days it is a good idea to have them looked at by your doctor. Sinus infections will be treated with antibiotics if your doctor feels the cause is bacterial.

Strep Throat:

Strep throat is one of the most common bacterial infections you will see in children because it is contagious. Strep throat is spread by contact with the bacteria found in infected people’s spit. Therefore it is most commonly spread by drinking after infected people, eating after infected people, kissing infected people or putting things in your mouth which have been in someone else’s mouth who was infected (all things that little kiddos like to do all the time). It is uncommon to see strep throat in babies less than nine months old just because of the method of transfer, but I have seen them get it from older siblings who sometimes steal their pacifier, bottle or sippy cup.

The biggest symptoms of strep throat are going to be fever, sore throat, headache, and abdominal pain. In the little ones who still cannot tell you what is bothering them you will usually see fever, decreased appetite, drooling, fussiness and sometime vomiting. You may notice your baby’s throat looks red if you can get them to open their mouth wide enough to get a look inside (try it sometime and you will have a new appreciation for my job). Sometimes you can see a red, bumpy rash on their body too. Your doctor is usually going to make the diagnosis by a throat swab in the office where they may do a rapid test or send the swab for culture. Strep throat is usually treated with antibiotics in the penicillin family unless your child is allergic to penicillin and it can be given by mouth or by a shot. The way it is treated is going to depend a lot on how your child is doing. If they are vomiting prepare yourself for a shot. The real reason we treat strep throat is to decrease the spread of the disease and to prevent rheumatic fever. Rheumatic fever is what happens when your body fights off strep with antibodies it makes itself, but the antibodies start to attack parts of your body, of which the most serious is the valves of your heart (not a good thing to happen). Children with strep throat are usually considered contagious until they have been on antibiotics for 24 hours.

Thrush:

This is a very common yeast infection little babies commonly acquire. In all honestly it is not really an infection it is more a yeast overgrowth. Everyone has yeast, but there are certain conditions allowing it to overgrow. The major cause is just being a baby and having an immature immune system. Another common cause is being on antibiotics as the antibiotics do away with the bacteria and the yeast has no competition and it overgrows. The thrush will look bright white and will typically be stuck to the roof of the mouth, side of the mouth and on the tongue. The baby may be fussy because the yeast does cause some pain. Thrush is usually treated with an antifungal medication like nystatin. Pediatricians recommend boiling pacifiers and nipples until the mouth is clear. It the baby is breastfed; mom’s nipples will also need to be treated.

Upper Respiratory Infection (URI):

This sounds like something very serious and very medical does it not? URI is medical lingo for a cold; yep the common head cold you have been getting every winter since you were a little kid. Colds are caused by a collection of viruses called the rhinoviruses and coronoviruses (like you would ever care what they were called). There are over 200 of these little monsters and they like to change over time insuring you will never stop getting colds your entire life. These are the most common infectious diseases in humans with the average child getting 6-12 per year and adults getting 2-4 per year (which seems to go up quite a bit when you have sick kids in your house). The most common symptoms with the common cold are cough, sore throat, runny nose, congestion and fever. Some of the highest fevers we see in pediatrics can happen with the common cold. The most effective treatments for the common cold are getting plenty of fluids, resting, and acetaminophen or ibuprofen for the fever and aches and pains (chicken noodle soup doesn’t hurt). Colds are spread by respiratory droplets being shot out of the infected person’s nose and mouth and ending up in your nose, mouth or eyes (nice huh?). The only proven way to cut down on colds is frequent hand washing, keeping your hands away from your eyes or mouth, and of course staying away from virus spewing sick people. The normal progression of a cold is to feel a little achy or tired, start running a fever if you are going to get one, congestion and sore throat and then finally to start coughing your bloody head off. You need to bring your little one to the doctor if the fever lasts longer than three days, if the fever goes away for more than 24 hours and then comes back in the middle or end of the cold, if your little one has a hard time breathing, or if they start acting like they are in any pain.

Urinary Tract Infection (UTI):

UTI comes in two different varieties. The more common and less severe is the bladder infection (which we in the snotty medical community would call cystitis) and the less common, but much more severe kidney infection (which the snobs would call pyelonephritis). Neither of the two is very nice to have but let’s talk about the different presentations and causes of both of them.

Cystitis:
(does that make me a snob?) Cystitis is an irritation of the bladder. It can be due to an infection by bacteria or virus, but most commonly bacteria. The most common bacteria causing cystitis is E. coli (it is called Escherichia coli, but let’s be honest that just doesn’t roll off the tongue). E. coli usually comes from the baby’s poop and just ends up in the wrong spot. This happens more commonly in little girls just because of the difference in plumbing (with the little girls the bacteria just has a shorter distance to travel to cause problems). This is going to cause your baby to hurt when they pee. The problem for you is knowing it hurts when they pee. It is more likely your pediatrician will notice when you bring your baby in because they are fussy and crying intermittently. Sometimes parents will notice a foul smell to the urine, a different color or blood in the front part of the diaper. Just to warn you, until a baby is potty trained most urine is going to be obtained by a urinary catheterization. This sounds like a terrible thing, but it is done under sterile conditions by people who do it everyday and is done with baby-sized catheters. You will sometimes hear of urine being caught by a “bag”. I was always taught “bags are for garbage” and I never use them because you always end up with bacteria from their bottom and you might be treating a urinary tract infection that is not really there. Once a urinary tract infection is diagnosed and the doctor is sure it is cystitis the baby is put on antibiotics and typically gets better in a few days. Most doctors will send the urine for a culture to make sure the antibiotic they are using will work and to make sure what bacteria it is they are treating.

Pyelonephritis:

Pyelonephritis is an infection of the kidney. This type of urinary tract infection is very serious and if untreated could lead to severe damage to the kidney and even death. It is usually caused by the same type of bacteria as the less severe cystitis but causes much worse illness. With pyelonephritis you see symptoms of high fever, chills, vomiting, back pain, painful urination, and they also look and feel really sick. Again most of the little ones we are talking about in this book cannot talk so we are looking for this in babies with fever, fussiness and vomiting. Again the diagnosis is usually made by performing a urinary catheterization in babies who are not potty trained. A diagnosis of pyelonephritis is usually going to get you some additional blood tests and most likely a little stay in the hospital for some I.V. antibiotics until your little one’s fever is gone. Your doctor should also order a couple of tests once your baby is feeling better to determine why the bacteria was able to get up to the kidney. The two tests they should order are an ultrasound of the kidney to make sure it looks good, is the right size and is where it is supposed to be; and a voiding cystourethrogram (or a VCUG — thank goodness for abbreviations) which is where the baby has a urinary catheterization done and dye is injected into the bladder to make sure nothing is wrong with the plumbing and urine is not going a direction it’s not supposed to go. The dye is used to look for malformations that could require surgery to fix. The most common abnormality found is urinary reflux, which is discussed, in the next chapter.