Dr. Mindy Calandro, Author at Baton Rouge Family Fun

Multi-system Inflammatory Syndrome in Children – Dr. Mindy Calandro

May 31, 2020 by Dr. Mindy Calandro

Until recently, the headlines about Covid-19 have largely been about the disease in adults, especially the elderly and those people with underlying health conditions. As a pediatrician, I’m used to seeing virus like influenza and Respiratory Syncytial Virus (RSV) wreak absolute havoc in children. So, it has been an unexpected, albeit very welcome, “surprise” that Covid-19 seems to be having very little effect on children. However, over the past few weeks, it seems that doctors around the globe are noting cases of children who are being diagnosed with severe inflammation throughout their body – something the Center for Disease Control is now calling Multi-system Inflammatory Syndrome in Children or MIS-C for short. The headlines about this new development in kids are frightening, so let’s talk about what MIS-C really is and how worried parents need to be (keep reading for the good news here).

Multi-system Inflammatory Syndrome in Children

Doctors really like to follow trends or clusters of illnesses, so when doctors in New York City started to see an increase in cases of children with overwhelming inflammation presenting to the hospital, it certainly was noteworthy. Symptoms of children presenting with MIS-C have been varied but include high unrelenting fever, abdominal pain, diarrhea, rash, red eyes, and neck pain. These children are showing massive amounts of inflammation in their blood vessels causing problems in organs such as the heart, kidney, gastrointestinal tract, and brain.

Covid-19

Some of the children who have been diagnosed with MIS-C have been found to have positive antibody tests to Covid-19 without a prior diagnosis of a Covid-19 infection. This would signal that MIS-C would have occurred weeks after a Covid-19 infection (again most likely an asymptomatic infection). It is important to note, however, that there have also been children diagnosed with MIS-C who have had all negative testing to Covid-19. The bottom line right now is that we are not sure what is causing MIS-C.

Kawasaki Disease

MIS-C “Multi-system Inflammatory Syndrome in Children” is closely resembling two other rare illnesses that we see in children…one called Kawasaki disease and one called Toxic Shock Syndrome. The cause of Kawasaki disease is not truly known, but doctors have long suspected that it is likely a post-viral illness where the body’s immune system starts to almost attack itself, leading to inflammation of blood vessels in different areas of the body including the heart. Children with Kawasaki disease present with high fever for more than 5 days, rash, redness to the eyes, changes to their lips or tongue as well as swelling of the extremities and swollen lymph nodes.

Kawasaki disease can be treated, and the majority of children recover from this illness without long term effects (although in some cases, long-term damage to the coronary arteries can occur). Toxic shock syndrome, on the other hand, is caused by bacteria (either Staph or Strep) and can be life-threatening very quickly as it causes extremely low blood pressure, also known as shock.

When the initial cases of MIS-C were seen, children seemed to be presenting with some of the physical signs of Kawasaki disease but with the low blood pressure seen in Toxic Shock Syndrome. As more information is collected, it also seems that children with MIS-C are older with the most common ages being 5 and up. Kawasaki disease, on the other hand, is more commonly seen under the age of 5 (although both of these illnesses can be seen in anyone under the age of 18).

As with a lot of things in medicine right now, we are trying to learn as quickly as we can about the disease process of MIS-C, and work is ongoing to determine whether there is a direct link to Covid-19, whether some children more likely to get MIS-C than others, and whether there is any way to prevent MIS-C from happening.

The Good News for Parents

So, you might be wondering: what about the good news I mentioned above? Well, while the headlines are scary about MIS-C, the most important thing I want parents to take away from this is that MIS-C is still EXTREMELY RARE. While data collection is continuing on a daily basis, as of this writing, 23 states are reporting cases of MIS-C, there are around 250 cases across the US (with close to 100 of those cases being in New York alone), but at the moment, there have been less than 5 deaths nationwide. Just to be clear, while any child dying is absolutely tragic, do keep in mind for reference that influenza has already killed 176 children so far this year.

When it comes to Multi-system Inflammatory Syndrome in Children, doctors and parents alike need to be aware of this new illness and be on the lookout for concerning symptoms. But once again, there is no need to panic as this illness, while scary given its symptoms and complications, remains exceedingly rare. Doctors and scientists are feverishly working to try and learn as much as possible about MIS-C, and its causes, relationship to Covid-19 and, of course, treatment and a cure.

