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What is Swimmer's Ear (Otitis Externa)?

Jenny Boucher — Fri, 30 Jul 2010 05:00:00 GMT

What is Swimmer's Ear?

"Swimmer's Ear" refers to an infection of the canal that connects the outside of the ear with the inside of the ear. Normally this passageway is dry and slightly acidic so germs do not grow there. Swimmer's Ear happens when bacteria (Pseudomonas aeruginosa) or fungi have a chance to grow in the canal. This causes pain and swelling of the ear. Cleaning the ear and applying ear drops is usually needed to treat Swimmer’s Ear.

Figure 1. Anatomy of the ear.

Who is affected by Swimmer's Ear?

Swimmer's Ear can occur at any age, but is most common in school-aged children. In fact children get Swimmer's Ear most frequently between 7-12 years of age. This infection is nicknamed Swimmer’s Ear because swimmers get this ear infection much more often than non-swimmers.

What causes Swimmer's Ear?

When contaminated water stays inside the ear canal after swimming, several things can happen that can lead to an infection. The water can wash away the earwax that is usually in the canal to help keep out objects. The water changes the normally dry, acidic skin in the area. The ear canal is also warm and dark. All of these things allow for bacteria to grow in the ear canal.

What increases the risk of Swimmer's Ear?

Conditions that may break down the natural defenses in the ear include:

- When the ear stays moist or wet or keeps getting wet repeatedly - The presence of moisture or water can change the acidity that would help keep bacteria from growing. This happens in swimmers when the inside of the ear stays wet for long periods of time. The surface of the skin becomes irritated, allowing bacteria to grow rapidly in the ear canal.

- When cleaning or scratching the inside of the ear causes breaks or cuts in the skin - This lets bacteria get into the skin and cause an infection.

- Overuse of devices for the ear – Using earphones or hearing aids that do not fit properly and rub the skin can cause irritation.

- Certain skin conditions, like eczema, psoriasis, or even acne - These conditions can cause cuts in the skin.

How can I tell if my child has Swimmer's Ear?

Initial symptoms may be mild to severe. These usually include:

- Itching in and around the ear

- Pain or discomfort in and around the ear

- Small amounts of clear liquid is in or draining from the ear

As the infection gets worse, the symptoms may include:

- Pain when touching or pulling on the ear

- Large amounts of fluid (white or yellow) draining from the ear

- Temporary hearing loss as the ear canal swells up

- A feeling of pressure in the ear

If the infection is severe, other possible symptoms include:

- Severe pain

- Redness around the ear, face, or neck

- Dizziness

- Fever

How is Swimmer's Ear treated?

Treatment starts with cleansing of the ear canal by the doctor. Debris is usually removed with a small device. The ear canal is then rinsed with a cleaning solution like hydrogen peroxide diluted with water. One or more kinds of topical ear drops may be placed in the ear canal as part of the treatment. Try to have your child stay away from water sports for at least 7 to 10 days. If your child is a competitive swimmer, she may be allowed to return after two-three days of antibiotic treatment. Check with the doctor first. Well-fitted earplugs may also be needed.

If Swimmer’s Ear is caused by bacteria, the doctor will prescribe an antibiotic ear drop to kill the bacteria causing the infection. Examples are tobramycin or ofloxacin. Sometimes other drops may also be included in your child’s treatment, such as a steroid to help with the pain and swelling. Dexamethasone, hydrocortisone, and prednisolone are examples of steroid ear drops. The doctor may also prescribe an ear drop with acetic acid to restore the acidity of the canal. Products that combine one or more of these ingredients are available to make treatment less of a hassle.

If there is a lot of swelling in the ear canal, the doctor may use something known as a "wick". A wick is a small cotton sponge filled with medicine that is put inside the ear canal so that the antibiotic can reach the skin.

An antibiotic to take by mouth may be required if your child has a serious infection or is at risk for more severe infections. Sometimes the infection takes longer than usual to heal. This is another reason to start an antibiotic by mouth. Make sure your child finishes the course of antibiotics.

Acetaminophen (Tylenol^®) or ibuprofen (Motrin^® or Advil^®) can help with the initial pain. The condition(s) that led to the infection should be avoided to allow for healing and preventing the infection from coming back.

When should I take my child to the doctor?

If a Swimmer's Ear infection is suspected, consult a doctor for treatment. Some people are at a higher risk of having a more severe form of Swimmer's Ear infection. People who have diabetes or any other condition that causes them to have a lower immune response are at risk for getting Swimmer’s Ear. These conditions delay the speed and process of healing. These children may need additional treatment. Also, some infections may spread into deeper tissues, even to the bone. Serious infections like these will also require more treatment than the topical ear drops.

If you suspect that any of these conditions exist, contact your child’s doctor immediately. Sometimes a concentrated infected area, also called an abscess, may form. The abscess may need to be opened and drained, Doing this will help to relieve the pain and allow for faster healing. For complicated infections, a long course of antibiotics either taken by mouth or through an I.V. (intravenous) may be necessary.

A child under 2 years old with a respiratory infection and a fever should also be brought to the doctor to make sure it is not a middle ear infection (otitis media).

How can I prevent Swimmer's Ear in my child?

Some great tips to avoid getting Swimmer’s Ear again or for the first time can be found at the CDC’s website and other resources. Here are KidsMeds’ favorites:

· Avoid getting water in the ears when bathing or swimming.

· Use cotton with petroleum jelly, earplugs, or tight-fitting bathing caps when swimming.

· Dry the ear canal after bathing or swimming by wiping the outside of the ear thoroughly.

· Tipping the head can help drain water from the ear.

· Using a hair dryer on the lowest heat setting can also work.

· Alcohol-based ear drops or other drops, such as aluminum acetate drops (Burow's Solution), may also be used to dry the ears after bathing or swimming. Check with your child’s doctor first, since these may be irritating to the infected ear. Ask the pharmacist to help you find these products.

· Acetic acid drops may be used to try to return the ear canal to the normal acidic environment there.

· Avoid using hairpins, fingernails, or cotton swabs. These may scratch the inside of the ear.

- Beware of polluted locations; do not swim in those areas.

References:

Otitis Externa, Swimmer's Ear. URL: http://www.fpnotebook.com/ENT/Ear/ActOtsExtrn.htm (Accessed July 29, 2010)

http://www.uptodate.com/online/content/topic.do?topicKey=pc_id/2947 (Accessed April 2009)

Waltzman AA. Otitis Externa. URL: http://www.medscape.com/article/994550-overview (Accessed July 29, 2010)

Mayo Clinic Staff. Swimmer's ear. URL: http://www.mayoclinic.com/health/swimmers-ear/DS00473/METHOD=print (Accessed July 29, 2010)

Swimmer's Ear - Otitis Externa. URL: http://www.cdc.gov/healthyswimming/swimmers_ear.htm (Accessed July 29, 2010)

Swimmer’s ear. (Figure 1 URL: http://www.mdconsult.com/das/patient/body/157391184-2/0/10041/35116.html (Accessed July 29, 2010)

30-Jul-10 0:00 AM

Allergies Can Be Serious

Catherine Revzon — Wed, 14 Jul 2010 15:00:00 GMT

What are allergies?

An allergy is a reaction of the protective immune system of your child’s body in response to something that does not usually bother other people. Certain substances, situations, or physical situations can cause this reaction. These irritants can be found indoors or outdoors. An allergy is also called hypersensitivity. Some allergic reactions need immediate attention.

What do I look for to see if my child has allergies?

Each child can show different signs and symptoms of allergies. However, common signs are itchy, watery eyes, itchy nose, sneezing, runny nose, itchy throat, congestion, rashes, or even trouble breathing. Congestion can lead to “allergic shiners” (which are dark circles under the eyes). The “allergic salute” (rubbing the nose upward because it is itchy) is also common in children. This leaves a small crease in the skin of the lower part of the nose. These signs and symptoms may occur during certain times of the year (seasonal allergies), may be constant (perennial allergies), or may show up after your child eats certain foods or is exposed to certain physical situations

How did my child get these allergies?

Allergies may be passed from parent to child through genetics. They may also be caused by exposure to certain substances that your child’s body thinks is a germ. The immune system normally fights germs. However, the defense system is responding to a false alarm in most allergic reactions. Common triggers include: pollen, mold, pet dander, dust mites, cockroaches, cigarette smoke, viruses, bacteria, insect stings, certain foods, medicines, chemicals, and plants.

What is considered a serious allergic reaction?

Although it is not common in the general population, children with severe allergies to insect bites and stings, foods, or certain medications or vaccines can be at risk for anaphylaxis. Anaphylaxis is a sudden, potentially life-threatening allergic reaction. This is a serious reaction that may affect the skin, gastrointestinal system, respiratory system, and / or cardiovascular system. It is considered a medical emergency if two or more of the systems are affected. Common signs and symptoms of anaphylaxis include difficulty breathing, tightness in the throat (feels like airways are closing up on themselves), hoarseness or trouble speaking, wheezing, nasal stuffiness and coughing, nausea, abdominal pain or vomiting, fast heartbeat or pulse, skin itching, tingling, redness, or swelling,

How do I manage my child’s allergies?

To prevent or treat these reactions, make a dedicated effort to avoid the triggers, using allergy medications, or take your child to an allergist. Your child may benefit from allergy shots. For anaphylaxic reactions, use an epinephrine pen (Epi-pen® or Epi-pen Jr®, prescribed by your primary care provider) and call 911.

First, try keeping your child away from things that cause him/her to have allergic reactions. Allergy-proof your house. Here are some tips:

A completely smoke-free environment is best for your child. Even smoking outside or in one particular room is not enough as smoke residue clings to EVERYTHING, including clothing, skin, hair, etc.
Wear a pollen mask when mowing the lawn or cleaning the house—to avoid pollen exposure
Stay indoors in the morning time because this is when the pollen in the air is high—to avoid pollen exposure
Keep windows and doors closed during pollination season—to avoid pollen exposure.

Listen to the local weather report, usually it will tell you when a pollen count outside will be high. You can also check www.pollen.comfor daily reports in your area

Don’t allow animals in the house—Animal dander can cause these reactions.

Change feather pillows, wool blankets and clothing to cotton or synthetic materials

Wash sheets, mattress pad, and blankets weekly in hot water (if possible, wash the curtains on a regular basis)

Remove carpeting, if possible.

Use air filters

Use a dehumidifier to keep indoor humidity low. Dust mites and mold increase in high humidity.

Keep a list of things that trigger an allergic reaction.

Teach everyone caring for your child how to use epinephrine pens and have two epinephrine pens available if your child is at risk for anaphylaxis to certain foods, medicines, vaccines, and other exposures.

In addition to these methods, over-the-counter medications are available that might give your child some relief. To get the maximum benefit from the allergy medicines, your child should be using these medicines everyday. Taking it only as needed will not work as well as taking it everyday. Continue giving the allergy medicines until the allergy season is over for your child or until the doctor tells you to stop giving it.

