Stay Away, I have “Pink Eye”

Blog contributed by Kathleen
Zimmerman, MD, Pediatrician

Why do we cringe when we see someone with a red eye? Perhaps it’s because it looks painful and our eyes water just looking at it.  But another reason is we are afraid of it spreading to us!  Pink eye, or conjunctivitis (the medical term), is extremely contagious and epidemics occur easily in daycares, school and work settings and even sports teams.

Conjunctivitis is inflammation of the lining of the eye.  This lining has a lot of blood vessels – when the inflammation occurs, the blood vessels get bigger and this gives the eye a red or “pink” appearance.

What causes conjunctivitis and how can we prevent it?  Sometimes the cause is not contagious, such as allergies to pollens or pets.  Other times it is from irritation from chemicals or something in the eye like contact lenses.  But the most common causes are viruses and bacteria. These ARE contagious and easily spread through the hands rubbing the eye.  Because the eye is inflamed, it itches and also produces a lot of watery or sticky discharge.  We rub our eyes and the bacteria or virus is then on our hands.  Anything we touch (doorknobs, toys) is then touched by someone else – if this person touches their eye then they will likely get pink eye in a few days. 

The best prevention for pink eye is hand washing.  Also, do not rub your eye with your hand – use a disposable tissue.  If you have pink eye you should avoid close contact with other people until it’s  cleared up or until you’ve been on antibiotic drops for at least 24 hours (if indicated and prescribed by your medical provider).   Antibiotic drops only work if the cause is bacterial.   It is also helpful to wash pillowcases and towels in hot water, throw away contaminated eye makeup, clean eyeglasses, and do not wear contact lenses during treatment. 

Although pink eye is a mild illness most of the time, you should watch for complications.  If your eye does not improve after 24 hours of using medicated drops, you should contact your medical provider. If the eye continues to be red for more than a week, if you have recurrent episodes of pink eye, if your symptoms are worsening, or if you have eye pain, you may need to see an eye specialist immediately.  Although it is not common, permanent damage to the eye and vision loss can occur if a red eye is not treated promptly or appropriately.

Questions? Contact your primary care provider.  If you are looking for a new primary care provider, visit: primary.pinnaclehealth.org.

Why Your Doctor Is Asking You About Guns

Joseph Cincotta, MD

One of the routine questions I ask my patients during an office visit is whether they have guns in their home. Some of my patients find this intrusive and even offensive, and they are not alone. But my goal, and that of other doctors like myself, is not to judge or debate, but to make sure my patients stay safe and healthy.

Whether or not health professionals should be asking about guns in the home has sparked a national debate. Emotions may run high when there is any conversation that is perceived to challenge one’s right to own and keep a gun, and those emotions can block any further conversation about guns and gun safety.  Health care professionals are not challenging anyone’s Constitutional right to own a gun.  Many health professionals own guns themselves and use them for a variety of recreational activities.  Our focus when we discuss this issue is one of safety, not the right of ownership.  According to a report by NBC News, firearms injured 15,576 children in 2010. And because of frightening statistics like this, the American Academy of Pediatrics recommends that pediatricians and other health care professionals counsel patients about gun safety.

When I inquire about guns in the home, it is with the best intentions. I am not calling a parent’s judgment into question, nor am I attempting to interfere with anyone’s right to own guns. But, the fact is that unsecured guns pose a health risk to children. Just as I would counsel parents about car seat safety, I counsel parents about precautions they should take to keep firearms safe.

A few states have enacted laws prohibiting doctors from asking patients about guns in the home. The practice is not prohibited in Pennsylvania, but patients are also not required to disclose whether or not they have guns in the home to their doctor.

For parents or caregivers who have guns in their home, I recommend taking the following precautions:

• Make sure that guns are unloaded and stored in a locked location, preferably out of a child’s reach and sight.
• Store ammunition in a different locked location from the gun, preferably out of a child’s reach and sight.
• Keep keys and combinations hidden from children.
• Do not leave your gun unattended when it is not locked up.
• Use gun locks.
• Do not leave guns, loaded or unloaded, anywhere where a child can access them (nightstand, table, etc.)
• Talk to older children about gun safety. Let them know that they should tell an adult immediately if they find one.
• Talk to your child’s other caregivers about gun safety.