In the meantime, I encourage parents that may be worried about MIS-C to speak with their pediatrician, and if you are worried about your child being ill with any kind of symptoms, please do not be afraid to bring them to the doctor. Pediatricians are available and equipped to see children both healthy and sick during these uncertain times of Covid-19.

“Ask the Experts” is a series on Baton Rouge Family Fun where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Disclaimer: The purpose of this site is to share experiences with food, fitness, health, and life as well as opinions from some of our local experts. This content is for informational purposes only and isn’t a substitute for professional medical advice. When it comes to your health or the health of your child, please be sure to contact your physician.

COVID-19 and Children – What a pediatrician wants you to know

April 6, 2020 by Dr. Mindy Calandro

The past 3 weeks have been anything but normal as COVID-19 has changed our daily landscape. Kids are out of school, parents and teachers alike are having to learn how to do distance learning, there is no date night with your spouse, and your social media feeds are filled with scary headlines about an enemy that is striking down those we love and yet we still know very little about the why and how of this foe. No one has all the answers right now, but I want to let you know a few important things about COVID-19 and possibly help you to decipher some of the flashy news stories.

What is Coronavirus?

Human Coronaviruses as a whole are by no means new. In fact, most people have likely had a coronavirus at some point in their life as these viruses typically cause mild respiratory illnesses like the common cold. So then what is the difference with COVID-19? It appears that this particular coronavirus likely started in bats. In the past, those coronaviruses that started in animals and then spread to humans have caused more significant illnesses. The two prior coronaviruses to start in this particular manner were SARS (severe acute respiratory syndrome) in 2003 and MERS (Middle Eastern Respiratory Syndrome) which surfaced in 2012. The COVID-19 virus is “novel” meaning that until December 2019, this strain had not been identified in humans.

What are the symptoms of COVID-19?

Reported symptoms include fever, cough, body aches, sore throat, headache, and diarrhea. The WHO has estimated that 1 in 6 people with COVID-19 will have a more severe illness that will include shortness of breath and difficulty breathing. Now, those milder symptoms could also describe this year’s influenza illness or even just the common cold. Take away message here…not every cough, fever or body ache is COVID-19. However, if you have fever, cough and any difficulty breathing, you need to call your medical provider immediately for guidance on where to be evaluated.

Who really needs to be tested for COVID-19?

The testing capability for COVID-19 is increasing across our area, but that does not mean that tests are readily available for everyone who wants to be tested “just because.” Those that are over 60 years of age, have diabetes, underlying severe lung disease, severe kidney disease or are immunocompromised or are a health care worker are primarily the groups that testing is indicated. Now, in pediatrics, those under 10 weeks of age, those with congenital heart or lung disease or those that are immunocompromised are the main groups of children who would meet testing criteria at this time. As tests become more available (and easier to get results as well), then these testing criteria might expand further. In the end, most COVID-19 tests can take up to 7-9 days to come back, so if there is any suspicion for COVID-19, presume that you have it and isolate accordingly.

I see that numbers of cases in Baton Rouge and Louisiana are jumping by hundreds or more each day. What does this really mean?

Let’s put these numbers into perspective. Test results are coming in usually 1 week after the test is done. So that means that the increase you see in numbers today were more than likely from the tests done a week ago. This goes to further show that Coronavirus is in our community and has been for some time. It does not mean that social distancing and other measures to slow the spread are a failure, but it likely shows that people might not have been practicing as strict isolation measures a week ago.

COVID-19 and Children

Is COVID-19 causing illness in children?

As a pediatrician and a mom, this is one of the most important things that I am keeping an eye on. To this point and in looking at data from China as well as across the US, the number of cases of COVID-19 in children has been dramatically low. YEA! Do a happy dance!! Now, this is not to say that there have not been some children hospitalized with COVID-19 and even several deaths, but the rate of children becoming seriously ill has been drastically lower than what we are seeing in the adult population. The reason for this trend in children is puzzling and yet another aspect of COVID-19 that we are trying to figure out. Perhaps a child’s immune system is handling this virus differently than an adult. Perhaps because children see other strains of coronavirus all the time (i.e. the common cold), they have some protection for this novel strain. Either way, for now, it seems that kiddos are doing ok through this pandemic.