Antihistamines, such as children’s loratidine (Claritin®) or cetirizine (Zyrtec®)—help with itch, watery eyes and runny nose.
Nasal sprays such as nasal saline—help clear out the nose
Oral nasal decongestants—help the stuffy nose
Table 1. Antihistamines, nasal sprays, and decongestants for kids

Antihistamines	Approved Ages
Benadryl® (diphenhydramine)	Ages 6 and older
Claritin® (loratadine)	Ages 2 and older
Zyrtec® (cetirizine)	Ages 6 and older

Nasal Sprays	Approved Ages
Little Noses Saline Spray/Drops	All ages
Baby Simply Saline Nasal Drops	All ages
*Little Noses Decongestant Drops	Ages 2 and older

*Oral Decongestants	Approved Ages
*Children’s PediaCare Decongestant	Ages 2 and older
*Children’s Sudafed	Ages 2 and older

*Speak with your child’s pharmacist or pediatrician to make sure your child will benefit from the decongestants before using any of these products.

Check with your child’s pharmacist or pediatrician before giving any of these

medications to your child to make sure you give the right dose

Table 2. Common over-the-counter and prescription medicines used to treat allergies.

Antihistamine (Oral Formulations)	Approved Ages	Dosage Forms	Drowsiness
Allegra^® (fexofenadine)	Seasonal Allergic Rhinitis: ≥ 2 yrs	Generic Tablets: 30mg, 60 mg, 180 mg Allegra ODT: 30 mg (only approved for ≥ 6 yrs of age) Allegra Capsule: 60 mg Allegra Suspension: 30 mg/5 mL Allegra Tablets: 60 mg, 180 mg	1.3%^a
Benadryl^® (diphenhydramine) *many other generic forms available	Allergic Rhinitis: ≥ 6 yrs	Generic Capsules and Liquid Benadryl Liquid and Perfect Measure: 12.5 mg / 5 mL Benadryl Fastmelt Tablets: 12.5 mg Benadryl Tablets, Liquid Gels, Quick Dissolve Strips, Kapgels: 25 mg	Most Sedating; May also potentially cause opposite effects, i.e. excitation^b
Clarinex^® (desloratadine)	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	No Generic Available Clarinex ODT: 2.5 mg, 5 mg (safety and efficacy have not been established for ≤6 yr old) Clarinex Syrup: 0.5 mg/mL (safety and efficacy have not been established for ≤6 months old) Clarinex Tablet: 5 mg	9.1%^c
Claritin^®/Alavert^® (loratadine) *many other generic forms available	Seasonal allergic rhinitis: ≥ 2 yrs	Generic Tablets and Syrup Claritin Syrup*: 5 mg/ 5 ml Claritin Chewables: 5 mg Claritin Tablets, Liquid Gels, Reditabs: 10 mg (only approved for ≥ 6 yrs of age) Alavert Tablets: 10 mg (only approved for ≥ 6 yrs of age) Alavert Orally Disintegrating Tabetls: 10 mg (only approved for ≥ 6 yrs of age)	8%^d
Xyzal^® (levocetirizine)	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	No Generic Available Xyzal Solution: 0.5 mg/mL Xyzal Tablet: 5 mg	3%^e
Zyrtec^® (cetirizⁱne) *many other generic forms available	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	Generic Tablets, Syrup, Chewables Zyrtec Tablets, Liquid Gels: 10 mg (only approved for ≥ 6 yrs of age) Zyrtec Chewables: 5mg, 10 mg (10 mg only approved for ≥ 6 yrs of age) Zyrtec Perfect Measure: 10 mg (only approved for ≥ 6 yrs of age) Zyrtec Syrup*: 5 mg/ 5 mg	5 mg = 1.9%^f 10 mg = 4.2%^f
Antihistamine (Nasal Sprays)	Approved Ages	Dosage Forms	Drowsiness
Astelin^® (Azelastine)	Perennial Allergic Rhinitis: ≥ 12 yrs Seasonal Allergic Rhinitis: ≥ 5 yrs	No Generic Available Astelin Ready Nasal Spray: 137 mcg/actuation	11.5%^g
Astepro^® (Azelastine)	Perennial Allergic Rhinitis: ≥ 12 yrs Seasonal Allergic Rhinitis: ≥ 12 yrs	No Generic Available Astepro Nasal Spray: 205.5 mcg/actuation
Patanase^® (Olopatadine)	Seasonal Allergic Rhinitis: ≥ 12 yrs	No Generic Available Patanase Nasal Spray: 0.6%	in poisoning^h
Antihistamine (Opthalmic Solutions)	Approved Ages	Dosage Forms	Drowsiness
Optivar^® (Azelastine)	Allergic Conjunctivitis: ≥ 3 yrs	Generic Opthalmic Solution: 0.05% Optivar Opthalmic Solution: 0.05%
Pataday, Patanol^® (Olopatadine)	Allergic Conjunctivitis: ≥ 3 yrs	No Generic Available Pataday Opthalmic Solution: 0.2% Patanol Opthalmic Solution: 0.1%
Leukotriene Modifier	Approved Ages	Dosage Forms	Drowsiness
Singulair^® (Montelukast)	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	No Generic Available Singulair Granule Packets: 4 mg/packet Singulair Chewable Tablets: 4 mg, 5 mg Singulair Tablet: 10 mg	in overdoseⁱ

*May be marked as a solution

a: In patients 6 months to 5 years of age.¹

b: Most sedating antihistamine but it may cause excitation in children²

c: In patients 6-11 months old with syrup vs placebo (9.1%, 8.1%).³

d: In clinical trials versus placebo (6%) (no specific information regarding pediatrics); effect was dose-related⁴

e: In children.⁵

f: Somnolence rates in patients 6-11 years of age vs placebo (1.3%); patients 6-24 months, somnolence rate was about the same as placebo. ⁶

g: Up to 11.5% somnolence.⁷

h: Somnolence in mild to moderate poisoning.⁸

i: Drowsiness reported with overdose.⁹

References for Table 2:

sanofi-aventis U.S. LLC. Allegra (fexorendadine) tablets, ODT (orally disintegrating tablets) and oral suspension [product information]. Bridgewater, NJ: sanofi-aventis U.S. LLC; 2007.
Diphenhydramine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
Schering Corporation. Clarinex (desloratadine) tablets, syrup, Reditabs [product information]. Eden Prairie, MN: Schering Corporation; 2005.
Loratadine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
Levocetirizine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
McEvoy GK, ed. AHFS Drug Information 2009. Bethesda, MD: American Society of Health-System Pharmacists, Inc; 2009.
MedPointe Healthcare Inc. Astelin (azelastine) nasal spray [product information]. Somerset, NJ: MedPointe Pharmaceuticals; 2006.
Olopatadine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
Merck Sharp and Dohme Corp. Singular (montelukast) tablets, chewable tablets, and oral granules [product information]. Whitehous Station, NJ; Merck & Co., INC; 2010.

Table 2 Constructed by Amanda Jensen, Christina Christopher, and Michelle Eykamp (PharmD Candidates at time of development) and Lynnette Sever, PharmD, PGY1 Pharmacy Resident at time of development.

General References:

Tietze KJ. Disorders Related to Cold and Allergy. In: Berardi RR, McDermott JH, Newton GD, et al. eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 14th ed. Washington, DC: APhA; 2004: 240-245.

Allergy. National Institute of Allergy and Infectious Diseases. URL: http://www.nlm.nih.gov/medlineplus/allergy.html. Accessed: July 14, 2010.

Serious allergic reactions (Anaphylaxis). KidsHealth. URL: http://kidshealth.org/parent/medical/allergies/anaphylaxis.html. Acccessed July 14, 2010.

Allergy-proof your house. URL: http://www.mayoclinic.com/print/allergy/HQ01514/METHOD=print. Accessed: July 14, 2010.

All about allergies. KidsHealth. URL: http://kidshealth.org/parent/medical/allergies/allergy.html. Accessed: July 14, 2010.

Allergy treatment guide. Keeping Kids Healthy. URL: http://www.keepkids.healthy.com/welcome/treatmentguides/allergy.html. Accessed: July 14, 2010.

14-Jul-10 10:00 AM

Understanding Pain and Fever Medicine

Catherine Revzon — Wed, 05 May 2010 11:00:00 GMT

With so many different pain and fever medicines in the pharmacy, it can be confusing. There are infant drops, children’s liquid suspensions and chewable tablets. Each one of them contains different medicines and different doses. To add to the confusion, since November of 2008 infants’ and children’s TYLENOL^® (acetaminophen) packaging no longer gives dosing information for children less than two years old. The Food and Drug Administration (FDA) was concerned about reports of accidental acetaminophen overdoses in children caused by parents’ dosing mistakes. In some cases, parents had failed to either read or understand the label instructions, which led them to use an incorrect measuring device or formulation (for example, drops instead of suspension). Acetaminophen is not unsafe to give to your infant, just always talk to your doctor before you do so.

If your child is sick, you should give them lots of liquids to drink and make them rest.

Fever

If your child has a FEVER - See the Mayo Clinic Fever Guide below for recommendations on how to treat it. Although there are many thermometers on the market that measure temperature in different areas, parents should use rectal thermometers with their babies for the most accurate reading. “The ‘gold standard’ measurement is still the rectal temperature. For more information on how to take a temperature, click here for the Mayo Clinic's recommendations.

How high is it?

Pain

If your child is in PAIN: Pain may be treated for five days in children when using acetaminophen. Ibuprofen may be used instead, but for no more than three days. Take your child to the doctor if the pain doesn’t go away by that time. However, if the pain is due to a sore throat, make sure to you take them to a doctor if it lasts more than two days.

*Do not give ASPIRIN to anyone age 18 years or younger*

Aspirin has been linked with Reye's syndrome, a rare but serious condition that can affect children and teenagers recovering from a viral infection. Aspirin and products that contain aspirin should not be given to children less than 18 years old unless prescribed by your doctor. Some medical conditions require treatment with aspirin.

KidsMeds Tips:

Know your child's weight in pounds and kilograms.
Always check with your pharmacist or child's doctor first if you're not sure about the dosing of acetaminophen or ibuprofen.
Store brand products work the same way as the main brand (Tylenol, Motrin, Advil) products. Dosing is the same.
Use the dropper, medicinal cup, or oral syringe provided with the product for that product only! Do not use the measuring tool for other medicines.

Children's Tylenol and Motrin Liquid Product Recall:

What does the recent recall of Tylenol and Motrin products mean for you? Read more about it here.
Which lots of Tylenol and Motrin were recalled? Here is the complete list. Please note that the store brand equivalents were not recalled and can still be used.

5-May-10 6:00 AM

Taming Itchy Skin in Children

Catherine Tom-Revzon — Tue, 27 Apr 2010 15:00:00 GMT

There are many reasons why children have itchy skin. During the winter months, excessive dryness is the most common cause of itchy skin. Another common cause is a harmless skin condition called keratosis pilaris. Scratching the skin too much can lead to more serious skin conditions, including infections. Seriously dry skin can also lead to other skin conditions, such as [CT1] eczema (atopic dermatitis). Using a simple moisturizer can relieve itchiness and prevent dry skin.

Dry Skin and the Itch Sensation

Water is the main "softener" of skin. Cold air and dry air from artificial heat act like a sponge to pull water from the skin. When the skin becomes overly dry, it becomes rough and scaly, then red, inflamed and itchy. Children with eczema may have flaky skin. Those with keratosis pilaris will have a sandpaper like feel to their skin from the flesh-colored to slightly red bumps.

