By Genna Lipkin
June 09, 2018
Category: Infectious Disease
Tags: Untagged

 

Its that time of year again...the weather is finally warm, your kids are playing in the grass, and you find a tick.  Should you panic??  Not quite.  Lyme disease is harder to get than you think and pretty easy to treat!

Where is Lyme disease found?

Lyme disease is caused by a bacteria called Borrelia burdgorferi which is transmitted by certain types of ticks called Ixodes ticks.  Lyme disease is almost exclusively found in New England/mid Atlantic states, northern Midwest, and a little in the rest of the country. 

  

How is Lyme disease transmitted?

It is transmitted through tick bites.   A minority of ticks have the Lyme bacteria in their stomach.  In these cases, if a tick is attached for at least 48 hours the bacteria can make it up to the salivary glands of the tick and be transmitted to a human.  Some studies have even shown that Lyme disease cannot be transmitted unless a tick is attached for at least 72 hours. 

What are the symptoms?

The early symptom of Lyme disease is a rash called erythema migrans.  It starts as a small red bump and expands to be very large (can be over 6-12 inches) over the next couple days.  The rash can be a large red circle or might look like a bulls eye with a light ring.  Usually the rash doesn’t bother kids but sometimes it is a little itchy or uncomfortable.  Some people may also have fever, muscle aches, joint pain, or headaches.  The rash typically is seen 7-14 days after exposure, but may be anywhere from 1-32 days.  Later symptoms of Lyme disease include multiple erythema migrans lesions, facial droop, or joint swelling (typically just of one large joint such as the knee).

How is Lyme disease diagnosed?

This is the tricky part—tests for Lyme disease are not very good.  We usually diagnose Lyme disease clinically based on the presence of an erythema migrans rash after a tick bite from an area known to have Lyme disease.  Antibodies take weeks and weeks to develop; they are typically not detectable when the rash first develops.  Only 1/3 of people who are tested early in infection are positive.  In fact, some people who are treated early in the disease never develop antibodies at all.  When testing is required, we do a blood test that looks for different types of antibodies. 

What is the treatment?

Lyme disease is treated with antibiotics for 14-21 days.  We use amoxicillin or doxycycline, depending on the child’s age.  Outcomes are excellent with no reported bacterial resistance.  Blood tests after completion of antibiotics are not recommended. 

What should I do if I find a tick on my child?

Remove the tick by grasping it with fine-tipped tweezers as close to the skin as possible and pull the tick straight out.  If part of the tick stays in the skin, don’t worry about it.  Digging to get it all out will cause more skin damage and may increase the risk of bacterial skin infections.  The body will push the rest of the tick out over time. 

Antibiotics for an asymptomatic person after tick removal are not routinely recommended.   

How do I prevent Lyme disease?

Use insect repellant with DEET up to 30% (for children 2 months and older).  Clothing and gear can be treated with 0.5% permethrin.  After your children have been outside in grassy or wooded areas, especially up in Wisconsin, check them over for ticks.  Remember, a tick that hasn't been attached for at least 48 hours cannot transmit disease.

Other common questions:

Can Lyme disease be transmitted from mom to baby during pregnancy? 

All studies say no.  There are no documented infections of a fetus or infant.  Studies have found no difference in birth outcomes between moms who have Lyme antibodies and moms who do not have Lyme antibodies. 

Can Lyme disease be transmitted from breastfeeding?

Again, studies say no.  Transmission through breastmilk has not been documented.

By Dr. Tram Luu
May 15, 2018
Category: infant
Tags: Untagged

Dr. Luu's awesome blog post is too long to put in text--click here to read all about baby poop! Warning, graphic photos!

By Meghan Sullivan
March 26, 2018
Category: Uncategorized
Tags: Untagged

Car Seats 101


Rear-facing, convertible, booster seats, oh my! Choosing and installing the right carseat for your child can be a daunting task for novice and expert parents alike. The American Academy of Pediatrics (AAP) has a great car seat guide to help navigate the world of car seat safety.


The type of car seat that a child needs depends on their age and size.  Your little one should be in a rear-facing seat from birth until at least 2 years old, so when it is time to graduate from the infant car seat to a convertible or 3-in- 1 seat, the new seat needs to remain rear facing. In fact, it is best to keep that toddler rear facing until they reach your particular car seat manufacturer’s height or weight limit. It is okay for their feet to touch the back of the seat while rear facing; this is not a reason to turn their car seat around.  Because his head is so big in proportion to the rest of his body, rear facing protects the neck better if you get into an accident.  Many countries in Europe now keep kids rear facing until 4 years old!

