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My Cool Trick To Seeing A Kid’s Throat

Everybody hates having the dreaded tongue depressor down their throat when the doctor is trying to take a look. I have kids flinch and cry at the mere sight of the stick. I have a great trick for being able to see the back of your child’s throat without having to use the tongue depressor. It works for children 2-2 ½ or older (the child needs to be able to follow instructions).

Steps for seeing in the throat:

  1. Have the child sit at your eye level.
  2. Be ready with a light to shine in the mouth.
  3. Have your child stick out his or her tongue (as far out as it will go and aimed downward).
  4. Have your child “pant like a puppy” (with the tongue hanging out). I typically will demonstrate the move for the child.

The maneuver will lift the uvula (in the back of the throat), get the tongue out of the way, and distract the child from the real reason you are doing this “fun thing.” It works like a charm. If your child is a patient of mine, then you’ve already done it. If you’ve never been in my office, share the trick with your pediatrician; it’s gold.

The Sore Throat Going Around: Coxsackievirus

This miserable little summer bug is making an early debut in the spring this year (at least in our neck of the woods). I’ve seen a few cases each day for the last week or two, clearly indicating to me that it is now “going around.”

Coxsackievirus (group A subtype) is the virus that causes (among other things) “Hand, Foot, and Mouth disease,” as well as “Herpangina.” The difference between the two is essentially where the infection is. The first is, as the name implies, on the hands, feet, and in the mouth; herpangina is only in the mouth. It is characterized by little sores (that kind of look like canker sores) all on the back of the throat. As you might imagine, it causes a wicked sore throat.  The other symptoms are sort of non-specific.

Coxsackievirus Symptoms

Can include some or all of the following:

  1. Painful throat (with ulcerative sores on the back of the throat)
  2. Decreased appetite
  3. Sores on hands and feet which look like little blisters when they start (a newer strain is causing sores to extend up legs and sometimes onto buttocks)
  4. Fever
  5. Generally feeling crummy (called malaise)
  6. Headache
  7. Joint pains
  8. Muscle aches

How Coxsackievirus is passed?

The virus is very easily spread from person to person. Essentially everything in the infected person is swimming with virus (the snot, spit, fluid in blisters, and feces). Contact with any of the infected fluids (breathing in someone’s cough, touching an infected surface and then touching your face, etc.) will spread it. The infected person is most contagious (there are more viral particles being replicated) early on in the illness. The bug typically lasts a week.

Who gets Coxsackievirus?

Generally, hand, foot, and mouth disease is considered a disease of the very young (think early school-aged kids and younger). While it can happen at any age, it usually happens in toddler and preschool-aged kids. Adults don’t usually get it because they had it when they were younger and the body has created protective antibodies. With that said, I’ve had plenty of patients who have had it more than once though. It’s unclear if that is because the body didn’t mount a lasting response, the virus has mutated, or it’s a different strain altogether.

Coxsackievirus Treatment

Unfortunately, there isn’t a cure. Because it is a virus, an antibiotic won’t do any good (it can actually make things worse due to antibiotic resistance). There isn’t a vaccine. Treatment is all supportive. The treatment is to manage pain (sometimes docs will prescribe oral rinses/mouth washes or numbing suckers) and keep the patient hydrated. As for over-the-counter pain management, I think ibuprofen (Motrin) works better than acetaminophen (Tylenol) for this particular bug because there is an anti-inflammatory effect with the ibuprofen which can really help the inflamed throat.

Coxsackievirus Complications

While there can be serious complications like meningitis and myocarditis (a heart problem), the virus is usually self-limited and resolves on its own without complications. If a child ends up in the hospital or ER, it is usually because the child wouldn’t drink due to the severe sore throat and consequently ended up getting dehydrated. So watch to make sure your child is getting enough to drink and is still peeing.

Hopefully, you can manage to escape this particular bug. But if you don’t, you now know what to look for and how to manage it (and could potentially save yourself a trip to the doctor).

Rhinovirus – The Bug That’s Going Around

Rhinovirus seems to be the virus de jour in the last few weeks. In medicine, we often don’t go to the effort to do specific viral testing on kids who appear to have “just a cold.” The test is painful (a swab up the nose), is expensive (hundreds of dollars), and takes time and effort. If there was a cure, it would probably be worth doing more often. However, there are still plenty of reasons to test (e.g., a child who isn’t getting better, a child with an underlying immune problem, a newborn with fever). In the last few weeks, most of the kids we have tested for one reason or another have been positive for rhinovirus. So it is definitely going around.

What is rhinovirus and do I need to stress about it?

Rhinovirus is the most common viral infection in humans. It is the predominant cause of the “common cold,” although there are other viruses that cause colds. It typically infects the upper respiratory system. Random trivia: “rhino” comes from the Greek word meaning nose, so I always think of it as the bug that causes all your crummy runny/stuffy nose symptoms. Rhinovirus is the most common in the fall and spring.