The itch sensation occurs when nerve signals from the receptors at the free nerve endings at the outer layer of the skin (epidermis) and derma go through the spinal cord to the thalamus. There the itching sensation is picked up in the somatosensory cortex. The somatosensory cortex is the area of the brain that receives information from the general sensory receptors in the skin and from the skeletal muscles. After the information is processed, the part of the body being affected is identified and the data is interpreted. Then the motor areas (fingers, for example) are signaled to initiate the scratching. Without treatment, a vicious cycle of itching and scratching can interrupt your child’s daily activities.

Treating Dry Skin

Here are some tips on how to keep the winter itch (or just dry skin in general) under control:

Use a humidifier. When the relative humidity of air is low, artificial heat can dry out the skin.
What’s the problem? Identify other factors that worsen the problem of dry skin and minimize them. These factors include taking many baths and using harsh soaps. Products with alcohol will also dry out the natural oils from the skin.
Avoid hot water. Hot water removes the skin’s natural oils more quickly. Use warm water to bathe your child. Shorter baths or showers (5-10 minutes) add moisture to the skin. The skin is less hydrated after the bath the longer your child stays in the water.
Don’t forget to add the “softener.” Moisturize the skin with lotions, creams, or ointments. Keep it simple. Use products without perfume. Apply right after a bath or shower to retain moisture.
Which product? For severely dry skin and keratosis pilaris, try an over-the-counter moisturizer that contains urea or lactic acid. These ingredients help the skin retain water. Some prescription moisturizers also contain these ingredients. Children with eczema should avoid these ingredients because it may irritate the skin. Speak with the pharmacist about the different available products. Table 1 lists some common over-the-counter and prescription products. (Click here for PDF of Table 1) If the condition worsens, bring your child to the doctor.

What if it’s “angry”? If the skin is red and inflamed, your child may need a mild topical corticosteroid or an immunomodulator (tacrolimus, pimecrolimus). Apply sparingly. Check with the doctor first before using any products for this condition.
Prevention is key. Prevent dry skin by using a moisturizer every day. Keeping the skin moisturized will also prevent eczema flares.

References:

Bernhard JD. Pruritus and Xerosis. The Academy of Dermatology. 2010. URL: http://www.aad.org/education/students/pruritusxerosis.htm. Accessed: March 3, 2010.

The Academy of Dermatology. Dry Skin & Keratosis Pilaris. 2009. URL: http://www.aad.org/public/publications/pamphlets/skin_dry.html Accessed: March 3, 2010.

27-Apr-10 10:00 AM

Don't Let the Ticks Bite

Catherine Tom — Wed, 17 Mar 2010 17:00:00 GMT

I. QUICK SUMMARY OF TICKS AND TICKBORNE DISEASES

What are ticks?

Ticks (Ixodidae) are six-legged insects responsible for transmitting diseases caused by bacteria and parasites. Ticks have four stages in their life cycle: egg, larva, nymph, and adult. Nymphs must feed once to develop into an adult tick. When they feed on blood from an animal infected with rickettsia, they become infected. After ticks develop into adults, the infection may be spread to humans or other animals during their feeding process. Humans may be bitten by either the male ticks or female ticks, but females are responsible for spreading most of the infections.

What do ticks look like and what diseases do they transmit to humans?

Ticks are hard to spot at a glance. In fact, nymphs are the size of poppy seeds. The following table describes the different kinds of ticks, their reservoirs, places where they are commonly found, and infections they can cause.

What ticks look like	Animal Reservoirs	Where transmission has occurred	Disease Transmitted
Blacklegged Tick, also known as deer tick	White-footed mice, squirrels, and other small mammals	Parts of New England, New York State, New Jersey, Wisconsin, and Minnesota	Lyme Disease
Western Blacklegged Tick	White-footed mice, squirrels, and other small mammals	Pacific coastal US	Lyme Disease
Rocky Mountain Wood Tick	Small rodents	South-Atlantic region of the US (Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida) Southern Canada	Rocky Mountain Spotted Fever
Dog Tick	Small rodents	South-Atlantic region of the US (Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida Southern Canada	Rocky Mountain Spotted Fever

In the United States, common infections caused by tick bites include: Lyme disease and Rocky Mountain spotted fever.

How did my child get a tick bite?

Your child may have gotten exposed to ticks by playing outdoors in areas with woods, brush, or grass where infected ticks may be found during warm months. The toxins from tick bites can lead to Lyme Disease or Rocky Mountain Spotted Fever.

Lyme Disease

Lyme Disease is the most common tickborne illness. The number of reported cases of Lyme Disease has been rising in the last several years. In 2007, about 27, 000 cases were reported to the CDC. Lyme Disease is caused by bacteria called Borrelia burgdorferi. It is transmitted to humans by bites of infected blacklegged tick (Ixodes scapularis) in the northeastern and north-central regions of the United States and by infected western blacklegged ticks (Ixodes pacificus) in the west coast. In general, ticks need to be attached for 36 to 48 hours before the bacterium gets transmitted. Thus, it is important to check for ticks and remove them promptly. Most infections in humans are caused by the bites of nymphs in the late spring and early summer, but adult ticks can also transmit the bacterium in the fall and early spring. They can attach to any part of the body, but are often found in the thigh, armpits, groin, trunk, and scalp.

The diagnosis of Lyme disease is based on symptoms, physical findings (rash), and the possibility of being exposed to infected ticks. In later stages of the disease, laboratory testing to look for antibodies may be helpful. There are two stages of Lyme Disease: Early Lyme Disease (ELD) and Late Lyme Disease (LLD). Signs and symptoms to look for in ELD are chills and fever, headache, fatigue, muscle and joint pain, swollen lymph nodes, and a characteristic skin rash that looks like a bull’s eye (erythema migrans). The red circular patch appears where the tick bite has occurred within 3 days to 1 month, and it will grow larger (up to 30 cm) across. If Lyme disease is not treated, the infection can spread to the large joints, the heart, and the nervous system within a few days to weeks. This is known as Late Lyme Disease. Problems with memory or cognition, fatigue, headache, and sleep disturbance sometimes continue even after treatment. Not all signs and symptoms are present in infected patients.

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is the most severe tick-borne illness in the US. It is caused by the bacteria Rickettsia ricketsii. It can be transmitted to humans by the bite of an infected tick, the American dog tick (Dermacentor variabilis) and Rocky Mountain wood tick (Dermacentor andersoni). It usually occurs during April through September in the south-Atlantic region of the US (Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida). The three most important parts of how a person with the illness presents are fever, rash, and a previous tick bite. The initial symptoms of RMSF may include fever, nausea, vomiting, muscle pain, lack of appetite, and severe headache. Later signs and symptoms include rash, abdominal pain, joint pain, and diarrhea. RMSF is a severe illness that requires hospitalization. The diagnosis is based on the clinical signs and symptoms and special laboratory tests to confirm the presence of the bacteria. Other blood tests will check the platelets, sodium, and liver enzyme levels.

II. HOW ARE TICKBORNE DISEASES USUALLY TREATED?

LYME DISEASE

The treatment of Lyme Disease usually depends upon a few factors: the symptoms that the child displays, diagnostic tests, age of the child, and if the child has any allergies to any medications. Based upon these factors antibiotic therapy will be given either orally (by mouth) or intravenously (through a vein) for more severe disease.

Lyme Disease and Body Systems Affected

The most common type of Lyme Disease, that which has some flu like symptoms and usual rash is generally treated with 2 to 3 weeks of oral antibiotics.

If children have any signs that the disease may be affecting the nervous system the physician will often need to rule out meningitis. If meningitis is ruled out, the child may be able to receive oral antibiotics but if not intravenous antibiotics (or sometime oral doxycycline) are generally needed. The duration of therapy for this is usually 2 to 4 weeks.

Although rare, Lyme Disease affecting the heart can occur, and is treated with 2 to 3 weeks of antibiotics. In children with less severe disease oral therapy may be okay. Most recommend intravenous antibiotics for children with more severe disease that requires hospitalization.

If a child has Lyme Disease affecting the joints (i.e. arthritis), they will usually need 4 weeks of oral antibiotics. Lyme arthritis is one of the few conditions that sometimes will require a repeat course of oral therapy or a trial of a few weeks of intravenous antibiotics. This second course is generally used if the child does not respond to the initial 4 oral therapy.

Antibiotic Therapies Recommended for Treatment of Lyme Disease:

Oral Therapy

For children at least 8 years old, doxycycline is the preferred oral therapy. Because the bacteria that causes Lyme Disease also responds to other antibiotics, doxycycline is not generally recommended for children less than 8 years old. The oral antibiotics recommended for young children include amoxicillin and cefuroxime. If a child cannot receive doxycycline, amoxicillin or cefuroxime a macrolide (azithromycin, clarithromycin, or erythromycin) may be considered. The reason that the macrolide is only used if they cannot receive the other agents is because it may be less likely to work.

Intravenous Therapy

Ceftriaxone is usually the preferred intravenous therapy for the treatment of Lyme Disease. Other antibiotics that are also efficacious, but need to be administered more frequently are cefotaxime and penicillin G.

ROCKY MOUNTAIN SPOTTED FEVER

The CDC suggests that because these diseases are often severe, doxycycline is the preferred drug in children of all ages. Treatments can be either oral or intravenous depending on the severity. Duration of therapy is usually between 5 to 14 days. Longer therapies are sometimes needed for more severe disease.

MEDICATION SUMMARY

For all of medications you should give your child all of the doses prescribed.
If your child has any concerning reactions (rash, throat swelling, severe or bloody diarrhea, etc) contact your physician right away.
If your child is given the medication as a liquid – shake well before giving each dose and ask your pharmacist for a measuring device.
If there is any drug remaining after the course is done, throw it away.
Many of these drugs may have interact with other medications, please let your pharmacist know if your child takes any prescription, over the counter medication, or herbal supplements.

Penicillins

Amoxicillin (oral)

Amoxicillin should not be used in children that have an allergy to penicillins.
You should talk to your child’s doctor if your child has an allergy to cephalosporins it is possible that your child will also be allergic to amoxicillin.
Could cause tooth discoloration that is lessened by brushing your child’s teeth well.

Penicillin G (intravenous)

Penicillin should not be used in children that have an allergy to penicillins.
You should talk to your child’s doctor if your child has an allergy to cephalosporins your child may also be allergic to penicillin.

Cephalosporins
Cefuroxime axetil (oral)

Cefuroxime should not be used in children that have an allergy to cephalosporins.
You should talk to your child’s doctor if your child has an allergy to penicillins as there is a chance that your child will also be allergic to cefuroxime.
Cefuroxime axetil liquid should be taken with food.
Cefuroxime axetil tablets can be taken with food to make it less likely to cause upset stomach.

Ceftriaxone or cefotaxime (intravenous)

Ceftriaxone or cefotaxime should not be used in children that have an allergy to cephalosporins.
You should talk to your child’s doctor if your child has an allergy to penicillins as there is a chance that your child will also be allergic to either ceftriaxone or cefotaxime.

Tetracyclines
Doxycycline (oral)

Your child should try to avoid prolonged exposure to sunlight and tanning because this can lead to a bad reaction.
This medication can cause tooth discoloration in young children.
This drug can discolor skin and/or fingernails.
This drug should be spaced at least 2 hours from iron, calcium, antacids, or dairy products.
If tolerated this medication should be taken on an empty stomach.
If your child is taking a tablet or capsule it should be swallowed whole with a full glass of water.

