Ask the Patch Pro: Local Pediatricians Answer Your Questions

Doug Barton, MD November 8, 2012 at 02:36 pm

There are many considerations depending on how long the cough and runny nose is on-going. Certainly, most parents will be concerned about allergies. Asthma is closely related to allergies. Often, a sinus infection will be result of allergies that are persistent. One of the more common issues, however, is that the child does not have a chronic runny nose or cough, but rather a recurrent runny nose/cough.
The average toddler gets 6-12 colds a winter and each lasts 10-14 days. With that frequency, one can easily see how recurrent colds would look like chronic problems. There are a number of less common syndromes that your pediatrician could help walk you through.

Doug Barton, MD November 8, 2012 at 02:39 pm

Very frustrating, obviously. There are no easy answers to this. Gastroesophageal reflux is the most common cause, especially if the toddler has been spitty from the beginning. There are multiple other causes, however. If this has been going on a long time, it might be time to consider consulting with a pediatric GI specialist. He or she can look into more unusual causes for the vomiting.
Good luck

Doug Barton, MD November 8, 2012 at 02:40 pm

The best person to answer that question is the orthopedist who repaired the ACL. I am not aware of any studies that support the use of HGH for this purpose, however.

Jennifer Moore November 8, 2012 at 02:47 pm

My son is 14 months old, but was born 10 weeks early last fall. We did the RSV vaccines last winter and his pediatrician would like to get them going again this year. He has never had any kind of respiratory problems and has been very healthy. I know that the RSV vaccine is a bit more painful than normal immunizations and I think he has surpassed the weight limit for a single injection and will require two, so I was wondering how important it is to do these vaccines a second year.

fariba azarpour November 8, 2012 at 02:54 pm

If the exam is normal with no chest,lungs findings,and family history is positive for allergies could try an antihistamine (like Zyrtec which is OTC ) for a week or 2 and have mother to call with an update.

fariba azarpour November 8, 2012 at 03:05 pm

I would think the best factor will be how much you are comfortable with the physician ,therefore it will be very important that you meet the physician in person ,
and ask her,him about the issues that are most important to you ,and most likely you will know then.

Doug Barton, MD November 8, 2012 at 03:07 pm

There are many factors. In my mind, the most important is whether you see eye to eye and match personalities reasonably well with your pediatrician. The smartest pediatrician in the world is worthless to you if you can't ask questions, feel like you've been listened to and that your thoughts about medical care are similar to his or hers.
Having said that, Board Certification is a good place to start. Referrals from friends are often quite reliable. Asking the hospital that you are most comfortable with will often produce names that are reliable. Your OB/gyn is also a very good resource. Office hours, insurance plans accepted, hospitals that they refer to, after-hours policies may also strongly influence this decision. Use internet resources as a last resort. Every professional has had the experience of a single bad review because of a mismatch between individuals. These poor reviews often reflect a miscommunication between the two parties involved and may not reflect your experience at all.

Doug Barton, MD November 8, 2012 at 03:22 pm

The CDC website lists the following:
American Academy of Pediatrics (AAP) Guidelines for Infants and Children at Risk for Severe Illness Due to RSV Infection According to the AAP1, palivizumab prophylaxis may be considered for the following infants and children •Infants born at 28 weeks’ gestation or earlier during RSV season, whenever that occurs during the first 12 months of life •Infants born at 29–32 weeks’ gestation if they are younger than 6 months of age at the start of the RSV season •Infants born at 32–35 weeks’ gestation who are younger than 3 months of age at the start of the RSV season or who are born during RSV season if they have at least one of the following 2 risk factors: 1) infant attends child care; 2) infant has a sibling younger than 5 years of age •Infants and children younger than 2 years with cyanotic or complicated congenital heart disease •Infants and children younger than 2 years who have been treated for chronic lung disease within 6 months of the start of the RSV season. •Infants born before 35 weeks of gestation who have either congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions With this information, I would not recommend Synagis without other information.

