Nail loss with Hand, Foot and Mouth Disease

I have previously posted entries about Hand, Foot and Mouth disease.  Sometimes, after a case of Hand, Foot and Mouth, children can lose their nails (both fingernails and toenails) in a process called Onychomadesis.  Here are pictures of what this typically looks like:






Onychomadesis is a separation of the growing nail from the nail bed at the nail matrix.  This is caused by a temporary arrest in nail matrix activity, and it may at first look like a dark linear line across the nail, known medically as a "Beau's line".

Nail matrix arrest has been described with a range of medical conditions and was first described in the literature associated with a case of Hand, Foot and Mouth disease in 2000.  The association between the Hand, Foot and mouth virus (a coxsackie virus) and onychomadesis is not very well understood.
The nail changes are temporary and the nails that are affected will regrow spontaneously.  This shedding of the nail is self-limiting, isn't painful and may not bother the child.  It can take up to 6 months to see regrowth of that nail.

The 2017 Dirty Dozen - Produce with the Highest Levels of Pesticides

Every year, I like to summarize the "Dirty Dozen" list - fruits and vegetables that the US Department of Agriculture has deemed the highest in detectable pesticides based on their testing.  This year, nearly 70% of samples of 48 types of fruits and vegetables had detectable pesticide residue.  Scarily, the residue remained on fruits and vegetables even after they were washed, and in some cases, after they were peeled.
Even low levels of pesticides can be harmful to the developing brains of infants, babies and young children.  We would all like to feed our children healthy fruits and vegetables, but "buyer beware" when shopping for them. 

Highest levels of pesticide residue in commercially grown produce:
1.  Strawberries - the most contaminated sample had over 20 pesticides detected! 
2.  Spinach - yikes!  We are all buying this because it has some many great health benefits.
3.  Nectarines
4.  Apples
5.  Peaches
6.  Pears - new on the list this year
7.  Cherries
8.  Grapes
9.  Celery
10.  Tomatoes
11. Sweet bell peppers
12.  Potatoes - also new this year

The solution?  Buy organic and look into locally grown options - growing your own or checking local farmer's markets where you can inquire about their use of pesticides.
The Environmental Working Group has also published this list to help us - their ranking of produce they call the "Clean 15", least likely to contain pesticide residue.  This helps if you are making a grocery list with "organic only" or "nonorganic ok" designations.

1.  Sweet corn
2.  Avocados
3.  Pineapples
4.  Cabbage
5.  Onions
6.  Sweet peas (frozen)
7.  Papayas
8.  Asparagus
9.  Mangoes
10.  Eggplant
11.  Honeydew melons
12.  Kiwi
13.  Cantaloupe
14.  Cauliflower
15.  Grapefruit

Head Lice in the House!

Though I have written about treating head lice previously, I decided to revisit the topic from a mom's perspective --- having lived through (and treated) head lice in my house this summer.
Somehow at the end of the school year, between end of year parties (and hugs) and a pool party at a local public pool, my 8 year old ended up with head lice for the first time.  Her endless complaints of an itchy scalp made me investigate and not just chalk it up to dry skin and dandruff.  To my horror, I found not only live little lice but nits.  This discovery prompted crying (her) and running to the drug store that night (me).


Here is what we did:


Day 1 - Nix kit (1% Permethrin) as directed; left on for 10 min. and then rinsed thoroughly.  The kit came with a cream rinse along with a gel designed to make combing out nits easier, and a spray for furniture and bedding.  The best thing about the kits, in my opinion, is the fine tooth metal comb - essential for combing out the nits that remain.  After treating her and combing her head really well, I stripped her bed and washed all the bedding.  I discovered an entire colony of stuffed animals in her bed - they promptly went into trash bags that I tied off.  According to what I read, several days in the bag should be good enough to kill live lice, but we decided to leave them in the bags for 3 weeks (just to be safe!).  As a good scientist, I put several lice in a plastic baggie so I could "watch" them. 
According to the package insert, if they are moving slowly or not at all after 24 hours, then one can assume that the 1% Permethrin killed them.  If they act like nothing fazed them, then the lice may be resistant to the Permethrin. 


