Saugatuck Pediatrics
191 Post Road West, Suite 201
Westport, CT 06880
We are located in the Connecticut Children’s Medical Center building, off the street and behind Schulhof Animal Hospital.
Phone
203-793-4747
Email
office@saugpeds.com
Fax
877-809-0848
Billing
978-208-5361 | biller@saugpeds.com
Patient Portal
Non-urgent medical or administrative messages can be sent through our patient portal. We will respond within 2-3 business days.
Sick visit requests may also be made through the portal on weekdays only.
Office Hours
Monday - Friday
8:30 am - 12:00 pm
1:30 pm - 5:00 pm
Weekends/Holidays
We offer urgent visits in the mornings only. Please call the office by 10 am for an appointment.
After-Hours Care
If your child’s illness or injury is life-threatening, please call 911.
For urgent after hours concerns, call our office. Our clinicians are on call 24/7.
Poison Control Hotline
800-222-1222
Insect Bites and Stings
April 18, 2024
We are starting to see a lot of insect bites on our delicious patients. Here is some information on how to evaluate and treat a bite or sting.
We cannot usually distinguish between an insect, spider or tick bite without seeing the actual offender in action. However, these bites are all initially treated in the same way (providing symptomatic relief.)
Mosquito bites start as puffy, white bumps that appear a few minutes after the bite. The bumps usually swell and turn redder, itchier over 24-48 hours, and can sometimes become quite large. Occasionally there will be a small blister in the center. As the swelling goes down, the area may look like a ringed lyme rash, but the size does not increase as a lyme rash would.
Occasionally a mosquito bite causes a large area of swelling, soreness and redness that can last several days. This type of reaction is called “skeeter syndrome”. Using an antihistamine such as Zyrtec or Allegra for several days will help.
Tick bites are less likely to cause initial inflammation and redness, and are only an issue if followed (3-30 days later) by a steadily expanding, ringed, pain/itch free, flat rash that is present for at least several days (or an acute, febrile, flu like illness.) If you are worried about a possible lyme rash, take a photo daily and come in if the area is increasing in size over several days. If you think the tick has been in place for more than 24-36 hrs, and appears engorged, make an appointment for an evaluation and possible preventative antibiotic treatment (bring the tick with you if possible.)
Bee and Wasp stings can cause similar reactions as mosquito bites, and the area may look worse 24-48 hours after the sting. A bee sting feels similar to a wasp sting, but the sting and a venomous sac will be left in the wound. You should remove this immediately by scraping it out using something with a hard edge, such as a bank card. Don’t pinch the sting out with your fingers or tweezers because you may spread the venom.
Black Fly bites are common in the northeast from April to July, especially in wet areas. These flies secrete an anticoagulant (blood thinner) into the skin, which both numbs the area and causes bleeding. The bites often look like blood blisters, and tend to be around the neck and ears, or by the ankles. Localized swelling and itch can last as long as several weeks.
Spider Bites: THESE ARE VERY UNCOMMON IN CONNECTICUT!
The brown recluse is most commonly found in the South and is not native to any of the New England States. Brown recluse spider bites within 4 hours develop a “bull’s-eye” appearance, forming a blister in some cases. This blister may rupture in 8 to 36 hours, creating an ulcer or brown/black scabbed center. There is no special treatment or medication used to treat a brown recluse spider bite. If infection develops it is treated with antibiotics.
Black Widows may be found throughout New England, but true black widow spider sightings or bites are very uncommon. Very often, no serious symptoms develop. Occasionally, after 20 to 40 minutes the patient may develop a dull ache or numbing sensation near the bite site. Pain progresses and spreads to the abdomen (stomach cramps), back, and extremities. If muscle cramps develop or pain is severe, go to the nearest hospital for treatment of the symptoms.
Treatment:
When the reaction is mild, the majority of bites and stings can be treated at home. Wash the affected area with soap and water, and apply an ice pack to reduce pain and swelling. Topical anti-itch creams (Cortaid, Benadryl, or Calamine), oral pain relievers (acetaminophen or ibuprofen) and antihistamines (Benadryl, Zyrtec, or Allegra) may be used to control itch and swelling.