What is research telling us about COVID-19?

Doctors love to have studies to back up what we are thinking or what we recommend. We love big, sweeping studies that include hundreds of thousands of people and studies that have variables that we can control and test. We just don’t have those kinds of studies in regard to COVID-19, at least not right now. Currently, doctors from across the US and the world are working together through panel discussions, message boards, and small data collections groups, telling of their patient experiences with this virus, telling what has worked or not worked for treatment, and sharing as much information as possible so that we can try and learn as fast as possible about how to handle COVID-19. Those big sweeping studies will be coming, but they will take time.

Should I wear a mask in public?

As we are learning more about COVID-19, the recommendations for wearing a mask in public have changed. Initially, masks were only recommended for those who had coronavirus. We now know that many people who have COVID-19 can be asymptomatic with no obvious symptoms, and we also know that people are likely to be able to spread the virus before they start showing symptoms. With this new information, the CDC made a recommendation on April 3, 2020, that everyone should wear a NON-SURGICAL, cloth mask when going out to necessary public places (remember you should not be going around town for non-essential trips anyway). This can be a mask sewn with fabric, a bandana to cover the nose and mouth, or there is even a video on the CDC website with the Surgeon General showing how to easily make a mask at home. Please note that surgical masks and especially N95 masks are NOT recommended for the public as there is already a frightening shortage of these supplies which are vital for our healthcare workers on the front lines of this pandemic.

How about wearing gloves in public places?

Think about this scenario…you put on latex gloves to go grocery shopping. With your gloves on, you touch the shopping cart and your groceries. You then reach in your purse to pull out your phone which has your shopping list. You then get out your wallet to pay for the groceries. When you load all the bags into your car, you then take off your gloves. If you are like most people, you will probably then touch your phone before starting your drive home (remember you touched that same phone with your gloves on). Then you touch the steering wheel to drive home. Once home you take the bags out of the car and unpack your groceries. Again, remember you had on those gloves when you were touching these items before. Hopefully, you can see that you are just causing the same contamination with gloves while probably giving yourself a false sense of security. The bottom line here…gloves are not needed. Please just make sure to wash your hands (all the time, 20 seconds each time) and wipe down surfaces such as your phone especially if you have been out in public.

Is daycare a good idea?

Bottom line here is that if you can keep your children out of daycare, then do so. However, I know that there are families where the caregivers are essential personnel and have to go to work. There are also families that cannot afford to have caregivers not working. This is a decision that will be personal to each and every family. Ideally, for those daycares that are open, children that attend as well as all staff should have their temperature checked at least twice per day, and PLEASE do not send kids to daycare if they are sick (none of this give a fever reducer in the morning for a fever and sending them on their way)!

How about those playdates?

I have had plenty of families asking me if playdates with friends are ok during social distancing. If we view this time just as we would a surprise snow day or summer break, then we have missed the mark for social distancing. If we have any hope of slowing the spread of the COVID-19 (notice I said slowing the spread and not stopping the spread), then we all must work together to limit our contact with others. While calling several friends to see about a playdate for a group of children is certainly a tempting break from trying to navigate the waters of e-learning, I really advise against it.

I think the most important thing to take away from reading this is that there is a lot that we are still learning about COVID-19, but scientists and doctors are working tirelessly and feverishly to learn and understand this Beast just as fast as we can. Please make sure and do your part by staying home, following shelter in place mandates, and above all else, WASH THOSE HANDS!

“Ask the Experts” is a series on Baton Rouge Family Fun where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Back to School: Ensuring an A+ start to the school year

August 10, 2019 by Dr. Mindy Calandro

Back to school…three words that represent great joy to parents who are ready to get back to routine and bring great anguish and “pain” to kids who aren’t quite ready to give up their summer freedom. In order to ensure a smooth transition from the fun and less structured summer into a new school year, I think it is important as parents to take the time to talk to our children about their worries and concerns going into the fall semester. The question could be as simple as, “Is there anything you are worried about for this school year?” I know in my office when I ask this question, I have had many a parent be surprised by the answer their child might give. When we know what our children are worried or afraid of, it makes us, as parents, better equipped to give them the guidance they need to maneuver through the unchartered waters of a new school experience happily and successfully.