Macrolides

Azithromycin, clarithromycin, or erythromycin (oral)

· Space antacids at least two-hours from taking the medication.

· If your child is taking a tablet or capsule it should be taken whole.

· Clarithromycin and azithromycin should be stored at room-temperature, not in the refrigerator.

· Some types of erythromycin are stored in the refrigerator while others can be kept at room-temperature.

· Erythromycin is best taken, if it does not cause stomach upset, on an empty stomach.

· Clarithromycin extended-release tablets should be taken with food.

Others
Atovaquone (oral)

· The drug should be administered with a high fat meal.

· Let your child’s doctor know if your child has diarrhea.

Clindamycin (oral)

· Do not refrigerate solution.

· Take capsules with a full glass of water.

Quinine (oral)

Let your child’s doctor know if you child has a heart condition.
Do not crush capsules.

III. Prevention of Tick Borne Illnesses in Children

How do I protect my child from a tick borne illness?

· The best way to protect your child from a tick borne illness is to keep your child away from areas where ticks may be found (for example: wooded areas, fields, infested animals).

· If you can’t keep your child away from a tick infested area, then protective clothing should be worn.

Your child should wear light colored clothing (so ticks can be seen on the clothing and removed before they attach to the child’s skin).
Your child should also wear long sleeve shirts, long pants and a hat to limit a tick’s access to your child’s skin.
Pants should be tucked in to your child’s boots or socks and shirts should be tucked in to your child’s pants.

· Products that contain DEET (like Cutter’s® and Deep Woods Off®) or permethrin (like Sawyer®) can be sprayed onto your child’s clothing to repel and/or kill ticks.

· DEET and permethrin should not be used in infants less than 2 months of age.

· Products that contain DEET may also be applied to exposed skin. Avoid spraying or applying DEET to your child’s face to avoid getting DEET in your child’s mouth or eyes. For younger children, you may want to apply DEET to your hands then rub your hands on any exposed areas of your child’s skin. Do not apply DEET to the hands of young children since they may rub their eyes or stick their hands in their mouths.

· Permethrin should never be applied to the skin.

· After your child has returned from an area that may be infested with ticks, check his/her body and clothing for any ticks. Be sure to check your child’s hair and behind his/her ears. Remove any ticks you find on your child.

· If you have pets in your household, they should also be kept free of ticks. Your veterinarian can help you pick a product that will keep your pets tick-free.

If I find a tick on my child, how do I safely remove the tick?

To remove a tick:

Use a pair of tweezers (not your bare hands) to grasp the tick as close to your child’s body as possible.
Steadily pull the tick straight out from the body without twisting your hand. Do not crush or squeeze the tick. If you cannot remove the entire tick, do not panic. Simply clean and disinfect the area as noted below.
After removing the tick, clean and disinfect the area with soap and water, a chlorhexidine wash, an iodine wash or rubbing alcohol.
Be sure to wash your hands thoroughly after you remove the tick from your child.
The CDC recommends that you save the tick in a sealed plastic bag (like a Ziplock® baggie) stored in your freezer in case your child later becomes sick. You should write the date of the tick bite on a piece of paper placed inside the plastic bag.

If my child is bitten by a tick, will he/she need antibiotics?

· In general, antibiotics are not recommended for most people who are bitten by a tick. Usually, your doctor will ask you to watch your child closely for signs of a tick borne infection, like a skin rash or flu-like symptoms, for one month after the tick bite happened. In states where tickborne illnesses are most common, your doctor may give your child a single dose of doxycycline.

· If your child does develop a skin rash or flu-like symptoms (low fever, tired, achy joints/muscles), then your child should be seen by his/her doctor as soon as possible.

References

1. American Academy of Pediatrics. Prevention of Mosquitoborne Infections. In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:193-195. Available at: http://aapredbook.aappublications.org/cgi/content/full/2009/1/2.14. Accessed September 30, 2009.

2. American Academy of Pediatrics. Prevention Of Tickborne Infections. In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:191-193. Available at: http://aapredbook.aappublications.org/cgi/content/full/2009/1/2.13. Accessed September 30, 2009.

3. Center for Disease Control and Prevention. Department of Health and Human Services. Lyme Disease: A Public Information Guide. May 2007.

4. Centers for Disease Control and Prevention. Learn About Lyme Disease. http://www.cdc.gov/ncidod/dvbid/Lyme/. Accessed September 30, 2009.

5. Centers for Disease Control and Prevention. Prevention and control. http://www.cdc.gov/ticks/prevention.html. Accessed June 17, 2009.

6. Centers for Disease Control and Prevention. Removing ticks. http://www.cdc.gov/ticks/tick_removal.html. Accessed June 17, 2009.

7. Centers for Disease Control and Prevention. Rickettsial Diseases. Questions and Answers. What is Rocky Mountain spotted fever? http://www.cdc.gov/ticks/diseases/rocky_mountain_spotted_fever/faq.html. Accessed September 30, 2009.

8. Centers for Disease Control and Prevention. Tickborne Rickettsial Diseases. http://www.cdc.gov/ticks/transmission.html. Accessed September 30, 2009.

9. Chen LF, Sexton DJ. What’s new in rocky mountain spotted fever? Infect Dis Clin North Am 2008;22:415-432.

10. Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am 2008;22:315-326.

11. Nelson’s Pocket Book of Pediatric Antimicrobial Therapy. 16^th Ed. J Bradley and J Nelson, eds. Alliance for World Wide Editing, Buenos Aires, Argentina.

12. Pediatric Dosage Handbook. 15^th Ed. C Taketoma, J Hodding and D Kraus, eds. Lesi-Comp. Hudson, OH.

13. Treatment of Lyme disease. The Medical Letter 2007;49:49–51.

14. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006:43;1089-134.

17-Mar-10 12:00 PM

How Insect Repellents Work and What to Look For Before Buying

Bernard Lee, PharmD — Sat, 06 Feb 2010 06:00:00 GMT

1. How do repellents work?

Mosquitoes are attracted to moisture, carbon dioxide, warmth, odor, and estrogen on skin. Insect repellents work by producing a vapor layer that has an unpleasant taste or smell to insects.

2. Why should insect repellents be used?

Mosquitoes can transmit fatal diseases worldwide (i.e. West Nile virus, malaria and yellow fever).

3. When should insect repellents be used?

Anytime you or your child are going to be outside. In many areas of the country, mosquitos not only bite at night, but also during the day.

4. Who should use insect repellents, or take precautions against insects?

Anyone who is at risk for exposure to insects (i.e. mosquito bites) that may cause local skin or allergic reactions. If you or your child is exposed to insects that can cause serious illness or death by spreading bacteria or viruses (such as the West Nile virus).

5. Who should NOT use insect repellents?

-Anyone who has a history of a skin irritation or an allergic reaction to insect repellents should not use repellents with known ingredients (active or inactive) that caused these reactions. Read the labels carefully to find out what ingredients are in a product.

-The American Academy of Pediatrics (AAP) generally recommends that infants under 2 months old should not use insect repellents containing N,N-Diethyl-meta-toluamide (DEET).

6. What makes a product an ideal insect repellent?

•   Long lasting or works long enough against a wide variety of insects
•   Nonirritating to the skin when it is put on
•   Odorless or has pleasant odor
•    No effect on clothing after application (i.e. staining, bleaching, weakening of fibers)
•    No oily residue on skin and resists removal by wiping, washing, or sweating
•   Inert to commonly used plastics
•   Chemically stable
•   Economical for broad use by all
•   Non-toxic

7. What is(are) the safest and most effective product(s)?

• The Environmental Protection Agency (EPA) and Centers for Disease Control and Prevention (CDC) recommend products that contain either DEET (N,N-diethyl-m-toluamide) or Picaridin (KBR 3023) as the active ingredients of insect repellents. These have been shown to have the best efficacy in clinical trials. Products with these active ingredients typically offer longer-lasting protection than others.

• Oil of lemon eucalyptus [active ingredient: p-menthane 3,8-diol (PMD)] and oil of citronella are plant-based repellents. When used against mosquitoes in the US, scientific trials have found that they provide protection similar to insect repellents containing low DEET concentrations.

• The amount, or percentage (%), of the active ingredient makes all the difference in an insect repellent product. When comparing two products, make sure you are looking at the same active ingredient. Typically, the higher the percentage of the active ingredient a product contains, the longer the protection from mosquitoes. However, the concentration of different active ingredients cannot be directly compared (for example, 10% concentration of one ingredient doesn’t mean it works exactly the same as 10% concentration of another ingredient).

8. What are the different kinds of insect repellents available over-the-counter (OTC)?

There are MANY different brands of products available in the pharmacy. Read the label carefully for instructions on how to properly use the insect repellent. Find out what the active ingredient is and how much of it the product has. See Tables 1 and 2.

Table 1. Main ingredients and products names

Main ingredient Products

DEET Cutter, Cutter Backwoods, Cutter Backyard, Cutter Deep Woods,

Skedaddle, Skinastic, OFF!, Muskol, Outdoorsman, Sawyer, Ultrathon

Picaridin Repel, Off Skintastic
Lemon eucalyptus oil Cutter Advanced, Cutter Advanced Sport
Citronella oil Buzz Away, Green Ban, Herbal Armor, Natrapel

9. What are the differences between the products, brand vs. generic/store brands?

There are no known significant differences between brand, generic, or store brand insect repellents. The active ingredients of and past experiences with the most effective products should determine what you should buy and use.

10. Why are there so many different products?
Different products contain different concentrations of the main ingredient. A product should be chosen based on the duration of protection needed (from 20 minutes – 8 hours). See Table 2 for more information. Additionally, certain characteristics such as odor, sticky/greasiness, irritation, and potential damage to clothing and plastics differ between the products.

Table 2. Main ingredients with concentrations and their duration of action

Main ingredient              Concentration           Duration of Action
DEET 5 - 7%                     Up to 2 hours
DEET                                    10 - 30%                  Up to 6 hours
Picaridin                                 5 – 7 %                     Up to 4 hours
Picaridin                                    15%                         Up to 8 hours
Lemon eucalyptus oil 10 – 30%                    Up to 4 hours
Lemon eucalyptus oil 40%                         Up to 6 hours
Citronella oil 5 – 15%              About 20 – 30 minutes

11. Where is the best place to find insect repellents?

Repellents are found at retail, discount, and drug stores. Larger selections may be found at "outdoor" stores.

12. Where should insect repellents be applied?

Insect repellents should be applied to clothing, especially if the material is thin enough for insects to penetrate through. They should be applied to any exposed areas of skin, but avoid sensitive places like the face. Avoid breathing in the repellent through the nose or mouth. Do not let it contact the eyes. This can cause painful irritation.

13. What should be done if a side effect or reaction happens?

• If the reaction is local (limited only to the skin) and is not severe (no skin breaking, blisters, or hives), the area can be washed thoroughly with plain water. Do not use soaps or other harsh to remove any excess repellent chemicals as they could worsen the irritation.

• If the reaction is more severe, skin breakdown, spreading skin reactions, or anything happens beyond the skin (difficultly breathing, fast heart beats, “feeling very sick”), call 911 emergency services or your local Poison Control Center at 1-800-222-1222.

14. What are some alternatives to chemical insect repellents?

• Children and adults can wear protective clothing with long pants and long sleeves while outdoors. Be sure to apply insect repellent on the clothing and not directly contact the skin. Mosquitoes may bite through thin fabric.

