Should a mother continue to breastfeed if she has been exposed to influenza?

What if she has tested positive for the flu, or has other children that have it? Should she temporarily wean the baby to protect him? 

These questions have been frequently asked by many mothers of breastfeeding newborns over the last few weeks. As the lactation consultant at Carolina Kids Pediatrics in Raleigh, NC, I have been asked these questions several times in the last few days alone.

Breastfeeding mothers SHOULD continue to breastfeed even if they have influenza, or have been exposed to it. Breastfeeding protects the newborn from infections, as antibodies from the mother’s body are passed to the newborn through the milk. The flu virus, as with any virus, has an incubation period. This is the time before the onset of symptoms. Since breastfeeding mothers and babies share the same environment, the mother and baby are likely exposed to the virus at the same time. During this incubation period, the mother’s body begins to produce these protective antibodies for the baby. Breastfeeding (and handwashing!) is the best protection for the newborn.

In the case where a mother is receiving anti-viral medications, such as Tamiflu, breastfeeding is still not contraindicated.  The mother should continue to breastfeed as desired.

Please do not hesitate to contact your pediatrician in Raleigh, NC, to discuss any concerns you have about flu symptoms, or breastfeeding.

You may call Carolina Kids Pediatrics at (919) 881-9009 to schedule an appointment with me. I’ll be glad to help with any of your breastfeeding concerns. 
Jerrianne Webb, RN, IBCLC
 
For more information:
https://ibconline.ca/maternal-illness1

A new report released from the American Academy of Pediatrics this month addresses the topic of preventing the spread of infectious disease in organized sports. This is a hot topic for pediatricians in Raleigh who do lots of sports physicals, including those of us here at Carolina Kids Pediatrics. 

The highlights of this report: Skin infections spread by direct contact with other athletes account for 10-15% of time lost from sports. At Carolina Kids Pediatrics, we see kids from around Raleigh for sports physicals on a regular basis who have acquired skin infections through direct contact with other athletes or contaminated sports equipment. A general rule we can review during sports physicals is never to share equipment, towels or clothing, and make sure that wrestling mats and protective sports equipment are cleaned regularly – a dilute bleach solution works quite well to kill many bacteria, viruses and fungi which cause skin infection. Some additional advice about common sports-related infections:

1. Strep and staph (including MRSA): Resistant, aggressive staph infections often cause skin infections and abscesses (which look like hard, red painful lumps) on skin. If a team member is infected, up to 10 to 23% of fellow athletes on football teams and wrestling teams can develop MRSA skin infections. If there is a team outbreak, athletes with eczema or skin scrapes are at higher risk for infection. Having kids take a bath in a tub of water with 1 cup of bleach twice weekly can help decrease the risk of infection, especially during a team outbreak. Infected athletes should not return until they have been treated for at least 24 hours, and sites of infection should be covered during sports.
    
2. Tinea (ringworm): Ringworm can appear in the scalp (often causing patches of flaky skin with hair loss), the body (often causing scaly, raised rings), or the feet (athlete’s foot - often causing peeling and redness that most commonly starts between toes. Prevent ringworm of the scalp by avoiding sharing of hats, combs and brushes among athletes, and using an antifungal dandruff shampoo (like Nizoral) once or twice a week. Prevent spreading ringworm on the body by avoiding shared towels and cleaning equipment regularly as described above. Studies have shown that use of foot powder after bathing can decrease risk of athlete’s foot by 75%.  Ringworm on the body or athlete’s foot can be treated with over the counter creams and sprays, including terbinafine (Lamisil) and clotrimazole (Lotrimin) twice daily for 3-4 weeks – but ringworm on the scalp requires oral prescription medications.
    
3. Herpes: This refers not just to genital herpes, but also to the herpes virus which causes fever blisters. This can cause painful, blistering skin infections (called herpes gladiatorum), sometimes with fevers, in contact sports. Up to 34% of wrestling team contacts can be infected during a team outbreak. Athletes with active skin blisters should be excluded from contact sports for about a week, and the blisters should be covered until healed. Herpes skin infections are treatable with acyclovir and other prescription medications – and earlier treatment, within a day or two of symptom onset, works better. Athletes with frequent outbreaks can be treated with preventative medication during the sports season.
    
4. Molluscum & warts: Kids who come in for a sports physical often have these. Both are viral skin infections, which cause single or clustered skin bumps. Bumps from molluscum are usually smooth with a dot in the middle, while warts are usually rougher and scalier. Both molluscum and warts can be spread by direct contact in sports, and covering them is the best way to prevent spread. Plantar warts (warts on the bottom of the feet) are easily spread in communal showers – in fact up to 25% of athletes who use communal showers are affected, so it might be worth coming in to treat plantar warts if your athlete uses a communal shower in sports (or wear pool shoes in the shower if they don’t want to treat their warts). We can treat both molluscum and warts in the office with treatments such as liquid nitrogen and cantharidin extract, but treatment is not always necessary for bumps which can be easily covered in sports.

