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It’s cough season, with a few causes that weren’t on our bingo card this year…

Coughing is an important physiological defense mechanism that helps clear the airways of germs, irritants and mucous. As a result, we try not to suppress coughs unless they are unnecessarily disturbing daytime activities or sleep.

Acute coughs are most often caused by an upper respiratory tract infection, usually a common cold. Coughs with colds can last a few weeks- unless it is accompanied by ear pain, chest pain, shortness of breath, wheezing, gagging or vomiting after cough episodes or fever for more than 5 days you can treat at home. Any cough not improving by day 10-14 of an illness should be evaluated in the office as well.

Other causes of acute cough include:

• Pneumonia (most commonly viral in children)- these symptoms can evolve over time; keep an eye out for fast, shallow breathing, working hard to breath (pulling in of chest/abdomen), chest pain, wheezing, or a cough that is worsening after 7-10 days of illness.
• Viral rhinosinusitis (nasal and upper respiratory congestion)
• Acute bronchitis (usually viral, inflammation of lower airways producing a deeper sounding/barky type of cough, often hoarseness; coughing up yellow phlegm is a normal part of the healing process- if your child is bringing up brown or dark green/blood tinged mucous they should be seen).
• Listen to what a croup cough sounds like HERE.
• More information on croup HERE.
• RSV (Respiratory Syncytial Virus)*- a particularly bad cold virus that can cause wheezing in infants (this sounds like a whistling with exhalation, or a long exhalation that seems forced.) If you child breathing very fast, flaring their nostrils or pulling in their chest/abdomen when breathing they should be evaluated. Sounds of RSV/wheezing in infants HERE.
• Acute sinusitis (again, often viral, we suspect bacterial infections after 10-14 days of worsening, thick, discolored nasal discharge along with headache, fever, cough.)
• Allergic/irritant rhinitis- caused by allergens like pollen, dust and mold.

*We now have an injection of monoclonal antibodies against RSV (Beyfortus) for infants under the age of 8 months as of 10/1. This will help avoid RSV infection in the first year of life (stay tuned for more information about scheduling this injection.)

The two less common infections in the community right now are:

• Pertussis (whooping cough) which causes episodes of violent coughing often followed by gagging/vomiting. Children are vaccinated for Pertussis in infancy/toddlerhood and boosted starting at 11 years of age, but immunity may wane over time. There is currently a small outbreak of Pertussis in the area- if your child has been exposed, and/or has a persistent/disruptive cough we can test with a nasal swab sent to a lab. Pertussis is treated with an antibiotic. More information HERE.
• Listen to how a “whoop cough” sounds like HERE.
• Mycoplasma (a type of bacteria that causes a mild “walking pneumonia”, with or without fever, usually a persistent deep, wet cough). This, too, is treated with an antibiotic if symptoms are prolonged or significant (your body can clear this on its own.) More information HERE.

Treatment of cough and congestion:

• Teach children to cough into their elbows, rather their hands.
• Coughing with a “closed mouth” helps prevent airway irritation caused by the sides of the airways rubbing against each other.
• Try to use non-medicated measures (honey, hydration) during the day for coughing. Reserve use of medications for night-time coughs that disturb sleep or particularly persistent daytime coughing.
• If your child is experiencing chest pain, unrelenting cough, difficulty breathing, wheezing, or shortness of breath they should be evaluated in our office.

Water/fluids– water, juice, warm chicken soup or tea helps loosen congestion and prevents dehydration. Avoid caffeine, excess sugary beverages.

Salt water– a saltwater gargle (1/4-1/2 teaspoon salt in 8 ounces of warm water) can temporarily relieve a scratchy or sore throat

Saline nasal drops/sprays-

• Over the counter saline nasal sprays help relieve thick congestion and stuffiness.   For infants, lay baby on its back and squirt saline up each nostril- don’t be shy about the amount, it is safe for them to swallow or inhale the liquid.
• You can gently suction out excessive mucous with a “snot-sucker” but avoid using too frequently. Do not use bulb syringes which tend to collect mold and old secretions.
• Saline sprays can be used in older children as often as necessary. Nasal sinus rinses are also very helpful in clearing out clogged sinuses (avoid if any significant ear pain.)