Rhinovirus Signs and Symptoms

  1. Runny or stuffy nose
  2. Cough
  3. Sore throat
  4. Fever
  5. Headache
  6. Decreased appetite
  7. Muscle and body aches (can happen, but are atypical).

Rhinovirus Incubation

Everyone always wants to know where they got a bug (secretly we want to shake our fist and curse the person who possibly gave us the bug). Knowing the incubation period (the time it takes from exposure to showing signs of illness) will help in your detective work. The typical incubation period is 2 days. There have been reports of as short as 20 hours and as long as 4 days, but usually 2 days. The bug is passed via respiratory droplets (people coughing/sneezing around you) and from direct contact or touching (e.g., an infected child wipes his/her nose with his hand, touches a toy, then your child plays with the infected toy and later touches his/her own face).

Rhinovirus Treatment

In case you haven’t heard, there is no cure for the common cold. I’m working on it, but failing miserably. For now, treatment is all symptomatic. (See my article DECODING COUGH AND COLD MEDICATIONS for specifics.) As a quick reminder, rhinovirus is a virus and an antibiotic won’t help (since antibiotics only treat bacteria). So unless there is a complication (e.g., pneumonia, an ear infection), your doctor shouldn’t prescribe an antibiotic. In general:

  1. Treat fever, sore throat, and/or body aches with Tylenol (if over 2 months) or Motrin (if over 6 months)
  2. Run a humidifier
  3. Keep the nose as clear as possible
  4. Try OTC meds (depending on age of child and symptoms)
  5. Encourage fluids
  6. Rest
  7. Let time pass

Colds tend to go away on their own, so be patient. Rhinovirus typically lasts 7-10 days. Complications can happen (e.g., pneumonia, ear infections), but are uncommon. Complications tend to happen in children who are compromised in some way (e.g., have weakened immune systems, asthma). FYI, there is not a vaccine to prevent rhinovirus.

Rhinovirus Prevention:

  1. Wash your hands often
  2. Don’t touch your face (the virus enters through the mouth, nose, and eyes)
  3. Steer clear of sick people (if one of your children is sick, try to keep them away from the others as much as possible)
  4. Disinfect infected surfaces
  5. Improve your immune function (eat healthy, exercise, and sleep well)

Call your doctor if (because I’m worried about developing complications)

  1. Your sick child is under 2 months old (just about any bug under 2 months should be seen by a doc)
  2. The fever goes beyond 5 days or reoccurs (e.g., has been gone for 3 days and starts again)
  3. Any one of the symptoms is getting significantly worse when it should be getting better (e.g., after a week of coughing it should be gradually improving not getting worse)
  4. Your child is disproportionately symptomatic or miserable (e.g., a child shouldn’t cry inconsolably for hours with the common cold)
  5. Your child is having trouble breathing

Rhinovirus isn’t fun, but also isn’t the worst virus out there. If you or your child falls victim, take heart. It too shall pass.

Is My Sore Throat Strep?

Strep throat is one of the most common infections seen in a pediatrician’s office. With all the viruses that cause sore throats, the challenge for parents is to know which sore throats to take in for testing. I’m going to endeavor to help you decipher when to go into the office and when to stay home. There are a couple simple differences.

  1. Viral sore throats usually have many other associated respiratory symptoms, like cough and runny nose.
  2. Strep sore throats have limited other symptoms (headache, and/or stomachache).
  3. Both can cause red, sore throats +/- white patches, painful swallowing, swollen lymph nodes (bumps in the neck), and/or fever.

So why is it so important to know if it’s actually strep? Strep throat is caused by a bacteria Streptococcus pyogenes (a.k.a. group A streptococcus). Because it’s caused by a bacteria, it needs to be treated with an antibiotic. While it is technically possible that one’s body could clear the illness on its own, most people will require treatment. First line treatment is with Penicillin (most docs prescribe Amoxicillin, a derivative of penicillin, because it is convenient to dose and generally well tolerated). Treatment decreases the risk of serious complications including Scarlet fever—prominent rash, poststreptococcal glomerularnephritis (kidney inflammation), or Rheumatic fever (affecting the heart and joints).

Strep throat is highly contagious. It is spread through respiratory droplets in the air. This happens when the infected person coughs or sneezes, touches and contaminates surfaces, or shares food or drinks. If you’re still reading, here’s a piece of strep trivia that no one knows. The reason docs make you swab every symptomatic person in a household instead of just treating everyone is due to rates of transmission. The transmission rate in a household is 25%. Now I know, you would think that if one of your kids has strep and a second gets a sore throat the risk of it being strep would be like 95%, but it simply isn’t the case. The risk is 25% (way higher than the general population, but not nearly as high as one would think).

So don’t get mad at your doc if she insists on testing every one of your sick children before treating. She is just trying to be responsible about antibiotic prescribing and not expose your child unnecessarily to antibiotics and increase your child’s risk of antibiotic resistance.

-Photos courtesy of