pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Child Diseases Parents Should All Know About – Part 3

July 29, 2014

Once the two “pre-clinical” years of medical school were completed, all us “padawans” donned our new white clinical coats and headed for the various hospitals in town where we would begin two years of “clerkship rotations” in varied medical specialties to learn about adult and child diseases.
Pediatric resident examining boy’s heart
In every one of our coat pockets was a small ring binder where we kept our “second brains,” as we called them, full of thousands of normal lab values, treatment protocols and mnemonics which we used to recall important facts.

We might not instantly recall something BUT we sure knew where to find it quick; and if it wasn’t there it would be for the next time we needed it.

When we were finally presented with our formal, embossed “doctors bag” the second thing most of us placed in it (after the stethoscope) was our now worn, dog-eared, so-thick-it-had-to-be-closed-with-a-rubber-band second brain.

More Childhood Diseases To Know

Hand, Foot and Mouth Disease, Conjunctivitis and Fifth Disease

Of course after many years in clinical practice my old second brain’s list of diseases to remember needed a bit of an overhaul; but, that’s what we’re doing in this set of articles — listing the “commonly common” childhood infections parent’s would do well to have at least a passing knowledge about.

In part 1 we talked about Croup and Bronchiolitis. Then, in part 2 ear infections and “glue” ear; but, there’s a few more before we’ll be done.

Hand, Foot and Mouth Disease

I’ll bet fully 25% of pediatric residents saw a case of Hand-Foot-Mouth Disease (HFMD) in the first ten clinic patients they ever saw, and the rest saw it in the first month. It’s caused by the fairly ubiquitous Coxsackie A virus (in our area it was Coxsackie A-16) and guess where the blisters are?

 
The blisters of the Coxsackie A16 virus on the hands, feet and mouth.

HFMD causes a fever along with blisters on the palms of the hands, the soles of the feet and the inside of the mouth. Unfortunately, about like everything else in medicine, the disease is not quite so clean-cut and simple.

Unfortunately, HFMD doesn’t limit itself to just the H, F & M.For example, in the US the disease is mainly caused by the Coxsackie A16 virus; but, the world-wide disease as a whole we now know is caused by enteroviruses, of which there are many. Other parts of the world have their own HFMD predilection for causative agents.

Additionally, the blisters are usually always seen on the “H, F and M” but are not infrequently also seen on the buttocks and even genitals. That area was apparently left out of the name, one might think for aesthetic reasons (unless we want to pretend that “F” stands for “fanny” too.)

And, HFMD is NOT the same disease as your veterinarian friend treats in his sick livestock – that’s “hoof and mouth” and has a completely different cause and treatment.

Even though most cases are not serious they may cause a lot of discomfort and last a week to 10 days in summer and early fall “epidemics.” Being a virus, antibiotics will NOT help and the disease will need to run its course. Most doctors have their own favorite methods of assuaging the comfort of blisters in the mouth so if that becomes an issue, call for advice.

Conjunctivitis

Girl with conjunctivitis – pink eyeIf you’ve been reading about “pink eye,” “red eye” or conjunctivitis on the internet and are confused – I don’t blame you. Each article is written from a different point of view. let’s see if we can shed some light on a fairly simple condition with many different causes.

It’s a case with several different causes but the organ having only one or two ways it can respond: getting red, swollen, itchy, tearing and “mattering.”

The immediate cause: SOMETHING in the eye that’s not supposed to be there like smoke, chemicals, allergens, bacteria, viruses, chlamydia…
The REAL cause: Poor eye “hygiene” – poor hand-washing, contact with airborne material, wiping things into your eye…

Often it is caused by the same viruses as the common cold. Often a bacteria. Often, in the middle east and Africa, by Chlamydia. ALWAYS it is contagious and spreads rapidly in schools and nurseries where touching eyes is frequent and hygiene (like hand washing) is poor.

Conjunctivitis due to chemicals has a very rapid onset, is more often one eye and responds to washing with eye wash (or water realizing it may make the whites temporarily soggy and bulge.)

Conjunctivitis due to allergens has a slower onset, in both eyes, more itchy and associated with scratchy throat and runny nose. It responds to antihistamines and pollen/dander control.

All of the causes can cause some “mattering” and crusting of the eyelids but conjunctivitis from viruses and bacteria cause it most. Onset isn’t rapid. It can spread from one eye to the other. There might be cold symptoms or not. They can be washed with eye wash too but it often doesn’t help for very long, in which case you should seek medical advice for either some eye drops or ointment.

Eye with conjunctivitis – no exudateI usually give both. Ointment is less “stingy” but the child can’t see well afterwards so it’s used at night. Drops sting a bit more while the infection is worse, but are good for the day time.

Most cases clear up in four to seven days but can keep cycling through any family or group until they get the hand washing and cleaning surfaces correct.

Slapped Cheek (Fifth Disease)

I’ve written extensively about Slapped Cheek disease before; but it is so common that it deserves to be at least mentioned in this series.

You remember ‘ol “disease number five”, Erythema Infectiosum, which attacks 3 – 15 year olds, in winter and spring, with a red, lacy rash on the cheeks spreading to the torso, arms and legs and lasting for a few days to five weeks? Sure you do – caused by Parvovirus B19? Yea, that’s the one.

Sometimes it can lead to new onset of joint pain and be mistaken for rheumatoid arthritis but it doesn’t last long.

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We’re almost half way through the updated list of childhood diseases parents should know about. We’ll talk again in part four where we’ll begin with… Rotavirus (Diarrhea).