A new over the counter nasal decongestant spray called ASTEPRO can help with congestion caused by allergies and colds. Avoid afrin or neo-synephrine as they can cause rebound congestion if used more than 2-3 days at a time.

Honey– safe to use for coughs and sore throats in children older than one. 2 teaspoons (10 milliliters) of honey has been found to be as effective as cough medicines in a study of children with upper respiratory tract infections. Best given straight up, honey coats and soothes an irritated throat.

Pectin cough drops/lollipops– safe to use in children at least 3 years of age who don’t choke easily. Pectin coats the throat,and helps soreness and cough.

Humidification– cold viruses thrive in dry conditions, and dry air also dries mucous membranes causing a stuffy nose and sore throat.

• Cool mist humidifiers help add moisture to the air- but be sure to clean it daily following the manufacturer’s instructions. Place it close to your child’s head so they are breathing in mist while sleeping or doing an activity.
• Sitting in a steamy bathroom for a few minutes also helps loosen secretions and soothe irritated throats.
• Warm mist humidifiers are fine as well,but can cause steam burns if touched.

Benadryl– a first-generation (sedating) antihistamine that may provide minor relief of congestion, sneezing and watery eyes, can be used in infants and children. Newer antihistamines like zyrtec and allegra are good for allergy, but not for colds. Can use with acetaminophen or ibuprofen. Dosing is available by weight/age on our website HERE.

Delsym/Robitussin DM–  long acting cough medications containing dextromethorphan that can be used for irritative coughs in children over age 4. This only suppresses the cough reflex, and does not decongest. Can use with Benadryl, acetaminophen and/or ibuprofen.

Delsym dosing:

· Children 12 and older- 10 ml (2 teaspoons) every 12 hours

· Children 6- 11 years- 5 ml (1 teaspoon) every 12 hours

· Children 4-6 years- 2.5 ml (1/2 teaspoon) every 12 hours

· Children under 4- discuss with physician prior to using

What NOT to use for coughs and colds:

Antibiotics- these attack bacteria, but do not work against viruses. You should have your child evaluated by the pediatrician prior to starting antibiotics, which are generally reserved for treatment of likely bacterial ear infections, bacterial sinusitis and bacterial pneumonia. Overuse of antibiotics can lead to antibiotic-resistant bacteria.

Over the counter cold and cough meds in children younger than 4- the FDA has recommended against the use of such medications due to serious and significant side effects and lack of efficacy in young children. You can use Benadryl for decongestion in young children, but recommend not using delsym in children younger than 4 unless directed by the physician.

Zinc- most high quality studies show no benefit to the use of zinc, and the mineral can cause significant side effects such as bad taste, nausea, and even permanent loss of the sense of smell in zinc-containing nasal cold remedies.

How do the symptoms of Flu differ from COVID19? Read more HERE.

We will be experiencing a partial (approximately 90%) solar eclipse on Monday, April 8^th from 2:11-4:37 pm. https://www.timeanddate.com/eclipse/in/usa/westport?iso=20240408  We are expecting sunny weather with scattered clouds, so should have a great view!

Partial or annular solar eclipses are different from total solar eclipses – there is no period of totality when the Moon completely blocks the Sun’s bright face. Therefore, during partial or annular solar eclipses, it is never safe to look directly at the eclipse without proper eye protection.  Please make sure your children are properly protected during this fun event.

When watching a partial or annular solar eclipse directly with your eyes, you must look through safe solar viewing glasses (“eclipse glasses”) or a safe handheld solar viewer at all times. Eclipse glasses are NOT regular sunglasses; regular sunglasses, no matter how dark, are not safe for viewing the Sun. Safe solar viewers are thousands of times darker and ought to comply with the ISO 12312-2 international standard. NASA does not approve any particular brand of solar viewers.

