HOT TOPICS:  

1)Medicaid patients may need to reapply

2) Seasonal Allergy Updates

3)Ticks

MEDICAID PATIENTS: As the "Public Health Emergency" phase of the COVID-19 pandemic is drawing to an end, some Medicaid patients may need to re-apply even if they still qualify. Please be sure to check that your family or child is still eligible and that you are still active. 

SEASONAL ALLERGY TIPS: 

This is a general guide to help you manage seasonal allergy symptoms with your children. Seasonal allergies are most commonly caused by pollen and mold spores released as the weather gets warmer. In the fall other spores and pollen are released that can cause the same type of symptoms.

General recommendations would be to ***WASH*** off the face, hands and even change clothing, if possible, after your child comes indoors. Just as the pollen collects on cars and windows, it will land on your child as well. Whenever your child touches his/her hair, skin, clothing and then rubs his or her eyes or nose, your child can cause continuous exposure to the pollen even when indoors. Wearing a hat to cover hair and removing it when he/she comes indoors can also help. Keep your children off of their beds and furniture in the home after coming in from outdoors until they have changed their clothing to keep pollen from those surfaces as well.

Keeping windows closed at night can be helpful as well. Many pollens and mold spores are released into the air in the very early morning hours even before sunrise.

The following may be helpful tips to help manage seasonal allergy symptoms.

Intermittent symptoms (if your child has sporadic symptoms—only has sneezing or runny nose with some exposures like a freshly mowed lawn, etc.) might only need a dose of Benadryl (diphenhydramine) at the times that he or she is having symptoms. This is an antihistamine that works fairly quickly but only lasts about 4 hours. Most children do just fine with this medication but some kids will get a bit tired or sleepy. A small percentage of children can actually get a bit of an energy boost for those hours. 

MAINLY EYE SYMPTOMS: Over the counter antihistamine eye drops work quite well and can be used as needed on days that your child has symptoms. Some examples of these eye drops are:

Pataday or Patanol (generic is olopatadine)***Works really well, used to be Rx but now it’s over the counter

-Zaditor

-Alaway

Most major pharmacy chains have their own store brand as well.

Children under 3 may not do as well with an eye drop and some are not formulated for very young children. Children younger than 3 may benefit more from a long-acting oral antihistamine. (see below)

MAINLY NASAL SYMPTOMS: (itching, runny nose, congestion) can be controlled with a long-acting oral antihistamine or a nasal spray. Children under 3 may not be able to use or tolerate many nasal sprays. Check with our office for recommendations if the oral antihistamine is not giving your child enough relief.

It should be noted that nasal sprays DO NOT give immediate relief so your child may need to use BOTH a nasal spray and an oral antihistamine for the first 5-7 days while the nasal spray is beginning to work on the nasal passages.

Medicated nasal sprays should always be used in conjunction with a SALINE nasal spray to rinse the nasal passages anytime your child has been outside or before using the medicated nasal spray to clear out the nose of pollen and mucus. Saline nasal rinses can be used several times a day.

Nasal Sprays available over the counter include:

-Fluticasone proprionate(Flonase), Children’s Flonase available as well as Sensimist which is a finer lighter mist that may be better tolerated by young children)

-Budesonide (Rhinocort) “Children’s Rhinocort” available **Fragrance free option**

-Mometasone (Nasonex)

-Triamcinolone (Nasocort) **AGE 2 and up**

Major pharmacy generic versions are also available and more affordable. They are medically equivalent to these name brands.

 These should be given as 1 spray to each nostril once daily. Older children and teens may benefit from 2 sprays once a day for the first week and then decrease to 1 spray daily.  Using a higher dose longer than a week may cause nosebleeds. 

There are other prescription nasal sprays that are similar to the over the counter sprays listed above. These include Qnasl, Veramyst and Beconase among others but they work very similarly to the over the counter medications and are generally not covered by insurance carriers.

Multiple symptoms (itchy eyes, watery eyes, nasal congestion, runny nose, sneezing, itching) will likely require using multiple remedies.

In addition to eye drops and nasal spray, a long acting antihistamine can be used.

Long acting antihistamines include:

Loratadine (Claritin or Alavert) 2.5mg for children 20-30lbs, 5mg children between 30-40lbs, 10mg above 40lbs (liquid and dissolve tabs are available in both dosages)ONCE A DAY

Cetirizine (Zyrtec) 5mg daily for children between 3 and 6, 10mg for children over 6 (liquid and tablet available) ONCE A DAY

Fexofenadine (Allegra) liquid for age 2 and up, liquid and dissolve tab for age 6 and up. Follow directions for once or twice a day dosing depending on the type you purchase.

Step-Wise Approach to managing allergies

-Be consistent with all of the prevention measures listed above

-If there is one main symptom, choose the right fit (for eye itching, use eyedrops, for nasal congestion and itching, use nasal spray)

-If there are multiple symptoms (eye, nose, itching, running nose, sneezing, etc)

1. First, start with a long-acting antihistamine.

2. Next, add eye drops or nasal spray or both

3. Next, add in another long acting antihistamine. Generally using loratadine in the morning (less likely to cause sleepiness) and then another in the evening. ***For children under 4 please talk with a physician about using more than one antihistamine.

TICKS

The following PDF from the CDC contains general information about managing a tick bite. 

https://www.cdc.gov/ticks/pdfs...

Removing a tick:  https://www.cdc.gov/ticks/remo...

If you find a tick on your child, the best thing to do is remove it quickly by lifting straight up with fine-tipped tweezers. You may need to give a bit of a tug as ticks adhere to the skin quite well. The key is to get off all the parts of the tick that are at and above the surface of the skin. The ticks have barbed "antennae" that they use to hold themselves in place but the "feeding" part of the tick is not on the barbed antennae. Often there are one or two small black dots that remain after removing the tick. These may remain behind and do not cause lyme disease. The body will work them out like a small sliver over the next few days. Digging out these antennae can increase the risk of skin infection. It is best to leave them alone.

Next, clean the area off with soap and water. 

If the tick was possibly imbedded in the skin and feeding it will be engorged (full) of blood. Ticks that carry Lyme disease need to be actively feeding for at least 24-48hours to transmit lyme disease to a person. If a tick was found on your body and was removed within that time frame, the risk of getting lyme disease is extremely low.  This is why doing a very thorough tick check every night before bed is important. Ticks tend to like areas with folds or creases such as behind ears, armpits, the back of the neck, the groin, belly button, under scrotum, behind knees, etc. so check those areas particularly closely. 

**Old fashioned "tricks" for removing ticks with vaseline or a hot match actually increase the risk of transmitting lyme. The best thing to do is to remove the tick quickly with tweezers.  

If the tick was possibly attached for longer than 24-48 hours and was engorged, it is best to closely monitor the area of the bite daily for the next 3-4 weeks. There will be some pinkness and even a "bug bite" mark at the site that lasts a few days as would any insect bite. However, if an enlarging ring-like rash evolves in the area of the bite, your child should be seen in our office for evaluation. The lyme rash is generally flat, not itchy or warm and it does enlarge over several days. This would suggest early lyme disease and this rash is easily treated with a course of antibiotics. 

Other symptoms that would require a call to the office in the weeks following a tick bite would be an unexplained fever, joint pain or swelling, or severe headache. 

Then monitor the area closely for the next 

Additional information can be found on the Healthy Children Website:

https://www.healthychildren.or...