Aaahh-choo! Spring is here!

As I listen to my kids happily playing basketball in the driveway, digging dirt in the front yard (my daughter is planting an orange tree apparently), and throwing sand anywhere but inside the sand table on the deck, I’m sitting in the kitchen enjoying the sunshine and cool breeze that wafts through my backdoor.  All the windows are open, and I can feel the stuffiness of the house being gently blown outdoors.  I inhale and take a deep breath of the wonderful fresh spring air… and then, I sneeze.

And then I sneeze again.  And again. 

Sniff... sniff...  sniff... (clear throat)… (blink-blink)… I love spring... really… I do… (cough)… but boy, do I suffer from allergies!

My kids do, too.  At least three of them have seasonal allergies.  I’m waiting to see if the youngest one is going to also.  Kids generally do not develop allergies to the environment (pollen, mold, etc) until they are around three years old or older.  The immune system is not usually ready to start recognizing that allergens, such as pollen, are something to be allergic to until then.  It is possible for younger children to have seasonal allergies, but it is less common.  Younger children tend to have food-related allergies if they have any.

If there is a strong family history of allergies, asthma or eczema, or if your child has asthma/wheezing or eczema, then the chances of your child having seasonal or environmental allergies are higher.

Testing for allergies can be performed by an allergist through skin testing.  Your pediatrician may be able to do blood testing for allergies called RAST testing.  While there are differing opinions, it is generally thought that skin testing is more accurate when diagnosing environmental allergies.  This includes allergies to trees, grasses, molds, dust mites, molds, cockroach dander, cats, and dogs.

Skin testing is performed by putting small drops of diluted allergen (such as extracts from grasses) on the skin and then pricking the skin under the drop.  If you are allergic, you will develop a red, itchy bump (called a wheal).  The size of the wheal can indicate how allergic you are to the substance.  The testing is briefly uncomfortable, but many children tolerate it without difficulty.

Testing is useful so that you can identify what your child is allergic to and make adjustments as needed.  For example, if your child is allergic to dust mites, there are special coverings that you can put on your child’s pillow and bed mattress to reduce the number of dust mites that your child is exposed to at night.  If your child is allergic to pollen, you can avoid too many outdoor activities when the pollen count is high.

Allergies can be managed usually with over-the-counter medications.  These include Claritin, Zyrtec, and now Allegra.  These come in liquid, dissolvable tablet and swallow tablet forms. Benadryl can be useful for short-term treatment, but can sometimes make children very drowsy.  If your child has many allergies or has significant other problems triggered by allergies, such as wheezing, then allergy shots may be useful.  Allergy shots help your child’s body get “used to” the substance that he/she is allergic to by introducing it to the body in very small amounts and gradually increasing the amounts over time.

Common symptoms of allergies include runny nose, sneezing, itchy eyes and/or mild sore throat without fever.  If your child has fever, severe cough, eye discharge, or persistent thick nasal discharge or cough (especially if more than two weeks), then it's not just allergies, and you should call your child’s doctor.

Enjoy the spring weather, and (aah-choo!) thanks for reading!

Coughs, stuffy noses, and fevers – Welcome to Winter!

“How can I help with the cough?” is one of the most common questions I get in the office during the winter cold season. 

When cold weather arrives, we all stay indoors and we share our germs.  Viruses love the winter season because it’s the best time to travel from one person to another and then to another.   Kids who are around many other people tend to catch more colds and viruses than ones who are not.   Common exposures come from daycare, school, and their brothers and sisters. 

Children build immunity by fighting illnesses from viruses.  Their immune systems learn how to fight these bugs, and then hopefully, will be more protected in the future as they encounter new viruses.  Any pediatrician will tell you that they’ve never been sicker than their first few years in training or in practice due to the large number of viruses that we’re exposed to.  If you’ve never been exposed to a virus, then your chances of catching it is much higher.  However, once you’ve battled the illness, then your immune system has a memory that will help it to fight future similar viruses.

So, when a baby is born, EVERY virus is new to his system.  It’s no wonder that babies will catch colds.  When a baby or toddler starts childcare, very often they have a new cold or illness every two weeks for a while.  Then when they reach elementary school, they are less likely to get sick because they’ve already had many of the viruses.

When a new virus emerges, like the H1N1 flu virus, we are all susceptible since none of our immune systems are prepped to fight it off. 

Most cold viruses can last up to two weeks.  Many people get concerned if their child is still congested or coughing a little after one week.  However, two weeks is still reasonable.  Fevers should be less than 103-104 F and should only occur during the first three days of illness.  If your child has a fever later, has a high fever, is breathing fast, or working hard to breathe, you should call your doctor immediately for guidance. 

Most coughs are protective.  The cough reflex is designed to protect your lungs from drainage that is trying to go down into them.  However, occasionally coughs can be more ominous and can be a sign of infection (bronchitis, pneumonia) or wheezing/asthma.  If your child seems to have a bad cough, has a fever with the cough or has difficulty catching his/her breath, call your doctor.