Do NOT look at the Sun through a camera lens, telescope, binoculars, or any other optical device while wearing eclipse glasses or using a handheld solar viewer — the concentrated solar rays will burn through the filter and cause serious eye injury.

If you don’t have eclipse glasses or a handheld solar viewer, you can use a homemade indirect viewing method, which does not involve looking directly at the Sun. One way is to use a pinhole projector, which has a small opening (for example, a hole punched in an index card) and projects an image of the Sun onto a nearby surface. With the Sun at your back, you can then safely view the projected image. Do NOT look at the Sun through the pinhole! Here are more fun eclipse activities: https://www.scholastic.com/parents/school-success/learning-toolkit-blog/7-activities-to-get-kids-excited-solar-eclipse.html

Spring has sprung, trees are blooming, noses are running and eyes are watering….
If your child has spring allergies, now is the time to start their maintenance medications such as nasal sprays, oral antihistamines and allergy eye drops. The vast majority of the medications are now over the counter; read below for more information the cause, prevention and treatment of seasonal allergies:

Allergic rhinitis and/or conjunctivitis is caused by things that trigger inflammation in the nose or eyes, called allergens. These allergens can be found both outdoors and indoors. When allergic rhinitis is caused by common outdoor allergens—such as mold or trees, grass and weed pollens—it is often referred to as seasonal allergies, or “hayfever.” Allergic rhinitis or conjunctivitis may also be triggered by allergens that are in your house, such as animal dander (tiny skin flakes and saliva), indoor mold, or the droppings of cockroaches or house dust mites—tiny creatures found in the home.
• If you have symptoms in spring, you are probably allergic to tree pollens.
• If you have symptoms in the summer, you are probably allergic to grass and weed pollens.
• If you have symptoms in late summer and fall, you probably are allergic to ragweed.
• Dust mites, molds and animal dander (saliva or skin flakes) cause symptoms all year.
Typical symptoms of allergies include clear nasal discharge with sneezing, sniffling, and nasal itching; ear and sinus congestion; headache- particular in the facial area; a tickly or scratchy sensation in the throat; itchy ear canals; hoarse voice; and itchy skin and/or hives.

Fever is NOT a typical symptom, despite the term “hay fever” used to describe seasonal allergies.

PREVENTION: the best way to avoid allergies is to avoid or remove the offending substance.
1. For pollen-keep windows shut and use the air conditioner. Shower immediately upon coming inside from the outdoors. Use a nasal saline rinse to wash pollen out of the nasal passages, and saline eye wash to clear pollen out of the eyes. Individual packets of eye saline can be purchased over-the-counter to carry with you to outdoor events.
2. For dust and dust mites- purchase plastic mattress and pillow covers for beds/pillows (available at most home goods stores.) WET dust in rooms. Wash bedding regularly, and limit stuffed animals and other dust catchers in the bed area. Remove old or thick carpeting, and vacuum remaining flooring regularly. For severe cases, consider a room HEPA filter- a machine that can filter out small particles of dust.
ANTIHISTAMINES: these products combat the irritating effects of histamine, a chemical released by the body when reacting to allergens. There are many over-the-counter products available for use. Chlorpheniramine and Benadryl work well for allergy, but are short-acting and may cause drowsiness.
Loratadine (Claritin), cetirizine (Zyrtec), Xyzal and fexofenadine (Allegra) are longer acting antihistamines available over the counter that are less sedating and work for 24 hours. They are available in liquid, dissolving tablet, chewable and pill forms. If they do make your child sleepy, try dosing at bedtime. Store brands work as well at half the price.
These products work best IN ANTICIPATION of allergic triggers- once symptoms have begun, histamine has already been released in the body and your child may not fully respond to the anti-histamine. They should be used daily during allergy season for peak effectiveness, but can be used on an as-needed basis for specific exposures (i.e. exposure to a cat.)
Claritin-D and Zyrtec-D are antihistamines paired with pseudoephedrine (Sudafed), a decongestant that helps shrink congested blood vessels in the nose.
For EYE symptoms you can purchase over-the-counter Pataday or Zaditor (use these first), anti-histamine eye drops that also contains an ingredient to prevent histamine release. If you cannot easily find these, try Naphcon or Opcon anti-histamine eye drops.
If the over-the-counter products are not working for your child, or have significant side effects, schedule a visit for an evaluation with your pediatrician. Underlying issues such as sinus infections can be treated, and prescription medications or eye drops can be tried.