When it comes to gun accidents involving children, there are very few second chances. A high percentage of accidental shootings result in death. Remember, when your doctor asks about guns in the home, they have your family’s best interests in mind.

For more information about gun safety. 

What is Juvenile Arthritis?

Blog contributed by Kathleen
Zimmerman, MD, Pediatrician

It is estimated that about 300,000 children in the U.S. have some form of juvenile arthritis.  Most people have heard of Juvenile Rheumatoid arthritis, or JRA.  But there are other forms of arthritis as well, including Juvenile Idiopathic Arthritis (JIA), which is the most common form in children.

Most forms of Juvenile Arthritis are autoimmune.  This means that the child’s immune system is attacking their healthy cells.  It is thought that this autoimmune attack may be triggered by a virus and in some cases children have a genetic risk if arthritis is in the family.

Arthritis in children can have different symptoms and these symptoms can come and go for long periods of time.  The most common symptom is constant joint swelling, joint pain, and stiffness.  This may be in one joint or in multiple joints.  Some children are limping or clumsy because of the joint pains.  The pain is often worse in the mornings.  Other symptoms may be high fevers or skin rashes that don’t have another cause.   Children may also have eye inflammation and growth problems.

There is not a single test for Juvenile Arthritis.  Your child’s doctor may suspect arthritis if they have the symptoms above and they do not have an explanation (no recent injury or recent illness) and also if the symptoms do not go away on their own.  If your child was suspected to have Juvenile arthritis they would need a thorough exam of the joints as well as bloodwork. Referral to a Rheumatologist (specialist in arthritis) is typically recommended to help with the diagnosis and treatment. 

Juvenile Arthritis is a chronic illness that comes and goes.  During a “flare”, children may need medication to help control their symptoms. Physical therapy is helpful as well.  If the pain is severe or difficult to treat, stronger medications that suppress the immune system are used to calm the symptoms down and allow the child to live a more normal life.  The goal is for the child to remain active and to have long periods of “remission”, where the symptoms are gone for months to years.   Children with juvenile arthritis may also have “silent” problems with the eyes or growth (without symptoms).  Therefore, it is also important to have regular eye exams and checkups even if they have no symptoms. 

Researchers are working on finding causes of Juvenile arthritis and also researching better medications with fewer side effects.  To learn more about Juvenile Arthritis and the most recent science on these diseases you can go the National Institute of Health site: www.niams.nih.gov and the Arthritis Foundation site: www.arthritis.org

Child Abuse Prevention

Blog contributed by Andrea Burks, DO, Heritage Pediatrics, PinnacleHealth Medical Group



April is child abuse prevention month.  In the United States of America there are approximately 3 million reports of child abuse and neglect each year involving 6 million children. 686,000 children were determined to be victims of abuse and neglect in 2012 and of those 1,640 resulted in death. That is greater than 4 child abuse related deaths per day. There are likely many more cases that are not reported. Child abuse and neglect happens at every socioeconomic level, across ethnic and cultural lines, within all regions and levels of education. Boys and girls are maltreated in equal numbers.  Children less than 4 years old are at greatest risk for severe injury and death from abuse. The most common abusers are parents, other family members, or an unmarried partner of a parent. Children who suffer maltreatment are at higher risk for cognitive delays, emotional difficulties, harm to development of nervous and immune systems, and health problems as adults. It is important to recognize, help prevent and report suspected child abuse and neglect because its lasting effects can impact us all. Small acts from everyone in a community can help save a child from harm.

The first step is to recognize child abuse. Child abuse can be physical, emotional, sexual, or involve neglect of a child by someone who has responsibility for the child. It is common for more than one type of abuse to occur at a time. It is important to note a single sign does not mean maltreatment has occurred but if signs appear repeatedly or in combination a closer look at the situation may be warranted.