Every organized sports team, whether school-based or not, requires that children be cleared by their Raleigh pediatrician through a sports physical. When your child gets their sports physical at Carolina Kids Pediatrics, please talk to us not only about injury and concussion prevention, but also the prevention of infectious disease from sports participation.
For more information on these guidelines on preventing infections in sports, check out this article before you come in for this year’s sports physical:

https://www.nytimes.com/2017/09/25/well/family/when-athletes-share-infections.html
 
Christian Nechyba, MD
Carolina Kids Pediatrics
Your Pediatrician in Raleigh, North Carolina

Perk up your ears, kids! Did you hear the good news about ear infections?

A new study of 615 kids showed that the rate of ear infections in kids under 3 years has dropped 3-fold over the past 10 years compared to the 1980's. This dramatic decrease in ear infections seems to be due to the pneumococcal conjugate vaccine, which your kids get at 2, 4, 6 and 15 months when they come to Carolina Kids Pediatrics. Pneumococcal bacteria used to be the most common cause of ear infections, but we didn't start immunizing against pneumococcus until the 1990s. Although the vaccine was primarily designed to prevent meningitis and blood stream infections (which it has done beautifully), this seems to be a nice side benefit of the pneumococcal vaccine.

A quick correction - our lactation consultant will teach our next prenatal class on Wednesday, August 30 from 6 pm to 7 pm (I had previously sent out a notification that the class would be from 6:30 pm to 7:30 pm). I apologize for the error. The class is free, and open to all. If you are interested, please call our office to sign up!

Like all pediatricians in Raleigh, North Carolina, and beyond, we at Carolina Kids Pediatrics spend a good bit of our summer completing sports physical forms – and a fair bit of the rest of the year managing some of the injuries that result from sports.

In last week’s blog, we talked a little bit about how to prepare your child for an upcoming sports season. This week, I’d like to address a few common sports injuries, and how to recognize them.

As a pediatrician in Raleigh, NC, these are some of the most common sports injuries I see, and what to do about them:

PATELLOFEMORAL STRESS SYNDROME: A common issue in teenagers – the complaint is usually a vague pain around the knee cap that worsens with going down stairs or squatting. This is caused by uneven movement of the knee cap across the knee joint, leading to inflammation and pain behind the knee cap. It’s often fixable with low-impact exercises that strengthen and stretch the thigh muscle and help it hold the knee cap in the right place as it moves.

ANKLE SPRAIN: This is usually due to stretching or tearing of the ligaments on the outside of the ankle when the foot turns in during a stumble or fall. An ankle brace or wrap, elevation, ice for the first day or two, and crutches for 2-3 weeks may be needed depending on the severity of the injury. What’s even more important is rehabilitation after the sprain. When the brace comes off, it’s important to strengthen the ankle before going back into full sports mode. Simple exercises like tracing the alphabet in the air with your toes are a start, with a gradual increase in training and activity until the ankle is strong enough for running and jumping. Kids get into trouble when they go straight from wearing an ankle brace to participating fully in their sport without proper rehabilitation.

OSGOOD-SCHLATTER DISEASE: Doesn’t that sound awful? It’s not as bad as it sounds, but it does hurt. The bony bump right below the knee cap (called the tibial tuberosity) has a growth plate in growing tweens and young teenagers. With a lot of running and jumping, this one spot right under the knee cap can become painful and swollen. A flexible knee brace can help, as can ibuprofen and ice. However, the ultimate cure happens when this bone stops growing in the mid to late teen years.

SEVER DISEASE: Same problem, different spot. There is a growth plate in the back of the heel which can become painful and inflamed with running and walking in tweens and young teenagers. The treatment is heel cord stretching, sometimes a soft gel heel lift in the shoe, and pain medications like ibuprofen.

SHIN SPLINTS: Pain in the shins with running can be due to swelling in some tight spaces, or compartments, in the front of the lower legs. If this is the case, ice and ibuprofen are the immediate treatment, and the pain should go away quickly with rest. It can be useful to decrease the intensity of training, and build up more gradually toward a goal. However, if pain continues at rest, particularly if it always remains in one spot, this can be a sign of a stress fracture (small break in the bone from over-exertion) - this may need orthopedic treatment and a prolonged period of rest and rehabilitation.

LITTLE LEAGUE ELBOW: If your young pitcher frequently hurts on the inside of his/her elbow, beware. There are growth plates here too, and pain on the inside of the elbow in a growing pitcher can be a sign of bone injury in this location. If it goes untreated, it can require surgery to heal, but injuries caught early can often be treated with rest and physical therapy. Be sure your child’s coach follows strict pitch limits – no more than 350 throws per week – to avoid this problem. A similar problem is also possible higher up – “Little League Shoulder”, which involves the growth plate in the upper arm.

A nice website for reading more is https://www.niams.nih.gov/health_info/sports_injuries/child_sports_injuries.asp#most - or call your pediatrician at Carolina Kids Pediatrics if you’re worried about a sports injury!