STEROID nasal sprays:
Both Flonase/Fluticasone (generic) and Nasacort are very effect intranasal steroid sprays that are available over the counter for kids and adults. They are one of the most effective treatments for allergic rhinitis, but must be used consistently for best effect.
To use a nasal spray properly, first lean forward (nose towards the toes). Use the left hand to spray the right nostril, and the right hand to spray the left nostril. Then place the nozzle in the nostril, aiming for the eye on the same side to avoid spraying the septum (middle part of the nose that can develop bleeding.)
Take a look HERE for a great video demonstrating proper nasal spray technique.
SINGULAIR:

Singulair is a non-steroidal anti-inflammatory medication that blocks leukotrienes, chemicals that cause inflammation. Singulair is taken as granules (sprinkled in food), pills or chewables, and is effective for both asthma and allergy symptoms. This medication should be taken daily throughout the allergy season for peak effectiveness.
This medication does not cause drowsiness or jitteriness, and is typically well-tolerated by children ages 1 and older (rarely it can cause some behavioral disturbances.)

ANTIHISTAMINE nasal sprays:
Over the counter decongestant sprays such as Neosynephrine and Afrin cannot be used frequently, due to the risk of “rebound” (or worsened symptoms) when discontinued.
Prescription antihistamine sprays such as Astepro and Patanase (both over the counter) and astelin (prescription) can be used chronically without risk. They can be particularly helpful in relieving congestion due to cold symptoms and cold weather induced rhinitis, in addition to allergies.

ALLERGY eye drops:
Many eye drops are now available over the counter. Start with Pataday or Zaditor (of their generic equivalents.) If these are not available, you can also try Opcon or Naphcon-A, though they are dosed more frequently. If these do not help (in addition to an oral antihistamine) make an appointment to see us.
Make sure when coming in from outside you flush eyes with a saline solution, along with washing faces (and hair) if there is a lot of pollen outside.

The “Stomach Bug” is cursing many households right now.  Here is our website article on how to manage vomiting and diarrhea symptoms, and directions on when to seek care.

Here is some great information from Immunologic (immunologic@substack.com) about this nasty infection:

Noroviruses are the most common cause of acute gastroenteritis (inflammation of the Gl tract). Norovirus outbreaks can occur throughout the year, but are most common during winter: which means, right now! Currently, norovirus test positivity rates are between 12 and 13%, with case rates especially high in the northeast. This is not quite as high as the rates this time last year, which peaked at around 15%.

While sometimes called “stomach flu”, norovirus is not remotely related to influenza viruses. Noroviruses are in the calicivirus family, which are non-enveloped viruses. Non-enveloped, or naked viruses like noroviruses tend to be more virulent than enveloped viruses. This is because they are more resistant to the elements and can withstand heat, humidity changes, and many disinfectants.

Most hand sanitizers are ineffective at inactivating non-enveloped viruses like noroviruses

Alcohol-based hand sanitizers work to inactivate viruses by a few mechanisms, based on the active ingredient: either ethanol or isopropanol (2 different alcohols).

Most commercial hand sanitizers range between 40-80% alcohol content. For effective inactivation of norovirus (and other non-enveloped viruses), you need 95% ethanol. As such, hand washing with soap and water is the preferred method for proper hygiene among the general public, especially if you’ve been in contact with fecal matter.

Detergents in soap form micelles (think of these like little fat cages) around pathogens which trap them and allow them to be washed away when rinsing with water.

What about cleaning surfaces?

Don’t panic – there are some chemicals that are effective for disinfecting surfaces that may be contaminated with norovirus:

Bleach (Sodium Hypochlorite): Bleach is your number one option and is the most effective disinfectants against norovirus. Bleach works by denaturing proteins and disrupting viral RNA, much more effectively than alcohol. A solution containing 5-25 tablespoons of household bleach per gallon of water is recommended. The exact concentration may vary based on the surface and situation.