Matthew Broom, MD November 8, 2012 at 03:22 pm

RSV can be a scary infection, particularly for those infants who were born premature, and also those who have a history of chronic lung disease, or congenital heart disease. Synagis, though not actually a vaccine, is an approved prescription antibody against RSV, which provides excellent protection for those children at greatest risk. As almost all children will likely be exposed to RSV by two years of age, those who acquire the infection (called 'bronchiolitis') as infants, are often at the greatest risk of hospitalization. Decreasing this risk is the goal of receiving Synagis and there is strong evidence advocating this risk.

Elizabeth November 8, 2012 at 03:27 pm

My son is 3 years old, he has several issues that include, seizures, failure to thrive, developmental delays, some minor GI issues, and proximal muscle weakness. I worry that he could have a mild case of some sort of metabolic disorder, but his pedi is always blowing off my concerns. He was just in the doctor for his failure to thrive and they want to wait another 3 months before thinking about sending him to a specialist. I am tired of worrying and being told to wait and see! Do you think this could be a possibility or am I worrying over nothing?

Doug Barton, MD November 8, 2012 at 03:32 pm

Ouch. From the outside looking in (ie. without the knowlege of your pediatricians point of view), I would be wondering as much as you are. I personally don't treat seizures. I generally refer to a neurologist for on-going care. I would be working closely with that neurologist to determine the need for consultation with other specialists. Given the limited data I see above, I would be considering a consultation with a geneticist.

christina pate November 8, 2012 at 03:44 pm

I have a three year old.that has severe temper tantrums, including throwing things at people and hitting,kicking,and screaming. The tiniest things set him off. He also has not slept throw the night since he was born and "wakes up" either screaming or crying multiple.times and their is nothing that I can do to.help console him. My pediatrician seems to think he is a normal.three year old. Is he? Are these things common in small children?

Doug Barton, MD November 8, 2012 at 04:01 pm

I'm sorry to hear that. There are MANY reasons for this behavior. Difficulty with limit setting is a common cause. Sleep disorders that can be either inherent in the child or a result of trained in behavior.
To some degree, this can be normal behavior. That doesn't make it any easier. I usually recommend starting with behavior modification techniques. Sometimes, I refer to a counselor to help parents learn how best to respond to their toddler in a way that decreases the frequency and severity of the behaviors. Over time, these things improve or, working with the counselor and pediatrician, you can get to the bottom of why these behaviors persist.

Matthew Broom, MD November 8, 2012 at 04:13 pm

I agree that there are a variety of apparent medical issues in your situation. Often a second opinion (for example via a diagnostic clinic) or a subspecialist familiar with children who have multiple medical problems can be very helpful. Pediatricians as a whole really appreciate receiving input from other colleagues on what are often complicated patients so that we can, sometimes as a collaborative effort, provide the best care for a patient and their family.

Matthew Broom, MD November 8, 2012 at 04:21 pm

I agree with what has been noted below- really it should come down to comfort for both you and your child. Convenience, a friendly atmosphere and access to your physician can go a long way as well. Families are most comfortable when they feel like they have been listened to and their concerns have been heard. Building that trust and familiarity can take time, but it is worth it. As a resource, the best way to confirm American Board of Pediatrics certification is checking at:
https://www.abp.org/MOCVerification/VerificationServlet

fariba azarpour November 8, 2012 at 04:27 pm

If child has no chronic lung disease (CLD) or congenital heart disease (CHD)and was born at 29-32 weeks gestational age and recieved the 5 doses of RSV vaccine last RSV season does not need any more of RSV vaccine
Referenced from : Red Book (American Academy of Pediatrics)

dan November 8, 2012 at 04:29 pm

This question isn't about kids but I recently quit smoking cigarettes and started smoking an e-cigarette. Is inhaling this nicotine and water vapor mixture healthier than smoking cigs?

Jen November 8, 2012 at 04:48 pm

I have a 4 year old who was born 9 weeks early and had RSV within his 1st year. Since then, every season he has a horrible cough, hard, dry and deep in his chest. He does breathing treatments as needed, but he struggles throughout the night. His pedi isn't worried. Is there anything I can do to to make this season easier on him?

fariba azarpour November 8, 2012 at 05:32 pm

I would think your child most likely has RAD/Asthma ,which usually acts up every winter,and he will benefit much being on controller medicine ( inhaled corticosteroids) on a daily basis , certainly on the winter months ,and that would make a big difference.
I hope you will find this helpful.

