November 2013

By Dr. Sri Narayanan, MD

It’s autumn. The weather is getting cooler, the leaves are changing colors and here at Children’s of Alabama, the gloves and gowns are on for bronchiolitis season.

Bronchiolitis is a viral respiratory illness that affects children under two years of age, most often between November and February. Viruses such as Respiratory Syncytial Virus (RSV) and influenza are the most common causes and full healing could take two weeks or more. The symptoms of bronchiolitis usually follow this timeline:

• Days 1-3: coughing and nasal congestion with low-grade fevers
• Days 4-7: wheezing, difficulty breathing and sometimes poor feeding or vomiting from thick nasal congestion and persistent coughing
• Days 8-14 (sometimes longer): gradual recovery with slowly improving cough and wheezing

If you suspect your child has bronchiolitis, focus on consuming fluids and nasal suctioning. Our suctioning tip: use a couple of saline drops in each nostril followed by bulb suctioning, up to 3 times a day if nasal congestion is severe. This will temporarily clear nasal passages, giving you the opportunity to feed your child and for them to get some much needed sleep. Your child may not want to drink as much as usual, but an ounce or two of Pedialyte every one to two hours can take care of hydration in the short-term.

Despite our best efforts, some children with bronchiolitis require urgent medical care and even hospitalization. Seek medical attention if your child is:

• breathing rapidly (count for 15 seconds – if you count more than 15 breaths, this is a cause for concern),
• breathing with increased effort, especially pulling in under the ribcage or neck,
• not making enough wet diapers (at least one every 6 hours),
• turning blue around the mouth or lips or
• is under two months of age and has a fever (rectal temperature over 100.4 degrees F).

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By Kari Kampakis

As parents, we’re wired to protect our children. We protect their bodies and hearts with vigilance, but what about their brains? How vigilantly do we guard those?

This question is particularly relevant in regards to concussions – a hot topic in sports today, thanks to strides made in research and awareness. Because the brain doesn’t fully develop until early adulthood, a concussion in a child or teen may have long-term effects on cognitive development if not handled correctly.

In the majority of concussions, recovery may take up to two weeks (one week for symptoms to resolve, another week to meet return-to-play guidelines). It’s important that parents understand this and not get aggressive in returning their kids to play, because an inadequate recovery time may make the athlete more susceptible to another concussion or even more severe brain injury.

Recent research suggests that multiple concussions may increase a person’s likelihood of developing chronic traumatic encephalopathy. Chronic traumatic encephalopathy is a degenerative brain disease that can cause memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and suicidal thoughts.

According to Drew Ferguson, MEd, ATC, Director of UAB Sports Medicine, the protocol for concussions has changed vastly as information about the brain has come to light. Ten years ago, a player suffering a head injury may have been sent back into the game if he could answer simple questions. Today, Alabama state law mandates that any player showing signs or symptoms of a concussion be taken out and not play again until a physician evaluates the athlete and clears them for return to play.

“Concussion used to be defined as loss of consciousness, but research shows that’s not the case,” Ferguson says. “A lot of physiological damage is done to the brain where there’s a head injury. In some cases, you won’t fully know the symptoms until 24 to 48 hours later.”

As part of a multidisciplinary effort involving Sports Medicine, Neurosurgery and Emergency Medicine, Ferguson helped establish the Concussion Clinic at Children’s of Alabama, which provides evaluation, treatment and medical clearance for youth and teenage athletes to return to play. One thing always emphasized after a concussion is mental rest. While “mental rest” may include being held out of school for a week, it also means no texting, video games, loud sounds, or other mental stimulation. Continue Reading

By Scott James, MD

Flu season is here. Ho hum. No big deal, right? Been there done that, didn’t even have to take the Tamiflu.

Well even if you think you know all there is to know about this respiratory villain, hang with me for a few minutes on this quick tour through the wide world of influenza. As a community, we owe it to each other to stay informed about key public health issues, and the yearly influenza epidemic is certainly one of those issues.

That’s right, I said epidemic. Did you know that each “flu season” is technically a regularly occurring epidemic? Influenza viruses continue to circulate at very low levels throughout the year, with infection rates spiking every fall and winter, usually peaking in February.

It’s important to remember that even though many of us consider flu to be old hat, it can be a severe illness and can be associated with serious complications, most notably pneumonia or worsening of an underlying illness such as asthma or congestive heart failure. Certain groups of people are at higher risk for severe influenza infections, including young children, adults older than age 65, pregnant women, and obese persons. Each year more than 200,000 people are hospitalized for influenza related illnesses in the United States alone. And while each season varies in severity, an average of 36,000 people in the US die each year from influenza or its complications – 36,000! While we can be thankful that most of us who get the flu will recover fully, we need to be careful not to take that for granted, thereby dismissing the real impact that influenza can have on a community.

The good news is that there are some proven things that we can do to curb the severity of flu season. A lot of it is just common sense:
• practice good hand hygiene and good cough etiquette (my kids continue to vigorously boycott these methods)
• avoid close contact with those who are sick
• stay home yourself if you are sick

Even with all of these excellent and necessary preventative measures, the single most effective way to prevent seasonal influenza infection is to get your flu vaccine every year. Everyone who is at least 6 months old should get the flu vaccine. Continue Reading