Other options if bleach isn’t available:

1.    Hydrogen Peroxide: Hydrogen peroxide at a concentration of at least 3% can be effective against norovirus. It acts as an oxidizing agent, damaging essential components of the virus.

2.    Quaternary Ammonium Compounds: Also known as “quats,” these compounds can be found in household cleaning products and some types of disinfectant wipes. They can be effective against norovirus but often need to be used at higher concentrations. (Note: this includes benzalkonium chloride, which is not as effective as bleach and requires longer contact time and higher concentration).

3.    Alcohols at Higher Concentrations: While regular alcohol-based hand sanitizers are not very effective against norovirus, higher concentrations of alcohol in certain disinfectants (95%) can have some efficacy. However, their use is more limited compared to other options like bleach.

If you aren’t sure what you have is effective, check the EPA list of antimicrobials for norovirus.

Norovirus is also extremely contagious.

Someone can get infected after being exposed to fewer than 20 viral particles. That’s why it spreads phenomenally easily through person-to-person contact, fecal-oral, contaminated surfaces, and food/water sources (such as shellfish harvested from contaminated areas.)

Another fun tidbit: you can shed virus in your stool for several weeks after symptoms disappear, and since it spreads so easily and the virus is so stable, it means that infections can rage in communities.

Illness caused by norovirus is fast and furious

Symptoms develop between 12 and 48 hours after exposure and are typically violent. They include nausea, acute-onset vomiting, watery, non-bloody diarrhea, and abdominal cramps. Fatigue, muscle aches, headache, and fever can also be present.

Now, for all you reading and thinking, jeez, what next?! There is some good news. Illness for most is usually mild, & symptoms last 1-3 days. However, norovirus can be particularly serious for young children and older adults.

How can you protect yourself and others if someone at home has norovirus?

Unfortunately, there is no vaccine for norovirus and treatment involves supportive care. But if someone at home has norovirus, it isn’t a guarantee that everyone else will get it. You can take steps to reduce the risk.

Hand hygiene, especially in any common areas and particularly in the bathroom and kitchen spaces. Soap and water is king here. This is especially important after using the toilet, after changing diapers (if applicable), and before eating, preparing, or handling food.

Food hygiene is essential. It goes without saying the sick individual should not be touching common food or prepping food for others in the house, and, if possible, should not be in the vicinity when food is being prepared. You should also not prepare foods for up to 3 days after your symptoms subside. However, additional measures can also be taken. Thoroughly wash fruits and vegetables before preparing and eating them, especially if eaten raw. Ensure seafood is washed and cooked thoroughly: norovirus can survive “searing” and quick “steaming” and temperatures up to 140F. Any foods that are potentially contaminated from the sick individual should be discarded. You can also consider wearing clean gloves while handling food or interacting with a sick individual.

Disinfect surfaces immediately. Any surfaces which have been in contact with vomit or fecal matter should be disinfected as soon as possible. Use a chlorine bleach solution with a concentration of 1000–5000 ppm (5–25 tablespoons of household bleach [5.25%] per gallon of water).

Thorough and prompt laundry. Anything: clothing, linens, etc., that may be contaminated should be washed. Minimize disturbance of potentially contaminated fabrics (remember: 20 viral particles can infect someone), wear gloves while handling and wash hands thoroughly after touching. Wash items in the washing machine with the highest cycle length and machine dry (for additional heat sterilization) afterward.

Caring for the sick individual. If the individual is actively vomiting, having diarrhea, and may not have the best hygiene for whatever reason, you can consider wearing a high quality mask around the house when you are in contact with them. This will reduce the likelihood of particles floating around that may contain virus. You can also consider wearing gloves if providing care for them, and always make sure to wash your hands extra thoroughly after interacting with them. You may also consider changing out of clothing you wore when in contact with them so you aren’t potentially carrying viral particles elsewhere around the house or out of the house.