Back to School: Ensuring an A+ start to the school year

I encourage parents to teach children to view school as their job. What better time to start teaching children about work ethic than from the very beginning of school. As parents, we should set expectations for our children in regards to their “job” performance, and if these expectations are not met, then they should be held accountable. Now, the expectations, as well as the consequences, will, of course, vary by age, but even the youngest child should understand that they should strive to be the best they can at their job. Even my son who is starting Pre-K 3, knows that mommy and daddy expect him to listen to his teacher, follow directions, and be a good friend to his classmates. If he doesn’t achieve these things, he doesn’t get to read books at night (his favorite pre-bedtime activity). These expectations are established from the get-go so that there is no confusion about the “job description.”

I also encourage all parents, but especially the parents of elementary aged children, to establish a good rapport with their child’s teacher. After all, the reality is that in many cases their teacher will spend more time with them during the weekday than we will. It is crucial to make sure there are channels of communication that exist between parents and teachers, and these should not be one-way avenues. Parents should feel comfortable bringing up concerns to teachers just as teachers should be respected when they bring concerns back to parents. A partnership between teacher and parent is vital to helping children achieve success in the classroom which often translates to increased self-confidence in kids.

So as everyone heads back to school, establish those expectations, let them know their “job description,” and then make sure your voice as a parent is a positive one with excitement, support, and encouragement for the upcoming school year. As kids make the trek up the ladder to reach those expectations you have set, make sure they know you are their biggest cheerleader and will always be behind them to catch them when they stumble, to give extra little pushes along the way, and to celebrate all of their achievements all from a place of unconditional love.

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Disclaimer: The purpose of this site is to share BRM’s experiences with food, fitness, health and life as well as opinions from some of our local experts. This content is for informational purposes only and isn’t a substitute for professional medical advice. When it comes to your health or the health of your child, please be sure to contact your physician.

Parents Ultimate Guide to Insect Repellent for Kids

May 20, 2019 by Dr. Mindy Calandro

It’s that time of year again, with warmer weather comes the return of Louisiana’s second state bird… the mosquito! In this installment of our Ask the Expert series, Dr. Mindy Calandro shares the best way to protect yourself and your kiddos from those pesky, Southern mosquitoes.

N,N dimethyl-m-toluamide (DEET)– This compound has been used as an insect repellent since the 1940s, and it is the insect repellent that is likely most widely known. DEET insect repellents may last anywhere from 2-8 hours depending on what percentage of DEET is contained in the products. On average, products with 10% DEET will last about 2 hours while those closer to 30% DEET will last closer to 8 hours. There are products available with DEET concentrations higher than 30%, but studies show that these products do not provide any longer/additional protection. DEET can protect against not only mosquitoes that transmit West Nile Virus and Zika virus but also against biting flies, gnats and ticks that can carry Lyme disease (although our ticks here in Louisiana do not carry Lyme disease). Now, a quick Google search will produce results citing that DEET can cause neurologic issues namely seizures. This sure makes for good headlines, but the bottom line is that there have been 10 reported cases of seizures in children after applying DEET products to the skin in over 50 years!! The Environmental Protection Agency (EPA) estimates that the risk of adverse reaction when DEET is appropriately used (i.e. applied only on the skin according to the recommended time intervals) is on the order of 1 per 100,000,000 people!

So what are the downsides to DEET? Well, if you have ever used a repellent containing DEET, you may recall a rather strong smell and a bit of a greasy feel. Also, DEET can cause skin irritation for those with particularly sensitive skin. Finally, DEET can cause damage to materials such as plastics, rubber, or leather so make sure to wash your hands prior to touching things like eyeglass frames, golf clubs or certain water bottles.

Recommendation for use: DEET 30% or less is ok for children 2 months of age and older.