Benadryl, ibuprofen and acetaminophen dosages by weight can be found on the website https://saugatuckpeds.com/resource/medication-dosage-calculator/
If, after a few days, the bite develops a golden crust or scab, with some flaking and/or oozing, it may be infected. Please schedule an appointment if your child’s bites look suspicious.
Photos of various stings and bites can be found here
For more information on tick bites, click here.
For more information on bug repellents, click here.
A (near) Total Eclipse of the Sun….
April 5, 2024
We will be experiencing a partial (approximately 90%) solar eclipse on Monday, April 8th 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 Allergies
March 14, 2024
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
February 27, 2024
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.
Fever
February 4, 2024
Fever: A Quick Guide For Parents
Adapted from a post by Natasha Burgert, MD
One of the most common reasons parents are calling or coming to the office is FEVER. Fever can make a kid look and feel lousy, which is not fun for a parent to watch.
First, A Few Fever Facts
A fever is a temporary rise in body temperature due to illness. Most consider a fever to be 100.4F degrees or higher (regardless of your child’s “usual temperature”).
Fever is a symptom of illness, not a disease. With very specific exceptions, fever is a normal, healthy way for the body to fight common infections. Bacteria and viruses that attack our bodies love normal body temperature, but cannot successfully replicate in hotter conditions. Fever reflects a robust immune system’s defense against these pathogenic attackers. The bacteria and viruses are the enemy, not the fever they cause.
It’s not your imagination – Fevers are worse at night. Our body systems follow a circadian rhythm. During the day, our level of cortisol (a stress hormone) is typically higher, slightly suppressing the work of the infection-fighting cells in our blood. At night, when cortisol levels drop, the immune system ramps up. When our immune system is working harder, higher fevers and more symptoms of illness can result.
Top 10 Fever FAQs
1. What is the best way to take a child’s temperature?
For healthy babies under two months of age, it’s okay to use an armpit thermometer to quickly screen for a fever. A simple digital thermometer will work. If a baby’s armpit temp is 99F degrees or higher, then a rectal temperature must be done to confirm your baby’s temperature. (Here’s a how-to video from Mount Sinai.) If the rectal temperature is 100.4F degrees or higher, call your pediatrician immediately or go to your nearest emergency room.
2. Is it true that the higher the fever, the more I should worry?
Although a high fever may indicate more serious illness in an adult, this is not the case for young kids. A young child’s immune system is always on high alert, and any sign of illness can result in a significant immune response.
Regardless of the actual numerical value, look for signs of serious illness in your child. Some kids appear fairly normal with really high temperatures, while others are sluggish and sad with a reasonably mild fever. Observe the amount of discomfort, level of activity and ability to maintain adequate hydration. Those symptoms are more important than the number itself.
3. When do I take my child to the doctor for a fever?
Over two months of age, most fever can be safely treated at home with fever reducing medication, hydration and patience. The fever caused by most viral illnesses of childhood are typically seen at the beginning of an illness, associated with other symptoms and last about 72 hours. But, there are few instances when pediatricians definitely want to see your child with fever.
It’s time to go to the doctor when:
A pediatrician’s job is to examine kids when parents are concerned. If you are worried, please portal us. We are here to help you determine when you need to bring them in.
4. What “number” on the thermometer means an ER visit?
Over the age of two months, there is no number on a thermometer that requires a trip to the emergency department. Nope, not even 105F degrees.
It’s never wrong to seek help when you’re worried about your child, but no one wants to sit in the ER needlessly for hours. If your child gets a high temp, grab the fever reducer (see FAQ #6) and try to lower the fever at home before jumping in the car.
Pediatricians are always going to be more worried about fever for multiple days in a row (more than five) than a kiddo with a brief 105F temperature. And, we are going to be more worried about a kid who is too sleepy, not drinking or in pain — no matter the number on the thermometer.
