It’s cold and flu season again, and with more than 55 flu-related pediatric deaths reported since September by the Centers for Disease Control and Prevention, it’s no surprise that some parents may become concerned with their child’s every sniffle and sneeze. But what’s a parent to do when their kid suddenly develops blisters in the mouth; fluid-filled lesions on a limb; or an inexplicable rash? Each is a symptom of a disease described below, which some parents may have never heard of but really should know, as these illnesses are usually more common in childhood.
Hand, Foot and Mouth Disease
This viral infection is often found in children under 10, though adults with compromised immune systems are vulnerable too. Hand, foot and mouth disease should not be confused with foot-and-mouth disease, which affects animals such as cattle and sheep. People cannot contract the animal disease, and animals cannot catch the human disease.
“As the name implies, affected patients experience sores on their hands, feet, palms, soles and inside their mouths,” says Sean Elliott, professor and associate chair of the department of pediatrics and medical director of infection prevention at the University of Arizona Health Network and College of Medicine. “The mouth lesions typically are ulcerated and very painful, so many patients become dehydrated due to their inability to swallow liquids or food. Patients [may] experience low- to mid-level fevers and malaise, and some also have vomiting and diarrhea.”
Hand, foot and mouth disease is very contagious; the virus can spread through saliva (think tainted toys) and feces (often from a diaper change), and symptoms typically occur three to six days after exposure. The best treatment course is supportive care, “meaning rest, plenty of fluids and antipyretics [drugs that reduce fever],” Elliott says. Seek medical attention if your child stops urinating or is unable to swallow anything due to the pain, Elliott adds.
“Proper hand-washing is essential in helping to prevent the disease from being spread to other children,” says Lisa Lowery, section chief of adolescent medicine at Helen DeVos Children’s Hospital in Grand Rapids, Michigan. Cleaning contaminated surfaces with sanitizers and disinfectants will help, Lowery adds, along with avoiding close contact with infected people. An infected person can still transmit the virus for up to two weeks after he or she no longer has any symptoms.”
Fifth Disease
Fifth disease got its name from a historical classification system that placed it fifth in a list of common childhood rashes. It’s also known as “slapped cheek syndrome,” since the rash can cause a child’s cheeks to become very red. “Anyone can become infected with the [parvovirus B19] virus that causes fifth disease,” Lowery explains, “but the disease is most often recognized in elementary school-aged children.”
Symptoms include a low- to medium-grade fever, runny nose, cough and decreased appetite for several days — not unlike the common cold, Elliott says. The child will then develop bright red spots over the face, particularly the cheeks, which, Elliott adds, may progress to the chest, back and belly and appear like pink lace. Children with fifth disease may not feel very sick, even when the rash makes its appearance, though children with weakened immune systems from conditions such as AIDS or leukemia or blood disorders like sickle cell anemia can become especially ill if infected.
Unfortunately, if a child develops fifth disease, treatment options are limited. “Since it is a viral infection, there is no cure,” Lowery says. “The goal of treatment is to help reduce symptoms.” An infected child should drink more fluids and may be given an antihistamine to relieve the itching. Parents can also use acetaminophen or ibuprofen to treat a fever, but Lowery warns: “Do not give aspirin to children, [which] can cause a serious health condition called Reye syndrome.”
Unfortunately, measures to effectively control fifth disease have not been developed, Lowery says, but as with most diseases, “good hand-washing may be a practical and effective method to reduce the spread of the virus in schools or daycare centers where there are known cases.”
Impetigo
Impetigo, sometimes referred to as “school sores,” is a bacterial skin infection caused by staphylococcus aureus or group A streptococcus. Fluid-filled lesions appear that eventually rupture and drain, leaving areas covered with honey-colored crusts. This typically occurs around the nostrils and mouth, but can really happen anywhere on the body, says Dyan Hes, medical director of Gramercy Pediatrics in New York. “They often spread from area to area as a child scratches and infects other body parts with a contaminated hand.” These lesions can be made worse by poor hygiene and warm temperatures, Lowery adds.
“It’s [also] easier for a child with an open wound or fresh scratch to contract impetigo,” Lowery explains. “Other skin-related problems — such as eczema, body lice, insect bites, fungal infections and various other forms of dermatitis — can make a person susceptible to impetigo.”
While children between ages 2 and 5 are most vulnerable, Hes says, impetigo can affect any age group. “It’s more contagious in crowded living areas, day cares and schools.”