So, what to do when your child has a cold?  Well… it depends on the age of your child.

Young Infants (under 6 months of age):  At this age, colds can be especially miserable because they can’t clear their own noses.  If congested, it is hard for your baby to feed since your child has to breathe through his/her nose when drinking or eating. Putting a few drops of nasal saline in each nostril and then suctioning the nose will help.  Sleeping upright in car seat or elevating your baby’s mattress may be helpful (do not use a pillow).   A humidifier (cool or warm) next to where your baby sleeps will also help.  Hydration is important, so small frequent feeds are good if your baby can’t eat his/her usual amount.  While fevers may be part of a viral illness, young babies need to be checked if they have a fever to rule out other illnesses (especially babies under 3 months of age).   Call your doctor if your baby has ANY fever>100.4 (rectally), has trouble feeding, is breathing fast, has coughing fits, is vomiting or is not improving.   No over-the-counter cough medications are recommended at this age.

Older Infants and Toddlers:  Children this age also have difficulty when their noses are stuffy and they are coughing.  Sleeping is a challenge and often they will lose their appetites and drink less.  While eating less is okay, it is important that your child drink enough fluids and stay hydrated.  Clear fluids, like Pedialyte, will help to hydrate without increasing the mucous production like milk-products can.  Nasal saline is also useful to clear stuffy noses.   Suctioning your child’s nose will help him/her to breathe easier.  A humidifier (cool or warm) will help to quiet coughs and make nighttime easier to manage.   Sometimes, babies tend to collect mucous in their throats or upper airway and then vomit the mucous after coughing.  While messy, this can be normal and is their way of getting rid of the drainage.  However, if your baby has a high fever (>103-104), has difficulty drinking, is working hard to breathe, is vomiting other than with cough, or has a fever after the first three days of illness, call your doctor.  No over-the-counter cough medications are recommended at this age.

Preschool-aged children:   Kids aged 2-5 often have colds in the winter, especially if they are in preschool.  The sharing of viruses is inevitable when every child seems to have a runny nose in class!  For this age, you can help by taking care of the symptoms.  Again, nasal saline is useful and teaching your child to blow his/her nose is important to prevent secondary infections such as sinusitis or ear infections.  To help with sleeping, use a humidifier and have your child sleep upright on pillows.  A teaspoon of dark honey has been shown to be as effective as cough suppressants.  Over-the-counter cold medications are not recommended at this age.  If your child has high fever (>103-104), has difficulty breathing, or has a fever after the first three days of illness, call your child’s doctor. 

School-aged children:  For older children, it’s primarily night time that is difficult.  Run a humidifier, keep your child hydrated, and use nasal saline sprays to help.  A teaspoon of dark honey can be effective for quieting coughs at this age.  Over-the-counter cold medications can be used sparingly.  It is important to pick a medicine that specifically treats your child’s symptoms.  Multi-symptom cold medicines have active ingredients for each symptom – fever, cough, congestion, runny nose, and so on.  Do not give your child medication for symptoms that your child doesn’t have.  Also, while cough suppressant might make it easier to sleep, try not to use it during the day.  Cough has a purpose (to protect your lungs from drainage), so suppressing it may lead to further complications.  High fevers (>104), fever after the 1^st three days of the cold, or difficulty breathing are all symptoms for which you should call your child’s doctor.

Hope you and your family have a safe and healthy holiday season!  Thanks for reading!

Chronic cough? Sore throat? Sneezing? It might be allergies...

Over the last few weeks, my kids all sound like they are sick.  Coughing and sniffling from one.  Hoarseness and sneezing from another.  Another one keeps rubbing his eyes.  My own face and nose feel like someone has decided to fill my sinuses with wet tissues.  That's how I know that the Fall season must be on its way!


Hay fever or allergic rhinitis is very common and can develop at any time.  Most children do not develop allergies to environmental such as pollen, grasses, molds, and trees, until around 3-4 years of age.  Right now at the end of August/beginning of September, ragweed is abundant in our area as well as grasses.  Anyone who is allergic to these is likely to be feeling the effects of their allergies now. 

Common symptoms of allergies include sneezing, itchy eyes, runny nose, occasional cough or sore throat.  If you suspect that your child may have allergies, you could try some over-the-counter allergy remedies for children.  Children's Zyrtec and Children's Claritin are readily available at stores.  Recently there were some recalls of name brand versions of these, so you may have to get store-brand or generic versions.

If your child has frequent cough, trouble breathing, fevers, or appears sick, then it is less likely to be allergies and you should call your child's doctor immediately.  Also, if your child is very young (under age 2), it is less likely to be related to allergies and you should call your doctor.

A good place to check to see what the pollen and allergen levels are in your area is at the website: www.pollen.com.  On the "red zone" days, it's a good idea to avoid outdoor activities if your child is allergic to outdoor pollens.  Reducing exposure to whatever your child is allergic to is the best way to avoid feeling bad from allergies.