Day 2 - In addition to the planned inspection and recombing/nit removal, I decided to use Lice Freee spray, a concentrated salt water solution that is designed to kill both active lice and eggs (nits), I presume by drying them out.  Lice Freee is designed to be used on dry hair, saturating it, before combing it out and allowing it to dry naturally.  I was tempted to also utilize another method of blowing her hair dry on the hot setting, but decided to save this for another day.  I combed out lots of nits, along with some lice - several still moving (but more slowly, it looked like).  The lice in the bag are moving slowly or appear dead - all good it seems.  Extra cautious, we changed and washed the bedding again.


Day 3 - We used tea tree oil shampoo, the Nix step 2 removal gel to aid combing, and combed through her hair again really well using the fine tooth comb.  This time, I found some nits but no live lice, which makes her a bit happier as she has been "freaking out" about the whole lice thing.  After combing, I used the blow dryer on the hot setting, which presumably helps to dry out the nits.


Day 4 -7 Lice Freee spray and combing; still think I am finding nits but no live or dead lice. 


Day 7 - Retreated with Nix cream rinse as instructed in the package insert.


It appeared that we had rid ourselves of lice, but I did continue to find nits every night on combing for about 10 days.  So - no matter what your treatment is, combing and inspecting every day is really important.  I think I actually inspected and combed her hair every night for about 3 weeks. 


Other take home points:
Follow the directions on the package - if it says apply to dry hair, apply it to dry hair.  I made a mess one night applying the Lice Freee spray to wet hair (still worked, but messy).  With the discovery of "super lice" in many states (lice that are resistant to 1% Permethrin), it is very important to re-treat as directed. 
Being diligent about inspecting and combing is really important.  It took about a week for us to be nit-free, and sometimes nit-free isn't the goal if all live lice have been eliminated.  I didn't want to take the chance of any nits hatching live little guys, so we made an attempt to remove them all. 
As I mentioned, the comb is really important - we liked the chunky red comb from the Lice Freee kit the best.

Adjusting Your Child's Sleep Schedule

Fall brings school, and with it, trying to adjust your child's sleep schedule.  For many of us, we become a little more lax in the summer time with bedtimes -- it stays light longer in the summer, and for some of us, that means that we allow our children to stay up a bit later and sleep in a little longer.  Sleep experts recommend keeping a regular bedtime that is the same on week nights AND weekends, but many of us don't do that - for our kids or ourselves.  This means for many families that we have to work to adjust our children's bedtimes since they will have to get up earlier for school once the school year begins.


 Start by adjusting your children's bedtimes back by 30 min. every few days until you get to your desired bedtime. Have a relaxing bedtime routine every night starting 30 min. before bedtime - this may include bath or shower, reading a book, etc. Limit screen time (TV, tablets, video games, cellphones) as the blue light from devices can interfere with sleep.


Average numbers for total hours of sleep per day based on ages (naps count too):
newborns 14-17 hours
infants/babies 4-11 months 12-15 hours
toddlers 1-2 yrs old 11-14 hours
preschoolers 3-5 yrs old 10-13 hours
school age kids 6-13 yrs old 9-11 hours


Many adolescents do not get the recommended amount of sleep.  The recent AAP policy recommends that teenagers get at least 8.5 hours of sleep per night, but this is a general recommendation and each child is different as far as how much sleep they need - some may seem to need 10 hours a night, and some as little as 7 hours.  A recent study showed that 59% of 6th-8th graders and 87% of high school students obtained less than the recommended 8.5 hours.  Natural changes occur in adolescents' circadian rhythm, resulting in decreased secretion of melatonin and delayed onset of sleep.  The AAP also advocates for later public and private school start times, allowing adolescents to get an extra hour of sleep.