• Mosquito netting can be used over infant carriers. Make sure there are no holes in the netting or large openings/gaps in the carrier.

• Dispose of containers or clear areas with standing water (bird baths, outdoor waterproof tarps, etc.), that provide breeding places for mosquitoes. Avoid stagnant bodies of fresh water, i.e. marshes, wetlands, farm ponds, shallow lakes, retaining/drainage ponds, etc.

15. What medications, or other products, can interact with insect repellents?

There are currently no known prescription medications taken that interact with common insect repellents. When using other topical products with insect repellents, the insect repellent should be the LAST thing applied to offer the best protection against insects.

16. Can sunscreen be used with insect repellents?

• Yes. People can, and should, use both a sunscreen and an insect repellent when they are outdoors. It is recommended NOT to use a single product that combines insect repellent containing DEET and sunscreen. The instructions for use of insect repellents and use of sunscreen are different. In most situations, insect repellent does not need to be reapplied as frequently as sunscreen. While no recommendations are available at this time regarding products that combine other active ingredients and sunscreen, it is important to always follow the label on whatever product you are using.

• To protect from sun exposure and insect bites, you can also wear long sleeves and long pants and apply insect repellent to your clothing, rather than directly to your skin.

17. When should insect repellents be reapplied?

• A product should be chosen with the concentration of insect repellent that will allow you to stay outside for the desired time. Use Table 2 to serve as a guide for the expected duration.

• Insect repellent should only be reapplied if mosquitoes have started biting. Products state that frequent reapplication and saturation are unnecessary. Repellent should not be applied more than 3 times per day.

• Combination sunscreen/insect repellent products should be avoided since sunscreen needs to be reapplied every two hours and the insect repellent does not need to be applied this often.

18. How do I read an insect repellent product label?

The active ingredient and concentration is listed on the label. Additionally, important directions and precautions are listed on the label. The pharmacist is available to help understand the label.

19. How can I find more information?

• Environmental Protection Agency (EPA) Web site

• Center for Disease Control (CDC) Web site

• National Pesticide Information Center (NPIC) through their toll-free number, 1-800-858-7378 or their web site

References:

1.   Brown M, Hebert AA. Insect repellents: an overview. J Am Acad Dermatol. 1997 Feb;36(2 Pt 1):243-9.
2.   Elston DM. Insect repellents: an overview. J Am Acad Dermatol. 1998 Apr;38(4):644-5.
3.   Combemale P, Dupin M. Insect repellents. J Am Acad Dermatol. 1998 Apr;38(4):645.
4.   Roberts JR, Reigart JR. Does anything beat DEET? Pediatr Ann. 2004 Jul;33(7):443-53.
5.   Buka RL. Sunscreens and insect repellents. Curr Opin Pediatr. 2004 Aug;16(4):378-84.
6.   Flake ZA, Hinojosa JR, Brown M, Crawford P. Clinical inquiries. Is DEET safe for children? J Fam Pract. 2005 May;54(5):468-9.
7.   Katz TM, Miller JH, Hebert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol. 2008 May;58(5):865-71.

8. CDC web site for “Insect Repellant Use and Safety”: URL: http://www.cdc.gov/ncidod/dvbid/westnile/qa/insect_repellent.htm Accessed 7/9/2009

6-Feb-10 0:00 AM

The Flu at a Glance

Tara Smith, PharmD — Wed, 03 Feb 2010 05:00:00 GMT

What is influenza?

Influenza, or the flu, is a contagious infection of the respiratory tract caused by influenza viruses that can make people very sick. People with the flu might have a cough, sore throat, fever, chills, or a runny nose. They may also have a headache, muscle aches, weakness, diarrhea, loss of appetite, nausea, and vomiting. http://www.flu.gov/individualfamily/about/index.html

What is the difference between seasonal influenza and H1N1 influenza?

Seasonal influenza virus usually makes people sick in the fall and winter months. It can be mild or serious. http://www.flu.gov/individualfamily/about/seasonalflu/index.html
H1N1 influenza virus (or "Swine flu") is a different flu virus than the seasonal flu virus. H1N1 flu will occur in the fall and winter, but it can also make people sick in the spring and summer. It can be very serious. http://www.flu.gov/individualfamily/about/h1n1/index.html
Antiviral medicines work against both the season flu and H1N1 viruses.
There are two different vaccines (seasonal flu vaccine and H1N1 flu vaccine) being offered. http://www.flu.gov/individualfamily/vaccination/index.html#seasonal

How do I recognize if my child has the flu?

Call your child's doctor if your child gets sick with a runny nose, sore throat, or cough along with muscle aches, fever (often high), chills, nausea/vomiting, and loss of appetite. It is important to treat the flu early with antiviral medicines. Call the doctor as soon as you think your child has more than just a common cold. http://www.flu.gov/individualfamily/prevention/medicine/index.html

What can I do to prevent my child and myself from getting the flu?

Wash hands often with soap and water.
Cover coughs and sneezes with an elbow. Turn away from other people.
Get both the seasonal flu vaccine and the H1N1 flu vaccine as soon as possible, especially if you or your child are at high risk for getting sick with the flu. Children and pregnant women are at high risk. Children as young as 6 months old can get the vaccines.
Avoid being around others who are sick. If a child you care for has the flu or flu symptoms, keep him home away from other children until he is well again. http://www.flu.gov/individualfamily/caregivers/index.html
Check with your child's school or daycare for rules about when a child can return to school after being sick.

How can I find out where the flu vaccines are being offered?

Call the local health department or your child's doctor to check their supply of the vaccines. They may offer clinic times to give the vaccines. You can also visit http://www.flu.gov/whereyoulive/index.html to locate a clinic near you.

If I get sick, how do I keep my child and those around me from getting sick?

Call your doctor to see if you need antiviral medicines or if you need to go to the hospital. Antiviral medicines can make the illness milder and help you feel better faster. The medicines must be taken as soon as you start feeling sick. http://www.flu.gov/individualfamily/prevention/medicine/index.html
If you must be around other people, wear a mask to cover your nose and mouth. http://www.flu.gov/individualfamily/prevention/facemasks/index.html
Stay in a separate room of the house as much as possible while you have flu symptoms.
There are some over-the-counter medicines that can help relieve flu symptoms. Ask your pharmacist about them.

Where can I get up-to-date information on the flu, vaccines, and treatments?

The Centers for Disease Prevention and Control (CDC) offers helpful information on their websites: www.flu.gov and www.cdc.gov/flu.

Specific information for your state can be found at http://www.flu.gov/whereyoulive/index.html.

2-Feb-10 11:00 PM

Cough and Cold Medicine

Leslie Briars, PharmD — Thu, 22 Jan 2009 17:00:00 GMT

As a parent, you may be confused by cough and cold medicines in the pharmacy. There are over a hundred of these products. Each one of them contains different medicines and different doses. If your child is sick, you should give them lots of liquids to drink and make them rest. Here are some tips to help you if your child has a cough or cold.

Non-medicine remedies: Non-medicine remedies may be helpful for some children. Here are some examples:
1. Cool mist vaporizers: These will add moisture to the air. They can also thin secretions.
2. Nasal bulb syringe: These can stop congestion in infants with stuffy noses.
3. Saline drops or spray: These can stop secretions in the nose for older infants and children. Use these four times a day. Follow the directions carefully.
Children less than four years of age: Ask your child’s pharmacist or physician before giving them medicines. These medicines can cause side effects in children less than four years of age. The Consumer Healthcare Products Association (CHPA) has recommended that manufacturers modify the product labels of OTC cough and cold medicines to state "do not use" in children under 4 years of age. The Food and Drug Administration supports this effort. Products will continue to be available during this transition time, so it is very important that parents ask their pharmacist or physician before giving these medications and follow the instructions on the label carefully. For older children, look at the label on the medicine. This label should give a dose for your child. Ask your child’s pharmacist or physician if you have questions.
Single product medicines: It is best to use single medicine product if your child is sick. These medicines will treat just the symptom that your child has. Here are some examples: Pseudoephedrine (Sudafed^®), (Dimetapp^®) and phenylephrine (Vicks^®, Neo-Synephrine^®) are used to stop stuffy noses. Diphenhydramine (Benadryl^®) and chlorpheneramine (Chlor-Trimeton^®) are used to stop runny eyes or noses. Guaifenesin (Robitussin^®) is to break up chest congestion. Dextromethorphan (Delsym^®, Vicks 44^®, Robitussin Pediatric Cough^®) is used to stop a cough.
Combination medicines: Medicines used to stop cough and congestion are not the same. Your child may not need a combination medicine if they are sick. Combination medicines may cause side effects. Many combination medicines have the same main ingredients. Ask yourself these questions to pick the best medicine. Does my child’s cough stop him/her from sleeping? Does the congestion make it hard for my child to eat? These questions will help you choose the best medicine for your child.
Medicines with acetaminophen (Tylenol^®): Do not choose combination medicines with acetaminophen (Tylenol^®). Read the label carefully. Give this only if your child has fever or pain.
Medicine measurement devices: You can use the measuring device that comes with your child's medicine or you can also use an oral syringe. These are sold at most pharmacies and are not expensive. Do not use tablespoons or teaspoons for medicines.
Vitamin C and Zinc: Do not buy vitamin C and zinc medicines. These medicines are not helpful. They can cause side effects in large doses.
Chicken soup: Chicken soup is a home remedy. It can help your child if they have a sore throat. It also helps with getting your child to drink fluids. It does not cure the flu or common cold.
Cold weather: Cold weather does not cause colds. The flu and colds are more common in the winter. This is when there are more viruses in the community. Your child can get a cold any time of the year. Make sure your child gets a flu shot every year. Hand washing is also very important to avoid catching colds from other people who are sick.

****You can find more information on the internet at the Food and Drug Administration

http://www.fda.gov/drugs/drugsafety/publichealthadvisories/ucm051137.html

22-Jan-09 11:00 AM

First Aid Fundementals

Jamie McCarrell — Wed, 14 Jan 2009 19:00:00 GMT

If this world were perfect, every accident (from bumps and scrapes to life-threatening injuries) would happen in the presence of skilled healthcare professionals. However, most of us tend to have homes outside of the emergency room, leaving us to fend for ourselves when these injuries occur. Most of the minor injuries that occur at home or in the outdoor setting can be adequately managed with a well-stocked first-aid kit. This guide is designed to educate parents on the typical items contained in a first-aid kit and special items included when the kit is being taken to camp or sporting events. Keep in mind that each person’s healthcare is slightly different than the next person, so some items that your child might need are not listed here.

It’s important that we keep in mind the purpose of the first-aid kit. When accidents happen, our first priority is to stabilize the wound. Most first-aid kits that we keep at home or take with us camping are equipped to handle small wounds for a short amount of time. Never try to treat major wounds with a first-aid kit. Although the kit may help to stabilize the wound until you can get to an emergency department, it is not meant to be the only treatment provided. Also, you should not continue to use first-aid kits to treat minor wounds that seem to be getting worse over time. Any minor wound that is not responding to treatment with a first-aid kit should be evaluated by a physician.