• Physical abuse involves non accidental physical injury including but not limited to hitting, kicking, biting, burning, choking, shaking, and throwing. It often leaves bruising at different levels of healing, marks on body consistent with objects or hand prints, or unexplained bruises, black eyes, or broken bones. The physically abused child may wear clothing inappropriate for weather (e.g. long sleeves in hot weather to hide bruising). They may also be reluctant to go home or fearful of parents.
• Emotional abuse involves with holding love, support or guidance from a child. Emotional abuse is as strong a predictor of subsequent impairment in child development as physical abuse. Emotional abuse may include ignoring, rejecting, isolating, verbal assault, threatening, blame, belittling, or shaming the child in a persistent chronic pattern. The caregiver may appear unconcerned about the child. The child may show overly compliant or demanding behavior, be extremely passive or aggressive. They may speak of attempting suicide or they may report lack of attachment to parent.
• Sexual Abuse can involve engaging a child in sexual acts, exposing a child to sexual activities, indecent exposure, or exploitation of a child through pornographic material. Effects of sexual abuse extend beyond childhood. These children often have loss of trust and feelings of guilt. The child may show signs of regression such as bedwetting, rocking, head banging, stranger anxiety, withdrawal from family and friends, suddenly refuse to change clothes in gym, or refusal to participate in physical activities. The adults may appear extremely protective and limit contact of the child with other children.
• Neglect is failing to provide the basic needs for a child including food, clothing, shelter, proper hygiene, education, and medical attention. Neglect can also involve abandoning a child or putting a child in unsupervised or dangerous situations. The child may miss a lot of school, beg or steal from classmates or friends, or lack medical/dental care. They may have dirty clothes or clothing inappropriate for weather.

Prevention of child abuse and neglect is a community effort. Individuals in the community can play a role in helping families find the strength to raise safe, healthy, and productive children.  A majority of parents don't want to harm their children. Abusers are more likely to have been abused themselves and don't know other ways to parent. They may suffer from mental or chronic health problems, struggle with substance abuse, and commonly have high stress and lack of support. Parenting is one of the toughest and most important jobs. We all have a stake in ensuring parents have access to the support they need to be successful parents. You can start by getting to know your neighbors. Help a family under stress by offering to give them a break and babysit for a few hours, help run errands, help a parent with a small child get through checkout line at the grocery store, or reach out to children in the community. If a child discloses they are victims of abuse, first believe them, listen, and don't be critical or negative of child or parent. Assure the child they are not to blame and report the incident.

It is the right and responsibility of everyone in the community to report suspected child abuse or neglect. You can make a report by contacting your local child protective service agency or police department. You do not need to have evidence or actual knowledge of abuse to make a report. You should have reasonable cause, heightened concerns, or belief based on observation. Reporters can be anonymous but giving your name may help the investigation. Good Faith Laws protect the reporters from legal liability. Trust your instincts. Reporting your suspicions may protect the child and get help for a family who needs it.

If you are a parent under stress find ways to regain control. Try counting to 10, take deep breaths, call a friend, put your child in a safe place and take a few minutes to calm down and relax. Never be afraid to apologize to your child if you lose your temper and say something in anger that wasn't meant to be said. Reach out to community centers, church, schools, and physicians for guidance on positive parenting skills. It is often helpful to learn good communication skills, appropriate discipline, and how to respond to children's physical, developmental and emotional needs. Understanding appropriate developmental milestones may help you set reasonable expectations for a child. Creating social connections with family, friends and the community gives encouragement and can help improve parent child relationships. There is also concrete community support that assists with food, clothing, housing and access to healthcare.  You can contact you physician for information about these services.

In Pennsylvania report concerns for child abuse and neglect to ChildLine 1-800-932-0313

Strep throat vs. Viral pharyngitis

Blog contributed by Julie A. Lundblad, MSN, CRNP

How do I know if child has strep throat? Medical care providers cannot always tell by looking in the throat. Most offices can run a rapid strep test and the results are just minutes away. 80% of all sore throat office visits are viral, only 20% are from Strep.

Common symptoms of step throat:

• Sudden onset of sore throat
• Pain with swallowing
• Fever >101
• Red, swollen tonsils (sometimes white patches)
• Swollen lymph nodes

Strep can also cause headaches, nausea, vomiting, rash, body aches, or tiny spots on the back of the throat (petechiae)

What is viral pharyngitis? Basically inflammation of the tonsils and back of the throat, with or without a fever. These are caused by viruses and upper respiratory infections.

Common symptoms of viral sore throat:

• Sore throat, dry and scratchy
• Runny nose, sneezing
• Headache
• Cough
• Fatigue
• Low grade fever

Strep throat is contagious, so if there is a known exposure, testing is necessary.  I recommend calling your Primary Care Physician for an appointment to rule out Strep. It is usually easily treated with an antibiotic for 5-10 days. If the sore throat is viral, the treatment is supportive and symptomatic.