I have previously addressed sleep hygiene on this blog, and will stress the importance of a relaxing bedtime routine for about 30 minutes before bed.  This can include a bath/shower, reading and "winding down" relaxation activities.  It is important to limit "blue screen" time such as computer use, video games, tablets, or cell phone use.  The blue light from devices such as these can decrease your natural melatonin production, and can make falling asleep difficult.
Lack of sleep in teenagers can also cause increases in their caffeine intake.  People who drink excessive amounts of caffeine are twice as likely to have sleep issues and shortened REM sleep.  Your teen should avoid caffeine (especially later in the day and evening) and eating at late hours to improve their sleep quality.

Salmonella Disease Associated with Backyard Poultry

The CDC has recently reported a multistate Salmonella food poisoning outbreak associated with live poultry.  Many ill people reported purchasing live poultry for backyard flocks from feed supply stores and hatcheries.  Many ill people reported bringing live poultry into their homes, and others reported kissing or cuddling with the live chicks.  According to the CDC, these behaviors can definitely increase your chance of becoming ill. 


If you have livestock of any type, including backyard chicks, make sure you wash your hands well before and after handling them.  I would also recommend that you use certain shoes when outside with livestock, clean them regularly, and leave them outside the house when you come inside.

Information about Teenage vaccines: Recommended vaccines and the diseases they prevent

Information about Teenage vaccines: Recommended vaccines and the diseases they prevent

 

Human Papillomavirus (HPV) – HPV is a common virus, and can be sexually transmitted.  It is most common in people in their teens and early 20s, and is a major cause of cervical cancer.  The HPV vaccine protects against the strains of the virus that cause genital warts and cervical changes that can lead to cancer.  The vaccine, originally recommended for girls, is now recommended for both girls and boys; the vaccine should be given before a teen or young adult becomes sexually active.  The HPV vaccine is given as a three dose series, and can be started as young as 11-12 years old.

Meningococcal disease (a common cause of bacterial meningitis) – Meningococcal meningitis is a very serious infection of the lining around the brain and spinal cord.  It can cause death, and it is a bacteria commonly seen in outbreaks of meningitis on college campuses.  Meningococcal bloodstream infections can also occur, and can cause loss of an arm or leg and even death.  The meningococcal conjugate vaccine protects against these infections, and it is given as a two dose series.  The first dose is recommended at 11-12 years old, with a second dose at 15-17 years old.

Pertussis (Whooping Cough) – Pertussis is a highly contagious respiratory infection with a prolonged cough that can last for several months.  It is very serious and can cause worse infections in young infants.  The pertussis vaccine is given together with a tetanus shot; the combination is commonly referred to as the Tdap vaccine.   Children should receive a single dose of Tdap at age 11-12.

Pertussis

What is Pertussis?


 Pertussis, or whooping cough, is caused by a bacterial infection. The disease occurs in three stages. The first stage appears similar to the common cold, with runny nose, low grade fever and a cough. After 1-2 weeks, the second stage begins, where the cough worsens, may be accompanied by coughing spells or "fits" and the cough may be followed by a large intake of air, or a "whoop" noise. Infants can be severely affected, and may turn blue during coughing spells due to lack of oxygen. This second stage can last up to two months. During the final stage, which can also last weeks or months, coughing spells will gradually decrease in frequency and intensity. Pertussis used to be called the "100-day cough" because of how long the cough lasted.

 There is a vaccine to prevent pertussis - DTaP for young children and Tdap for adolescents and adults. DTaP vaccine is usually given at 2, 4 and 6 months of age, with a booster at 15-18 months of age and at 4-5 years of age. Immunity can decrease over time, and a booster is recommended again at 11-12 years of age.
Young infants under 6 months of age, especially if they have not received all three doses of DTaP, are particularly vulnerable to severe infection and are at higher risk of needing hospitalization if they contract pertussis. 


 Approximately 15-20 babies die in the United States every year from pertussis. Almost all are younger than 4 months of age - too early to have been fully protected by the DTaP vaccine. Because young babies get sick from pertussis and because they are not fully protected until they have had several doses of the vaccine, healthcare providers recommend that older children and adults who will be around newborns be protected; this is known as cocooning. Mothers should request the Tdap vaccine between 27-36 weeks of gestational age during each pregnancy, or before leaving the hospital if they did not receive Tdap during pregnancy.