So what should we include in our first-aid kits? Try the following items for the best results when accidents occur around your house (see explanation below for the use of each item):

Equipment

Latex gloves
Scissors
Small flashlight
CPR mask

Dressings/Bandages

Sterile eye pads
Sterile gauze pads (various sizes)
Adhesive bandages (Band-Aid®, various sizes)
Butterfly bandages
Bandage tape

Medications/Sterilizers

Alcohol swabs
Tylenol or Ibuprofen*
Hydrocortisone cream
Triple antibiotic ointment
Benadryl*
Hydrogen Peroxide

*IMPORTANT—Make sure you know the dose needed for your child. Overdoses typically happen when parents act quickly to their child’s need and don’t correctly calculate the dose. If you need help with dosing, call your local pharmacist. Also, it is important to pick the correct formulation of the medications. For example, if your child normally takes the liquid form of Benadryl®, make sure that is what you include in the first-aid kit.

First-aid kits for outdoor adventures and summer camp:

Include all of the items mentioned above, but add the following things:

· Extra Benadryl

· Water purifying tablets

· An epinephrine pen (Epi-Pen®) if your child has severe reactions to stings or allergens

· Foil emergency blanket for warmth

The most common injury in the wilderness is an allergic reaction (other than scrapes). Having extra allergy medication on hand will help you to rest at ease while your child is camping. Also, if your child will be in the wilderness and should need to rinse a wound where there is no running water, you want to make sure you sterilize the water prior to pouring it on an open wound.

First-aid kits for sporting events:

Include all of the items mentioned in the “home” kit, but add the following things:

· ACE bandage wrap

· Analgesic muscle cream (such as Bengay®)

Important Points to Remember:

1. Anti-diarrhea medications are typically not to be used in children. Some causes of diarrhea (such as bacteria and viruses) need to be cleared from the stomach, and these medications stop that from happening. If you child starts experiencing episodes of diarrhea, see a physician as soon as possible.

2. If your child is diabetic, a glucagon kit should ALWAYS be included in his or her first-aid kit.

3. If your child’s wound is not healing (even a minor scrape), see a physician as soon as possible.

How to treat a minor wound:

· Make a general assessment of how severe the wound is. If the wound is severe (or if it is an injury to the head), apply pressure to the bleeding area and immediately take your child to the emergency room.

· If the wound is minor (i.e. little bleeding and only surface level scrapes or cuts), proceed with treating the wound with your first-aid kit.

1. Stop the bleeding. If the wound has any blood at all, the first goal is to stop the bleeding. Place a clean cloth on the wound and hold pressure against it. Occasionally remove the cloth to see if the wound is still bleeding. If the bleeding has stopped, move on to the next step.

2. Clean the wound. Use running water, if possible. If camping, DO NOT use water from streams or ponds unless it has been purified (the bacteria and other organisms in the water will get in the wound). Dab the wound dry with a clean cloth and apply hydrogen peroxide. Repeat the hydrogen peroxide application several times. Dry the wound with a clean cloth and move on to the next step.

3. Prevent infection. Sparingly apply the triple antibiotic ointment. The ointment should cover the entire wound and approximately ½ inch around it to prevent bacteria from getting into the wound. You do not have to use a lot of ointment. Too much ointment can just lead to increased cost and soggy bandages. Once the ointment is applied, move on to the next step.

4. Secure the wound. Choose an appropriate bandage based on the size and severity of the wound. For small wounds (smaller than a dime in size), a typical BandAid® will be fine. Larger wounds will need a larger bandage, and wounds that are oozing or bleeding might need gauze bandages to soak up the fluid. DO NOT APPLY THE STICKY PART OF A BANDAGE DIRECTLY TO A WOUND. Secure the bandage to the skin around the wound by using bandage tape or a cloth is the tape is not available.

5. Maintain bandages. The bandages will periodically need to be changed due to blood and other fluids coming from the wound. The cleaner and dryer you can keep the bandages, the better. Each time you change the bandage, repeat the cleaning steps (hydrogen peroxide) and re-apply triple antibiotic ointment. If the wound starts to look red around the edges and any puss or greenish fluid appears, take your child to a physician as soon as possible.

What about Sprains?

Many parents are confused about how to treat a sprain. The proper treatment for a sprain has three steps: stabilize, treat, protect.

1. Stabilize. Take all pressure off of the wound and get your child somewhere that they can rest the sprained area (usually an ankle).

2. Treat. Two things are going to happen with a minor sprain—swelling and pain. Treat the swelling by applying a COLD pack for 10 minutes every hour for the first 72 hours after the injury. If you use a compression wrap (such as an ACE® wrap) to hold the ice to the wound, you will also help treat the swelling by applying pressure to the sprain. Treat the pain by giving your child an appropriate dose of ibuprofen. The ibuprofen is an anti-inflammatory medication, so it will also help with the swelling.

3. Protect. Your child’s ankle will be slightly weak for a while after the sprain. During this time it is important to stabilize the sprain with a brace or athletic tape (not compression wrap) when weight is going to be applied to the sprained area.

When should I seek immediate medical attention?

1. If your child has an injury to the head or that is bleeding severely, go immediately to the emergency room.

2. If your child has a cut that may need stitches, go to the emergency room. Cuts that need stitches are typically ones that cut through the skin into the fat tissue or muscle. If you are unsure, secure the wound and go to an urgent care center.

3. If you suspect that your child has a broken bone, go to the emergency room immediately. You can suspect that they have a broken bone if there is extreme pain at the injury site and there will usually be immediate bruising. Compound fractures (when the bone comes out of the skin) are obviously a medical emergency and should be addressed in an emergency room.

4. If your child has a rare medical problem that would cause them to bleed easily, seek medical attention immediately.

Explanation of Use for Each Item:

· Latex gloves—Gloves protect the injured person from the care-taker’s germs on their hands. Gloves also protect the caretaker when handling blood and other body fluids.

· Scissors—Scissors are very useful in cutting bandages to fit wounds and cutting clothing off of an injured area of the body.

· Small flashlight—Not all injuries happen in the daylight. It is important that you can see what you are treating.

· CPR mask—In extreme circumstances, CPR may need to be administered. The mask protects both the rescuer and the injured person from spreading disease.

· Sterile eye pads—Useful for minor eye injuries or cuts to areas around the eye. All eye injuries should be immediately evaluated by your child’s eye doctor.

· Sterile gauze pads (various sizes)—These are very useful in protecting open wounds such as scrapes, minor burns, and small cuts.

· Adhesive bandages (Band-Aid®, various sizes)—Adhesive bandages are great for small wounds that are not bleeding or oozing much.

· Butterfly bandages—These are useful on the knuckles and other “irregular” surfaces when they get scraped because butterfly bandages are flexible.

· Alcohol swabs—Alcohol is typically used to sterilize and area before something gets injected, such as a glucagon pen or epinephrine pen. Try not to use alcohol on open wounds because it stings and your body will absorb some of it through the open skin.

· Tylenol or Ibuprofen—Use these medications for minor pain. Again, be sure you know the appropriate dose for your child according to their age and weight.

· Hydrocortisone cream—This cream can be used for minor itching caused by bug bites or allergic reactions. If at any point the itchy spot turns to an open wound (either from scratching or infection), call your pharmacist or physician before continuing the treatment.

· Triple antibiotic ointment—This ointment can be applied to a wound before bandaging is placed on it. This will help keep bacteria from attacking the wound while it is trying to heal.

· Benadryl®—Benadryl® is used for allergies. If your child experiences a minor allergic reaction (i.e. rash, minor swelling, runny nose/watery eyes), you can give Benadryl®. If the reaction is severe, however, get the child to an emergency department as soon as possible.

· Hydrogen Peroxide—Hydrogen peroxide is useful in cleaning wounds before they are bandaged. This will help to prevent infection and help the wound heal quicker by getting all of the “junk” out of there.

14-Jan-09 1:00 PM

All About Head Lice

Kathy Wheeler — Wed, 14 Jan 2009 18:00:00 GMT

What are head lice?

Lice are tiny, wingless parasites that live on the moist, warm, clean hair of the scalp of those that are infested. Outbreaks of head lice affect 10 to 12 million Americans annually. These outbreaks are generally seen between August and November after the beginning of school each year.

What do head lice look like?

Adult lice range in size from 1 to 4 millimeters—about the size of a sesame seed. Head lice lay 4-6 eggs on the hair shaft each day. These eggs, called nits, will hatch in approximately 5 to 10 days. The newly hatched lice are called nymphs and will mature in 7 to 10 days. Adult lice can live on the scalp for about a month.

This is a picture of a louse that is attached to a hair shaft. They are difficult to see due to their small size. Head lice can also crawl 6 to 30 centimeters per minute making them even more difficult to find when checking your child’s scalp. The nits are difficult to see as well. Generally the nits are found very close to the scalp. The picture to the right shows nits attached to hair shafts. Their size is compared to the head of a pin. Good places to find nits are behind the ears and the nape of the neck. Dandruff, scabs, and dirt may sometimes be mistaken for nits. However, nits are firmly attached to the hair shaft and are more difficult to remove than dandruff, scabs and dirt.

How do I know if my child has head lice?

The most common complaint your child will have is scalp itching. You may notice your child scratching their heads more than usual. In natural, bright light check your child’s scalp by parting the hair and examining the scalp. The most reliable sign of head lice infestation is, of course, actually seeing a louse on the hair shaft or scalp of your child. Look for nits attached to the hair shaft very close to the scalp. When checking your child’s scalp, you may notice a rash that is produced by the infestation. Excessive scratching can increase the chances your child may develop a secondary skin infection on the scalp.

How did my child get head lice?

Lice can crawl quickly; however, they generally do not like to leave the warmth of the scalp. They do not hop or jump. They can cling to clothing such as collars and hats, especially if there are a large number of adult lice present. Head-to-head contact is one way lice can be transferred to another person. Lice may be found in brushes, combs, scarves, hats, headphones and helmets and can be transferred through the sharing of these things.

How do I treat my child?

Getting rid of head lice involves not only killing the lice but also removing the nits from the hair shafts. You may shave the heads of boys to remove active lice and nits. If so, place all hair in a trash bag, close it tightly and dispose of the bag immediately.

There are medications in the form of shampoos and crème rinses that you can buy from your local pharmacy to treat head lice. In some cases prescription medications may be needed.

Pyrethrins and Permethrin are the two agents that are sold over-the-counter to treat head lice. Both of these products are made from chrysanthemums. Anyone with an allergy to chrysanthemums should not use these agents.

q Pyrethrins

o As much as 75% effective against lice.

o Anyone with ragweed allergy may experience an allergic reaction with this product.

o Apply medication to scalp for 10 minutes and then shampoo or rinse as directed by the product.

o Combing with a lice comb should be done following treatment. Parents must be diligent and patient in order to adequately remove the nits from the hair shaft. This may take a significant amount of time, but is an important part of treatment.

o Application must be repeated in 7 to 10 days to kill any remaining nits that have hatched.

o Rash, itching and burning may be experienced after applying the product.

o Avoid contact of medication with the eyes.

o Over-the-counter products such as A-200â Gel and shampoo concentrate, RIDâ, Prontoâ, R&Câ shampoo, and Licetrolâ are just a few that are available.

q Permethrin

o As much as 99% effective for lice after one application.

o Allow product to remain on hair and scalp for 10 minutes before rinsing.

o Comb hair with lice comb to remove nits. Parents must be diligent and patient in order to adequately remove the nits from the hair shaft. This may take a significant amount of time, but is an important part of treatment.

o May require re-application in one week if active lice are seen on your child’s scalp after the first application.

o Irritation with burning, stinging, and itching may be experienced.

o Avoid contact with your eyes.

o This product should not be used in children less than 2 years of age.

o Over-the-counter products such as Nixâ Cream Rinse, A200®, Acticin®, Rid®, and Elimite® are available.