Common Insect Repellent with DEET: Off! Familycare and Deep Woods, Cutter Skinsations and All Family, Repel Family

Picaridin– This product was approved by the Center for Disease Control for use as an insect repellent in April 2005 although it has been used for many years prior to this in other countries. Picaridin is created from the extract of the leaves from the pepper plant and has really no odor, does not damage plastics, and has less risk of skin irritation when compared to DEET products. Picaridin products are available in strengths from 5-20% with approximately 3-5 hours of protection with a 10% formulation. Studies show that Picaridin can protect people from many of the same biting insects that DEET protects from including those pesky mosquitos that carry West Nile and Zika virus.

So what is the downside to Picaridin? Since it is a relatively new product approved by the CDC and EPA, there are not as many long-term studies available here in the US. However, based on what we know of this compound as well as reviewing many years of data from other countries on the use of Picaridin, it seems that Picaridin is likely a very safe and effective alternative to DEET.

Recommendations for use: 10% Picaridin lotions for children 2 months and older.

Common products with Picaridin: Avon Skin so Soft Bug Guard, Natrapel, Sawyer Picaridin

Oil of Lemon Eucalyptus– If we are talking about the CDC and EPA approved version of this compound, it is actually a chemically synthesized version of oil of lemon eucalyptus and not the “pure” oil. Most versions of this repellent you will find are concentrations of 30% and can provide about 2 hours of protection. However, the data is still out on if oil of lemon eucalyptus can protect as well as DEET or picaridin against West Nile mosquitos. Another important thing to know about oil of lemon eucalyptus is that it should not be used on children under 3 years of age because of risk of skin irritation as well as significant eye irritation.

Recommendations for use: Only in children 3 and older, and I would consider it a distant 3rd to DEET and picaridin

Common products with Oil of Lemon Eucalyptus: Repel Lemon Eucalyptus, Off! Botanicals

Plant based oils: In this final category, we will group all essential oils but those referenced most commonly include soybean, lemongrass, citronella, peppermint, and lavender. It is important to realize that none of these oils have been approved by the EPA or CDC for efficacy in protecting against insects. If these products do provide any protection from bug bites, and that is a big “if,” it is likely a very short window of less than 1 hour. Also, as with all essentials oils, I would use extreme caution with these products on children with sensitive skin.

Recommendations for use: In my mind, I would not use these as insect repellents.

Common products with plant-based oils: California Baby Natural Bug Blend, Babyganics Natural Insect Repellent

A few things to keep in mind no matter what type of insect repellent you choose:

For young children, parents should use their hand to apply the repellent to children rather than spraying it on them. For those children who tend to put their hands in their mouth, do not put the repellent on the hands.
Do not apply in close proximity to the eyes or mouth of children
Do not apply to open cuts or wounds
Products that are a combination of sunscreen AND insect repellent should not be used. Since sunscreen should be applied every 2 hours, this would lead to most insect repellents being applied far too frequently.
When coming inside make sure to wipe/wash all insect repellent off prior to children getting into bed.

As you and your family are enjoying the last days of summer, and if you are like me, looking forward to the upcoming fall, realize that those pesky mosquitos will be hanging around for at least another few months. Across the board for all of those 2 months of age and older, there may be many options out there when it comes to insect repellents, but I would recommend sticking with either a DEET or picaridin based product to provide the most protection for your loved ones.

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Disclaimer: The purpose of this site is to share BRM moms’ experiences with food, fitness, health and life as well as opinions from some of our local experts. This content is for informational purposes only and isn’t a substitute for professional medical advice. When it comes to your health or the health of your child, please be sure to contact your physician.

West Nile Virus in Baton Rouge: What Parents Need To Know

July 18, 2018 by Dr. Mindy Calandro

If there is a mosquito within a 1 mile radius, it will find me. I am that person in our family that mosquitos seem to love which my husband finds as a convenient thing for him. Unfortunately, two of my three children “inherited” this trait from me. Not only do mosquito bites cause lots of itching and huge red welts if you are like me and my kiddos, but the bite of a mosquito can be the culprit of unwanted illness such as West Nile Virus. You may have seen recent news headlines here in the Capital City making us aware yet again this year that mosquitos in our area have tested positive for West Nile Virus. In this two part series, we will discuss what exactly is this virus, what does it mean for your time outside as the summer winds down, and how can you protect your family?