Matthew Broom, MD November 8, 2012 at 05:56 pm

Unfortunately, many children who have had RSV at an early age, particularly those with risk factors (e.g. prematurity) remain at risk of again contracting bronchiolitis. Some of these children may also be at greater risk of developing asthma. For those children who have recurrent coughing and/or wheezing, an evaluation by a medical provider is important to help define the course of their symptoms.
Some steps to minimize the risk of bronchiolitis among young children include keeping away from others that are ill, reducing day-care exposures (if possible), staying away from tobacco smoke (another significant risk factor), minimizing time in crowded areas with your child and practicing good hand washing.

fariba azarpour November 8, 2012 at 06:00 pm

First of all even if he is a normal 3 year old child,which I hope he is, his sleeping pattern and his behavior does not sound very normal to me and second his mother has concerns and worries about him which needs to be addressed
It will be very helpful if one knows the whole senario regarding his temper tantrum and what is the reactions of his care takers ( may be helpful to watch a video of 5-10 minutes what goes on and how you calm him) Then with a detail history about his past,family history and a good physical exam will be able to guide you in the right direction,which may include referral to developmental psychologist.

Matthew Broom, MD November 8, 2012 at 06:01 pm

In pediatrics, the use of human growth hormone (HGH) most commonly involves children who have short stature. I also am not familiar with HGH for use with ACL repairs, however this is not my field of practice. I do agree with following up with your orthopedist regarding the data, particularly adolescent/pediatric data, for the use that you are describing.

Matt B. November 8, 2012 at 06:03 pm

I have a walnut sized lump just below my left knee. Its painless and hard as a rock. Could anyone tell me what this may be?

Joel Kabak November 8, 2012 at 06:11 pm

My wife just went through this with a baseball sized lump behind her knee. Went to a specialist and was told it was a "bakers cyst". It should dissipate over time.

Doug Barton, MD November 8, 2012 at 06:22 pm

It would be very difficult to make any recommendation or even suggestion as to what this is without an history and exam of the area. There are numerous possibilities.

fariba azarpour November 8, 2012 at 07:43 pm

If the lump is on the anterior knee ( front of the knee) and is solid as a rock does not sound like a Baker's cyst as A Baker's cyst will be a fluid filled sac mainly on the popliteal fossa (behind the knee cap) ,
Without a detailed history and exam and may be imaging will be hard to say what it is ,as the anterior hard lump of the knee does not seem to be very common at least in pediatrics.

Matthew Broom, MD November 8, 2012 at 07:52 pm

A word on the flu season in pediatrics. Usually occurs fall to spring, though can be variable. Annual influenza vaccination for all children is recommended by the American Academy of Pediatrics. The flu vaccine protects against three different strains (types) of influenza. These types are considered the most likely to cause disease this year by the Centers for Disease Control and Prevention (CDC).
For more information on the influenza and the flu vaccine, two great resources are: 1) http://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Inactivated-Influenza-Vaccine-What-You-Need-to-Know.aspx 2) http://www.immunize.org/askexperts/experts_inf.asp#children

Matthew Broom, MD November 8, 2012 at 08:01 pm

I agree with the other comments on the variety of possibilities without more history and exam. One common (at least in adolescence) option for swelling just below the knee-cap would be Osgood-Schlatter Disease. This is common among young athletes, however usually painful, so less likely based on what has been described.

Jordan Lanham (Editor) November 9, 2012 at 12:23 am

Thank you to Dr. Broom, Dr. Barton and Dr. Azarpour for volunteering as Patch Pro experts today!

Matt B. November 12, 2012 at 07:35 am

I really appreciate all the feedback.. What should i do now? I've started to develop a 2nd bump on my left foot. Its on the left side of the foot just about 2 inches behind the "big" or "first" toe(side of the foot). I work for a company that doesn't offer me insurance. Where do i go from here? The '"lump" or "bump" on my right leg just to the lower left of the knee does not seem to be getting bigger, yet im still worried of what this may be.