To assist with the removal of nits you may use a 1:1 solution of vinegar and water applied to wet hair avoiding contact with eyes. Wrap the hair in a towel for 1 hour and then comb the hair with a lice comb. Do NOT cover the child’s face during this process. Supervise your child throughout the entire process.

Contact your doctor if your child is allergic to chrysanthemums, has ragweed allergies or if you have noticed a scalp infection. If your child is less than 2 years of age call your doctor before using any over-the-counter products. If your child has lice or nits in the eyebrows or eyelids, call your doctor prior to treating.

Prescription medications may be needed if over-the-counter products do not work. Available prescription products are Malathion and Lindane.

q Malathion

o As much as 95% effective.

o There are no lice that have shown resistance to this agent.

o Apply to clean, dry hair and leave on for 8 to 12 hours before washing the hair.

o Made in a flammable alcohol base so do not use a hair dryer or smoke while product is in the hair.

o Repeat application usually not necessary.

o Do not use in infants less than one month of age.

o Priodermâ and Ovideâ are malathion products available with a prescription only

q Lindane

o Apply to cool, dry hair only and let hair air-dry. Do not use a hair dryer following application. The heat of blow-drying may increase absorption through the skin and lead to side effects.

o Absorption through the skin may cause nausea, vomiting, and even seizures.

o Lindane is approved for a single use and a 4-minute application time only.

o This agent should not be used in infants less than one month or those with seizure disorders or skin diseases.

Are there any “natural” remedies that work?

There are several alternative remedies that you may have heard can cure head lice. These remedies have not been scientifically proven to kill head lice.

Vaseline treatment or mayonnaise treatment.

· Apply Vaseline or mayonnaise liberally to the head.

· Cover your head with a shower cap for 8 hours. Be very careful NOT to cover the face. Make sure that your child is supervised throughout this process.

· Shampoo the Vaseline or mayonnaise out of the hair.

· Brush out any remaining lice.

Shampoo + oils treatment

· Mix together: Small amount of an inexpensive shampoo

3 tablespoons of olive oil

1-teaspoon tea tree oil

1-teaspoon eucalyptus oil

· Work into hair.

· Cover your head with a shower cap for about an hour. Be very careful NOT to cover the face and supervise your child throughout the process.

· Wash hair to remove oils.

· May repeat as needed.

How do I rid my house of these lice?

All members of the household should be checked for possible head lice. All areas in your home and car that have come in contact with your child’s head should be cleaned.

All clothing, bed linens, and towels should be washed in hot water and dried on the hot setting in your drier. Dry cleaning and ironing with a hot iron will kill lice and nits as well. If you cannot safely wash the bed coverings in hot water then you can double bag them in black plastic bags and put away for three days. At the end of the three days, wash the bedding according to the normal washing instructions. NOTE: Be careful to supervise your child at all times.

Combs and brushes should be soaked in hot water with 1% Lysol or bleach for 10 minutes.

Vacuum all carpeted areas—even under the beds. Vacuum all upholstered furniture. Do not use chemical sprays in the home.

What can I do to prevent this from happening again?

Talk with your child and reassure them that head lice are not due to poor hygiene habits. Talk with your child about the signs of head lice. Ask your child to tell you if they develop any excessive itching on their scalp. Tell your child to only use her own comb/brush on her hair and not to share them with her classmates. Ask your child to not share sports equipment, hats, or scarves with her classmates. Understand that even with the most diligent of efforts, head lice infestation can still occur and should be promptly treated.

For more information on head lice, contact the National Pediculosis Association at www.headlice.org.

References:

Buff W. Insect Bites and Stings and Pediculosis. In: Berardi RR, McDermott JH, Newton GD, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 14^th ed. Washington, DC: AphA;2004:902-911.
Frankowski BL. American Academy of Pediatrics guidelines for the prevention and treatment of head lice infestation. Am J Manag Care.2004;10:S269-72.
Greene A. Treating head lice. Available at: http://www.drgreene.com/21_640.html. Last accessed on August 9, 2008.
Hensel P. The challenge of choosing a pediculide. Public Health Nursing. 2000;17:300-4.
Lebwohl M, Clark L, Levitt J. Therapy for head lice based on life cycle, resistance, and safety considerations. Pediatrics. 2007;119:965-74.

Pictures were downloaded from various Internet web sites to include:

Head Louse picture: http://www.borealforest.org/insects/insects7.htm
Pin and nit picture: http://ohioline.osu.edu/b893/b893_24.html
Child’s head picture: http://pediatrics.about.com/od/headlice/ig/Head-Lice-Pictures/Live-Louse-on-Hair.htm
Child and Mom: http://www.remedies-for-natural-health.com/home-remedy-for-head-louse.html
Pictures of products: http://www.ridlice.com/products.html; http://www.walgreens.com/popups/s_image.jsp?id=prod389053&skuid=sku389054; http://www.liceandscabies.com/liceusagerc.shtml; www.anbcanada.com;

http://www.abconlinepharmacy.com/ns/customer/product1792-c-p1; http://www.irxmedicine.com/products/pdt.asp?p_unitid=29009

14-Jan-09 12:00 PM

All About Nose Drops, Sprays, and Inhalers

Matthew Helms — Mon, 07 Jul 2008 21:15:00 GMT

QUICK-LINKS FOR THIS ARTICLE

NASAL DROPS

Infant
Older child

NASAL SPRAY
NASAL INHALER

Infant Nasal Drops:

The following list of instructions will help you properly administer nasal drops to an infant:

Wash your hands before giving the medicine.
Using a suction bulb, clear the baby's nose. Ask your pharmacist or pediatrician on the proper method for suctioning an infant's nose.
Warm the medicine to room temperature if it is cold.
Place the infant lying down in your arms with his head tilted back.
Draw up enough medicine into the dropper so the correct number of drops can be given.
Without touching the dropper to the nose, insert the dropper slightly (about one-third of an inch) into the nostril.
Aim dropper toward the back of the nostril and squeeze the prescribed number of drops from the dropper.
Repeat on the other side if the other nostril needs medicine.
After the drops have been given, tell the child to keep his head tilted back for 5 minutes. Allow the child to spit out any medicine that runs down his throat.
If the child coughs, place him upright. Keep him upright and watch for any problems with breathing or excessive coughing. If this occurs, call the pediatrician immediately.

Nasal Drops for the Older Child:

The following list of instructions will help you to properly administer nasal drops to an older child:

Wash your hands before giving the medicine.
Have the child gently blow his nose if he is able.
Smaller children (toddler age) should lie on their back with a small pillow between their shoulders. Tilt head back over top of the pillow. Older children can sit in an upright position with their heads tilted back.
Warn the child that he may taste the medicine drops.
Warm the medicine to room temperature if it is cold.
Draw up enough medicine into the dropper so the correct number of drops can be given.
Push up gently on the tip of the child's nose.
Without touching the dropper to the nose, insert the dropper slightly into the nostril (about one-third of an inch).
Instruct the child to breathe through his mouth while the medicine is being placed into the nose.
Aim the dropper toward the back of the nostril and squeeze out the prescribed number of drops.
Repeat the above steps if the other nostril needs medicine.
Tell the child to keep his head tilted back for 5 minutes. Allow him to spit out any medicine that runs down his throat.
If the child coughs, place him upright and watch for any problems with breathing or excessive coughing. If either of these should occur, call the pediatrician immediately!

NASAL SPRAY:

The following list of instructions will help you to properly administer nasal spray to your child:

Have the child gently blow his nose if able. An infant suction bulb can be used for infants.
Have the child sit upright with head tilted back
Plug one nostril with your finger.
Place the tip of the sprayer slightly (about one-half inch) into the other nostril.
While pointing the sprayer straight back, have the child hold his breath.
Squeeze the sprayer quickly and firmly.
The child should continue to hold his breath for several seconds.
Remove sprayer from nose and allow child to exhale through his mouth.
Repeat above steps if more sprays are prescribed, or if the other nostril needs medicine.
Have the child keep his head tilted back for at least 2 minutes and avoid blowing nose during this time.
Rinse the tip of the sprayer with warm tap water before replacing the cap.

NASAL INHALER:

The following list of instructions will help you to properly utilize a nasal inhaler with your child:

Have the child gently blow his nose if able. An infant suction bulb can be used for infants.
Shake the inhaler well and remove the protective cap.
Place the tip of the inhaler inside the child's nostril (see above picture).
While the child holds his breath, firmly press down on the top of the inhaler and then release.
Have the child hold his breath for at least 3 more seconds.
Remove the inhaler from the child's nose and have him exhale through his mouth.
Repeat the above steps if more sprays are prescribed or if the other nostril needs medicine.
Tell child not to blow his nose for at least 2 minutes after the last spray.

7-Jul-08 4:15 PM

Suppositories and Ointments

Matthew Helms — Mon, 07 Jul 2008 21:00:00 GMT

SUPPOSITORY:

The following list of instructions will help you to properly administer a rectal suppository to your child:

Wash your hands before and after administering the medicine.
Have the child lie on his left side. The left leg should be straight and the right leg should be bent up towards his chest. Infants should be face down across your knees.
Before unwrapping the suppository, run it under cold water to make sure it is firm.
Put on a pair of medical, or disposable, gloves and remove the suppository from its wrapper.
With one hand, gently separate the child's buttocks so you can see the anal opening.
With the other hand, dip the suppository into some cold water or place a small amount of Vaseline or KY Jelly on the tip. Gently insert the smooth, rounded end of the suppository into the anal opening.
With one finger [If Child under 3 years old, use pinky finger. If Child over 3 years old, use index finger] gently push the suppository into the rectum until there is no resistance (maximum distance=2-3 inches). Check with your pediatrician on the proper distance for your child.
Remove your finger and check to make sure the suppository is still in the rectum. If it is inserted far enough, the suppository should stay in place. If it comes out, reinsert it again slightly farther than before.
After the suppository has been inserted, hold the child's buttocks together until the immediate urge to go to the bathroom passes.
Have the child remain in the same position for about 20 minutes. If this becomes impossible, the child should at least sit or lie down for about 20 minutes without going to the bathroom.

OINTMENT:

The following list of instructions will help you to properly administer a rectal ointment to your child:

Wash your hands and put on a pair of medical gloves.
Have the child lie on his left side. The left leg should be straight and the right leg bent up toward his chest. Infants should be face down across your knees.
Place the applicator that comes with the ointment onto the end of the tube. Place a small amount of Vaseline or KY Jelly onto the tip of the applicator.
With one hand, gently separate the child's buttocks so you can see the anal opening.
With the other hand, gently insert the applicator into the anal opening.
Once the applicator is inside, squeeze the tube to insert the prescribed amount of ointment.
Remove the applicator from the rectum. Detach the applicator from the tube and clean applicator with soap and warm water.
Have the child remain in the same position for about 20 minutes. If this becomes a problem, the child should at least sit or lie down for this amount of time without going to the bathroom.