West Nile virus (WNV) is a virus that is transmitted through the bite of an infected Culex mosquito. The life cycle of the WNV involves mosquitoes feeding on infected birds. The virus then remains in the salivary glands of the mosquito, and when that mosquito “feeds” on humans, WNV can be passed onto the human host.

WNV has been documented across Europe, the Middle East, Africa, and India since the mid-1900s, but it did not make its appearance here in the United States until 1999. This virus was “imported” to the US by way of New York- most likely by a person who may not have even known they had the virus. Since 1999, WNV has been detected in every state except Hawaii and Alaska. We often see outbreaks of WNV during the mid to late summer months of June to September when the Culex mosquito is most common. In 2016, there were 40 cases of human infection with WNV here in Louisiana. By comparison, there were 335 cases of WNV in humans in 2012 here in Louisiana. So far this year, there have been mosquitos that have tested positive for WNV here in Baton Rouge, but from available resources, it does not appear that there have been any confirmed human cases thus far.

Ok so now to what everyone really wants to know…how common is WNV and what should parents be on the lookout for in regards to symptoms? Great news here- about 80% of people who become infected with WNV will have absolutely no symptoms. For 20% of people infected, they will most commonly have West Nile fever which is a mild, self-limited illness with symptoms that include fever, body aches, headache, vomiting and/or diarrhea and fatigue. Approximately 1% of those that are infected with WNV will come down with the serious form of the illness which can include swelling of the brain, known as encephalitis, or inflammation and swelling of the covering of the brain and spinal cord, known as meningitis. Symptoms of neurologic involvement with WNV include high fevers, stiff neck, confusion, muscle weakness, and seizures. For this 1% of infected people, WNV can be deadly.

There is no specific treatment for WNV. Since it is a viral infection, antibiotics are not helpful. For those with the more serious form of WNV, hospitalization might be required in order to provide fluids as well as pain control. There is lots of ongoing research into possible treatment options for those with encephalitis or meningitis from WNV, but at this time, all of these treatments are considered experimental. Also, at this time, there is no vaccine to prevent WNV.

Now, we all know that the chance of getting a mosquito bite in the next few months is almost as much of a guarantee as the afternoon rain showers here in the South, so how do you know when to be worried? No need to panic at the first sign of fever during the summer months as there are lots of other circulating summer viruses other than WNV (In fact, I have been seeing a particularly bad “fever” virus making the rounds in the past few weeks here in Baton Rouge). Now, if your child ever has a fever along with a drastic change in behavior, weakness or other neurologic changes, immediate medical evaluation is needed (and this is really true anytime of the year and not just during WNV season).

Stay tuned for the second part of this blog series where we will discuss the best ways to protect yourself and your kiddos from the bite of those pesky mosquitos.

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Dry Drowning 101: Know the Signs with Dr. Mindy Calandro – Ask the Experts

June 27, 2017 by Dr. Mindy Calandro

As if the idea of drowning didn’t strike enough fear into the heart of every parent, recent news headlines and social media posts have brought a new term to the forefront… dry drowning. You might be thinking, “Well of course my kiddo has had a cough a time or two after their face inadvertently went into the water. Is this something to worry about?” Here is what parents need to know about so called “dry drowning.”

What is dry drowning?

To get scientific, there are actually two entities here:

Dry drowning– This occurs when a small amount of water gets into the nose or mouth, and this water causes a sudden spasm of the airway where it shuts close. It is almost like the airway is “over protecting” itself from the water that isn’t supposed to be there. With dry drowning, there is no water in the lungs. In these cases, you will see symptoms almost immediately after the water gets into the airway (the airway will not spasm if the water isn’t there).

Delayed or Secondary drowning– In delayed drowning, a child inhales a bit of water through their nose or mouth, and the water actually does make it down into their lungs. Once in the lungs, the water begins to cause significant irritation and inflammation (after all, water is not supposed to be in our lungs) which leads to something called pulmonary edema. This can occur anywhere from 1-24 hours after the initial inhaling of the water.

You can see that while these two terms mean something different from a medical standpoint, the term “dry drowning” is often used in the news headlines and on social media to refer to secondary drowning.

How common do these type of submersion injuries occur?