Hooray, your big toddler is ready for the world of forward-facing travel! They should remain in a forward-facing seat with 5 point harness (this includes your seemingly brand new convertible or 3-in- 1) until at least 4 years old, as long as they remain below the height and weight limits of the manufacturer.  Once one of these limits is met, it is time to transition to a booster seat (high-back or backless). The booster seat is needed until your child reaches the magic height of 4’9” and is 8-12 years old. Then, they are big enough to use a seat belt without a safety seat, but cannot call “shotgun” until after they turn 13!

- Meghan

By Dr. Wilson
February 25, 2018
Category: Infants
Tags: Untagged
In the past seventeen years of practice, a common question I hear on a weekly basis is, "Hey doc, what is this scaly rash on my baby's head?"
 

The answer is seborrheic dermatitis, otherwise known as CRADLE CAP
 
Babies with cradle cap develop scaly, greasy patches on their scalp.  The patches can become thick and crusty.
 
How common is cradle cap?
Cradle cap occurs in infants between 3 weeks and 12 months.  It occurs in about 10% of babies, and peaks at 3 months.
 
How does cradle cap present?
Cradle cap presents as an accumulation of yellowish, greasy scales on the scalp.  The top and front of the scalp are most commonly affected.   Sometimes, cradle cap can occur on the face as well.  When this occurs, it can be hard to differentiate between cradle cap and baby acne, but babies with cradle cap on the face often have dry, flaky skin over the eyebrow area and behind the ears.
Babies with cradle cap are usually growing well and not bothered by the rash. 
 
What causes cradle cap?
The exact cause of cradle cap is not known.  But it is important to note, that cradle cap is not due to poor hygiene or allergies.  Also, cradle cap is not contagious. 
 
How is cradle cap treated?
Often no treatment is needed.  Cradle cap is self-limited (it goes away on its own) and resolves spontaneously in weeks to months.
Parents who wish to speed the process along can start with over the counter options.  These include a thin layer of Vaseline/Aquaphor or coconut/baby oil to loosen the scales, followed by brushing out the scale with a fine tooth comb or baby brush, then washing with a gentle baby shampoo.
 
~Dr. Wilson
 
By Dr. Lipkin
February 05, 2018
Category: Infectious Disease
Tags: Untagged

 

The flu has been getting a lot of air time these days and many people are getting nervous.  Whats the deal with flu deaths this year and what can you do to keep your family safe?  Lets take a look at an article from the American Academy of Pediatrics: 

"The number of children dying from flu this season continues to rise, now reaching 53, according to the Centers for Disease Control and Prevention (CDC).

“Right now, one of the biggest health threats we are facing is influenza,” CDC Acting Director Anne Schuchat, M.D ., said Friday. “Flu is incredibly complex and difficult to predict, and this season is a somber reminder of why flu is one of the world’s greatest public health challenges.”

Young children are especially vulnerable to flu complications. Sixteen pediatric deaths were reported during the week ending Jan. 27, according to new CDC data. During a regular season, pediatric flu deaths have ranged from 37 to 171 and spiked to 358 during the 2009 pandemic.

About 20% of children who died this season had been vaccinated, and roughly half did not have an underlying condition, according to the CDC. Signs of a potentially serious case include high fever, shortness of breath, rapid heartbeat, significant tiredness or confusion, and feeling better then getting worse."

(full article here)

 

The biggest takeaways here are that kids can get very sick from the flu EVERY year, and that the flu vaccine may not prevent influenza completely but it is having a big impact in preventing severe complications.

The treatment for the flu is an antiviral medication called Tamiflu.  Tamiflu is recommended for patients with influenza who are under age two, who have asthma or other medical problems, and those who live at home with newborns/immunocompromised people/pregnant women.  To be effective, it should be started within 48 hours of onset of symptoms.  People who do not fall into the "high risk" categories may also take Tamiflu, but some people choose not to because side effects include vomiting/diarrhea and insurance doesn't always cover it.  Come to walk ins if you think your child has the flu and needs Tamiflu.  

As with any illness, you should watch out for difficulty breathing, dehydration, or fever lasting more than a couple days.  Any child with these symptoms should be evaluated by a physician.  Kids who are drinking well and seem otherwise comfortable can weather the storm at home.  They can return to school or daycare when the fever has been gone for at least 24 hours. 

The best way to prevent the flu is with lots of hand washing, and of course, a flu vaccine.  The flu vaccine protects against 4 strains of the flu, so even if your child had the flu the season, the vaccine can protect them against getting it again.

 

.....only 137 days until summer

Dr. Lipkin





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