7-Jul-08 4:00 PM

How to Administer Topical Medications

Matthew Helms — Mon, 07 Jul 2008 21:00:00 GMT

The following list of instructions will help you apply topical medications to your child:

Always wash your hands before applying a topical medication.
Wash the affected area of the skin and pat dry with a towel. Do not wash the skin if a doctor has directed you otherwise.
If no specific directions have been given, follow these general guidelines:

creams, ointment, gels, solutions, oils, and lotions: Use only a thin layer of medicine and rub well into skin.
aerosol: Shake well; hold can 6 inches away from skin and spray for several seconds.

Be careful not to get any topical medication into your child's eyes, ears, or mouth.
Wash your hands after the topical medicine has been applied.

7-Jul-08 4:00 PM

How to Administer Ear Drops

Matthew Helms — Mon, 07 Jul 2008 21:00:00 GMT

The following list of instructions will help you to properly administer ear drops to your child:

Always wash your hands before and after giving medication.
Warm the medicine to body temperature by holding the bottle between your hands for several minutes. A medicine that is cold and placed in the ear could cause dizziness or nausea.
If the drops are a suspension, shake the bottle well.
Place child on his side so the affected ear is on top.
Straighten the ear canal by:

Child younger than 3 years old: Hold ear lobe and pull down and back.
Child 3 years and older: Hold upper part of ear and pull up and back.
something (a graphic) used to be here

Drop the correct number of drops into the ear. Do not touch the dropper to the ear. Try to place the drops onto the side of the ear canal and not dropped directly down the ear canal.
Keep child on his side for 5 minutes or insert a cotton plug into the ear.
Repeat steps 3 to 6 on other ear if necessary.

7-Jul-08 4:00 PM

How to Administer Medicine for the Eye

Matthew Helms — Mon, 07 Jul 2008 20:00:00 GMT

EYE DROPS:

The following list of directions will help you properly give eye drops to your child:

Always wash your hands before giving medication.
Be sure the eye drops are at room temperature before using.
Clean your child's eye of all secretions and/or old medication. This can be done by gently wiping the eye with a damp gauze or cotton pad.
Have your child stand or sit with his head tilted back.
Do not touch the dropper bottle to the eye.
Have the child look upward toward the ceiling. Use your index finger and thumb to gently pinch and pull down the lower lid to create a pouch. Drop the prescribed number of drops into the pouch and not directly in the eye.
Have child close eyes for 1-2 minutes.
If a second type of eye drop is also prescribed, wait at least 5 minutes before giving second drops.

EYE OINTMENT:

The following list of directions will help you properly give eye ointment to your child:

Always wash your hands before giving the medicine to your child.
Be sure the ointment is at room temperature before using.
Clean your child's eye of all secretions and/or old medication. This can be done by gently wiping the eye with a damp gauze or cotton pad.
Tell the child that the ointment may cause blurred vision. This is normal and will go away rather quickly.
Have child lie on his back or sit with his head tilted back.
Do not touch the tip of the tube to the eye, eyelashes or eyelids.
Pull lower lid down while your child looks up. Squeeze out a line of ointment along the lower lid from inner to outer eye. By rotating the tube when you reach the outer eye, you will help detach the ointment from the tube.
Keep eyes closed for 1-2 minutes.
Gently wipe any excess ointment from the eye while it is closed.

7-Jul-08 3:00 PM

All about Oral Inhalers

Matthew Helms — Fri, 27 Jun 2008 19:00:00 GMT

Contents of this Page:

ORAL INHALER
ORAL INHALER WITH SPACERS
CAPSULE INHALER
- Rotahaler
NEBULIZER

ORAL INHALER:

The following list of instructions will help you properly administer a medication with an oral inhaler:

Shake the inhaler well before use.
Remove the cap from the inhaler.
Ask your child to exhale completely (blow all the air from lungs through their mouth).
Position inhaler about an inch away from the mouth.
While child breathes in, press on the top of the inhaler to release a puff of medicine.
After child has inhaled completely, have the child hold his breath for 10 seconds or as long as he can hold it.
Have the child breathe out slowly.
If more than one puff is to be given: wait at least one minute after first puff to give second puff.
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol. To check if your child is taking a bronchodilator ask your pharmacist or pediatrician.

ORAL INHALER WITH SPACERS:

There are three different types of popular spacers. They are the Aerochamber with mask, the Aerochamber with mouthpiece, and the InspirEase spacer. The following list of instructions for each type will allow you to properly help your child use a spacer.

Aerochamber with Mask:

The following list of instructions will allow you to help your child properly use an Aerochamber with mask:

Shake the inhaler well before use.
Place the whole inhaler unit onto the end of the spacer as shown in the picture
Place the masked end of the spacer up to the child's face.
Be sure the mask fits tightly over both the child's mouth and nose. If it isn't a snug fit, you may have the wrong size. The masks come in several different sizes. Check with your pediatrician or pharmacist if you think you need a different size mask.
Press on top of the inhaler to release medicine into the spacer.
Tell the child to breathe in and out slowly several times, taking deep breaths and holding for several seconds.
If the spacer squeaks or whistles while the child is inhaling or exhaling, then the child is breathing too fast. Tell the child to take slower breaths.
If more than 1 puff is necessary: wait at least one minute after first puff.
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol. To check if your child is taking a bronchodilator ask your pharmacist or pediatrician.

Aerochamber with mouthpiece:

The following list of instructions will allow you to help your child properly use an Aerochamber with mouthpiece:

Shake the inhaler well before use.
Place the whole inhaler unit onto the end of the spacer as shown in the picture.
Place the other end of the spacer (mouthpiece) in the child's mouth.
Press on top of the inhaler to release medicine into the spacer.
Tell the child to breathe in and out slowly several times, taking deep breaths and holding for several seconds.
If the spacer squeaks or whistles while the child is inhaling or exhaling, then the child is breathing too fast. Instruct the child to take slower breaths.
If more than 1 puff is necessary: wait at least one minute after first puff.
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol. To check if your child is taking a bronchodilator ask your pharmacist or pediatrician.

Inspirease spacer:

The following list of instructions will allow you to help your child properly use an Inspirease spacer:

Shake the inhaler well before use.
Take the medicine chamber out the inhaler and place it on the top of the mouthpiece on the Inspirease spacer as shown in the picture.
Place the mouthpiece of the spacer in the child's mouth.
Press on top of the medicine chamber to release medicine into the spacer.
Tell the child to breathe in and out slowly several times, taking deep breaths and holding for several seconds.
If the spacer squeaks or whistles while the child is inhaling or exhaling, then the child is breathing too fast. Tell the child to take slower breaths.
If more than 1 puff is necessary: wait at least one minute after first puff.
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol. To check if your child is taking a bronchodilator ask your pharmacist or pediatrician.

CAPSULE INHALER:
Capsule inhalers require that you place the capsule of powdered medicine into the inhaler before giving each dose.

Rotahaler:

The following list of instructions will allow you to help your child properly use a Rotahaler:

Twist the back of the inhaler all the way to the right.
Follow the instructions from the packaging to puncture the capsule and release the medicine from the capsule. You may need to twist the back of the inhaler all the way to the left (Rotahaler®) or you may need to press both side buttons together once and release (Aerolizer®).
Tell the child to breathe out completely (exhale).
Tilt the child's head back slightly.
Have the child place his/her lips around the top of the inhaler as shown in above picture.
Tell the child to inhale quickly and hold his/her breath for 10 seconds or as long as he/she can.
Remove the inhaler from mouth and tell the child to exhale.
Repeat the above steps until no medicine is left in the inhaler.
Throw away the empty capsule.
Clean the inhaler by rinsing with water after each use and allow to air dry.

NEBULIZER:

The following list of instructions will allow you to help your child properly use a nebulizer.

Place the prescribed volume of medicine into the reservoir (usually a plastic cup at the end of the mouthpiece). Your child’s doctor may tell you to add a diluting liquid to the medicine to the reservoir also.
Turn the nebulizer on.
Be sure a mist is coming out of the mouthpiece before placing it into your child's mouth.
Place the end of the mouthpiece into the child's mouth and have the child breathe normally.
The child is usually finished when there is no more liquid in the cup.
Clean the nebulizer after each use by rinsing the mouthpiece and reservoir with water. Once a week the mouthpiece and reservoir should be soaked in soapy water, then rinsed and allowed to air dry.

27-Jun-08 2:00 PM

How to Administer Oral Liquids

Matthew Helms — Mon, 23 Jun 2008 17:30:00 GMT

When giving your child liquid medicine, always use either an oral syringe, a medicine dropper, a medicine spoon or a medicine cup, one of which sometimes accompanies children's medications. You can also buy any of these tools at your local pharmacy. Do not use a kitchen utensil such as a teaspoon or tablespoon. These do not deliver the correct amount of liquid medicine.

Sometimes children refuse to take liquid medicine because it tastes bad. One method used to overcome this problem is to mix the medicine in a small amount of water or fruit juice. NOT ALL medications, however, can be mixed with water or fruit juice. Contact the child's pharmacist and/or pediatrician for more information.

If your child spits out the medicine, vomits shortly after taking it, or drools some of the dose down his/her face, DO NOT give another dose. Consider this a partial dose and call your pharmacist and/or pediatrician for further instructions.

The following guidelines should help make it easier to administer a liquid medication by each method.

TABLE OF CONTENTS________________________________________

ORAL SYRINGE
MEDICINE DROPPER
MEDICINE SPOON
MEDICINE CUP

__________________________________________________________

ORAL SYRINGE:

The easiest method for getting the liquid into the syringe is to pour a small amount into a paper cup, or any small cup. Place the tip of the syringe into the liquid and pull back the plunger. This should pull the liquid into the syringe. To avoid air bubbles from entering, keep the tip below the level of the liquid. Draw up enough liquid to equal the dosage amount, and pour the remaining liquid back into the medicine bottle.

Sometimes a syringe adapter can be used to get the liquid into the syringe. This is a plastic device that fits between the medicine bottle and the oral syringe. This way the whole bottle of medicine can be turned upside down and the correct amount of liquid drawn out. These adapters can also be found at your local pharmacy.

When giving the medicine, slowly squirt into the side of the child's mouth so the child will swallow the liquid naturally. Do not squirt onto the back of the throat as this will cause gagging. The oral syringe should be rinsed in warm water after each use.

MEDICINE DROPPER:

Droppers are usually part of the medicine bottle you receive at the pharmacy. Withdraw the correct dose (volume) into the dropper. Squeeze the rubber end of the dropper and drop the liquid into the side of the child's mouth to avoid gagging. The dropper should be rinsed with warm water after each use.

MEDICINE SPOON:

Hold the medicine spoon upright. Pour the correct volume of medicine into the spoon. Use the markings on the side of the spoon as a guide. Put the spoon up to the child's lips and tilt it slowly. The liquid should flow into the mouth slowly enough so the child can swallow normally. Rinse the medicine spoon with warm water after each use.

MEDICINE CUP:

Some over-the-counter medicines come with a medicine cup included in the package. You should only use the cup with that particular medicine. There are slight differences in the cups from different manufacturers. Pour the correct volume of medicine into the cup. Use the markings on the side of the cup as a guide. Usually this method is only used when measuring volumes for older children (usually teaspoonsful). DO NOT try to measure something for an infant or small toddler with a medicine cup. The result will not be accurate!

23-Jun-08 12:30 PM