If there has been NO change in your child’s temperature after an hour of offering a weight-based dose of medication, reach out to us for advice. (*note that high fevers may not come down fully to normal range, especially at night- if a high fever comes down a few degrees, enough that your child is more comfortable and able to sleep, there is no need to worry. If, after an hour there has been no change in the temperature you can give a different fever reducer- i.e. acetaminophen if ibuprofen was given, and vice versa)
5. Isn’t it true that fever helps the body fight infection, so we shouldn’t use fever reducer?
The goal of offering fever reducing medication is NOT to get a high temperature back to “normal.” Fever reducers, like acetaminophen and ibuprofen, are simply medications to make your child feel better and might decrease the risk of dehydration.
As an aside, if you are coming to the pediatrician’s office because your child has a fever and her or she is uncomfortable, please give your child a fever reducing medication BEFORE coming to the office. The doctor doesn’t have to “see the fever.” We believe you. Plus, a comfortable child is much easier to examine. And a good exam will often determine the cause of the fever, allowing for accurate treatment.
6. What’s the difference between ibuprofen and acetaminophen? Which one should I use?
Fever reducers do NOT treat infection or cure a fever. The goal of these medications is to simply make your child feel better.
Acetaminphen (Tylenol) helps with pain and fever. This medication may be given to infants over the age of two months, sooner if approved by your healthcare provider. It comes in liquid, chewable, pill and rectal versions (Feverall). Acetaminophen is effective for 4-6 hours, and should not be used more than 5 times in a 24 hour period.
Ibuprofen (Advil, Motrin) helps pain, fever and swelling. Ibuprofen can be given to infants over the age of six months and is taken by mouth. Ibuprofen is effective for 6-8 hours.
Medications should be dosed according to your child’s weight, not age. If you feel that your child needs medication, give the correct dose. Weight based dosing charts are available on our website at www.saugatuckpeds.com. Learn more about safely using these meds in FAQ #7.
Fever reducer tips:
7. Acetaminophen can hurt the liver, so isn’t giving ibuprofen a safer choice?
Generally speaking, fever reducing medications are considered safe if administered properly (correct age, dose, dosage device, and frequency). However, when any medication is not taken properly, intentionally or unintentionally, kids can get hurt.
Tips to decrease the risk of using medications:
8. When my child gets a fever, I heard it’s best to alternate acetaminophen and ibuprofen. Is this true?
Although the results of a few studies have suggested fever reduction was slightly betterwhen using both medications, the risk of making a mistake while alternating fever reducers is higher than the increased relief your child may experience by using this method.
However, if your child’s fever is not coming down to a level of comfort with one medication alone, both may be used. If you choose to alternate, medication can be given every three hours. For example, acetaminophen at noon, ibuprofen at 3 pm, acetaminophen at 6 pm, etc. Make a chart to mark down the time each medication was given, and share it with all caregivers. Again, alternating two fever reducers is not needed for most illnesses.
9. Isn’t it true that a high fever causes brain damage?
Fever does not cause brain damage. Period. Full stop. Every normal brain has a internal thermostat that will prevent a person’s temperature from getting high enough to cause brain damage.
Organ damage can occur when an external factor is affecting our temperature regulation system. For example, when an individual is not able to cool oneself (as in a closed car on a summer day) or in the case of rare brain injury that has resulted in damage to the internal thermostat. A healthy child with fever is not at risk of organ damage.
10. What about febrile seizures? Don’t I have to treat fevers to prevent them?
Febrile seizures are scary to watch and terrifying for parents. But despite popular opinion, aggressive fever control does NOT prevent febrile seizures from occurring.
The cause of febrile seizure is thought to be due to a combination of genetic and environmental factors, and are the result of a developing brain’s reaction to fever. Fever reducing medications do not prevent febrile seizures from occurring. Rather, the risk of febrile seizures are associated with a child’s age at the first event and a history of family members who also had these events.
Simple febrile seizures most commonly happen in young children between 12-18 months of age. These events last for a few minutes, resolve on their own and rarely cause long-term health problems. Children grow out of these events as their brain matures, typically by elementary school.
If your child is having a unexplained or first-time seizure, call 911 for help.