Treatment is usually a topical antibiotic applied to the lesions, though if there are many, oral antibiotics may be prescribed. “Kids may go back to school once they’ve been on topical antibiotics for 24 hours, and exposed lesions should be loosely covered,” Hes adds.
Impetigo may be considered a superficial skin infection but there can be cases of bullous impetigo, where large blisters may form. For these infections, Hes urges parents to seek medical attention immediately. “Otherwise, this is not a particularly dangerous illness.”
What’s the best method of prevention? Daily hand-washing with antibacterial soap.
Ringworm
Despite the name, ringworm is an infection caused by fungus — not a worm. It affects the skin on places such as the scalp, hands and feet, along with nails. Lowery notes that ringworm most commonly occurs in children, specifically boys, though those with skin conditions such as eczema and a weakened immune system are also at risk.
With scalp-based ringworm, flaky areas (often misdiagnosed as dandruff) may appear. “However, they are often ring-shaped areas of inflammation and scaling with raised edges,” Hes says. “They can become intensely itchy, and in some cases, the hairs will break off.”
Ringworm affecting the skin will appear as round or oval scaly lesions with raised red boarders, Hess explains. They usually have a clear center, but not always. These rings can be very large or come in multiples.
A topical antifungal can be used to treat ringworm on the skin, while ringworm of the scalp requires oral antifungal medication because the fungus infects the hair shaft. Though ringworm complications are typically cosmetic, if left untreated, ringworm can cause boil-like swellings on the scalp with hair breakage and intense itching, Hes says. “An untreated skin infection will be itchy and can get super-infected from bacteria with all the scratching.” And untreated infections can continue for weeks to months.
To avoid ringworm, “be careful to thoroughly wash and dry any area susceptible to infections; for example, the region between the toes and skin creases near the groin,” Lowery says. “And it’s always a good idea to prevent the sharing of brushes, combs or hats.”
RSV
“Respiratory syncytial virus, or RSV, is a common, seasonal virus contracted by nearly 100 percent of infants by their second birthday,” says Paul Checchia, medical director of the cardiovascular intensive care unit at Texas Children’s Hospital. Babies born prematurely and those with certain types of congenital heart disease and chronic lung disease are especially vulnerable. In fact, RSV is the leading cause of hospitalization for babies in their first year of life.
Especially common November through March, the virus is typically caught in schools and day cares. RSV spreads by sneezing and coughing or physical contact with infected objects; the virus can “survive on hard surfaces such as toys, tables and crib rails for up to eight hours,” Checchia says.
Most babies with RSV develop a mild respiratory infection and show symptoms resembling the common cold or flu, but in severe cases, they may experience persistent coughing or wheezing; spread-out nostrils and/or a caved-in chest when trying to breathe; a bluish color around the mouth or fingernails; fever (a rectal reading over 100.4 degrees); or difficulty drinking from the bottle or breast. In some cases, Checchia adds, RSV can lead to congestion in the small airways of the lungs or pneumonia, which may mean a hospital stay or even respiratory failure requiring admission to the intensive care unit and assistance from a breathing machine.
Says Checchia: “There is no cure for RSV. All we can do is support children through the course of the disease. All parents should avoid crowds; people who may be sick; and frequently wash hands, toys and clothes.” Parents should also check with their pediatrician to determine if their baby is high-risk for RSV and learn the best preventive steps.
Staying Healthy
Despite parents’ best efforts, children can and will get sick on occasion — there can be no avoiding it at times — but most experts agree there are steps caregivers can take to keep a child armored against all these diseases.
You’ve heard it before, but we’ll say it again: Hand-washing is one of the most effective ways to keep germs at bay. Help your child learn to properly use soap and water, lathering for 15 seconds, then following with a thorough rinse. Use of an alcohol-based, waterless gel is also good, Elliott says. Children should be current with all vaccinations and get the annual flu shot as well, he adds.
“Parents [also] shouldn’t underestimate the power of good sleep and nutrition to help their children build and keep a strong immune system,” Lowery says. “With today’s busy schedules, which threaten sleep and healthy meals, be your child’s advocate. Eliminate electronic use in the hour proceeding bedtime, honor the dinner hour and keep healthy snacks within your child’s reach.”
And last but not least, Elliott emphatically requests that all people feeling sick and showing symptoms please stay home. Do not, he insists, share your or your child’s illness with others at work, school, playgroup and other public places.
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