Good news…these are both UNcommon! It is estimated that either dry or secondary drowning probably account for only 1-2% of all drowning related injuries in children. Think about all the times your child has inhaled a bit of water while in the bathtub or the pool, and vast majority of the time, they are a-ok.

What are the symptoms?

Good news again…dry and secondary drowning do not occur without warnings signs. When it comes to dry drowning, the symptoms will often be sudden in onset and remember, they will occur at the time of the incident (like while they are still standing in the pool water). Children will have immediate coughing that doesn’t resolve and sudden difficulty breathing. Now, with secondary drowning the symptoms usually do not start immediately after they inhaled the water. It takes time for the inflammation to begin in the lungs. Rather kiddos will start with coughing, trouble breathing, faster breathing, fever, vomiting, extreme sleepiness or a drastic change in behavior anywhere from 1-24 hours later.

What should parents do if they suspect dry or secondary drowning?

If your child has been swimming and in the hours following a swim they show any of the above signs, they need to be brought to medical attention immediately. These symptoms certainly might end up being just the start of a circulating summer virus, but it is important to make sure that it is not secondary drowning. Often a good physical exam by your child’s doctor as well as checking of vital signs including their oxygen levels and sometimes even a chest x-ray can help to ensure that their lungs do not have fluid that shouldn’t be there.

And a quick reminder here as well…anytime a child has required a pool rescue of any kind, at a minimum there needs to be a call to your child’s pediatrician. Depending on how long the child was under water, many of these kiddos also need to be evaluated by a medical professional.

How can you prevent dry or secondary drowning?

Both of these entities really fall on the spectrum of drowning related injuries, and the best way to prevent any kind of drowning is constant adult supervision while swimming. I have written before about drowning prevention (you can click here to check out that blog post), but close attention to child while they are in the water and vigilance for new onset of symptoms after a swim are key. And again remember, these dry or secondary drownings are NOT common.

So hopefully now that you understand these frightening terms of dry or secondary drowning, you will breathe a sigh of relief knowing that this does not happen commonly. Kiddos will be kiddos playing in the water which often means an inadvertent inward snif while in the water. Let them continue to play, of course under an adults watchful eye, and if something doesn’t seem right after pool time is done, then you know the next step. Happy summer!

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Mumps – 5 Things Parents Need to Know

March 16, 2017 by Dr. Mindy Calandro

Last week, Louisiana joined the ranks of 37 other states to have reported cases of mumps since January 2017. In an urgent memo released on Saturday, March 11, the Louisiana Office of Public Health reported that several cases of mumps have been confirmed in students at LSU. The number of student affected as well as their vaccine status has not been released at this point in time. So here is what you need to know about mumps and how to protect yourself and your children.

What is Mumps?

Mumps is a viral illness that is spread through respiratory droplets or saliva (so coughing, sneezing or sharing drinks). An infection with the mumps virus may begin as nonspecific fever, headache, and malaise, but then often progresses to the most common symptom of mumps which is pain and swelling of the parotid gland. As you can see in the pictures below, the parotid gland is located just in front of the ear and at the upper part of the jaw. Swelling of the parotid gland, called parotitis, can be quite impressive and cause the ear to push outwards and the angle of the jaw to no longer be easily seen. If you or your child currently have any health issues such as depression or stress inform yourself about kratom benefits that can have a positive impact on your life. More serious complications of mumps include orchitis (which is swelling of the testicles that may lead to sterility) or oophoritis (which is swelling of the ovaries), encephalitis (swelling around the brain) or deafness. Death from mumps is very rare (even in the pre-vaccine era).

How common is Mumps?

Mumps vaccination became commonplace in 1967, but prior to that time, there were over 186,000 cases each year here in the US. Since routine vaccination, there has been a 99% reduction in the number of mumps cases each year, however, mumps has not been eliminated from the US.

On average, there are anywhere from several hundred to several thousand cases each year. In 2006, there were 6,584 reported cases (many on college campuses) and in 2009, there were more than 3,000 cases. As of February 25, 2017, there have been 1,077 cases so far, and now our cases here in Baton Rouge will be added to that total.

How contagious is Mumps?

As with most viruses, people are contagious before they even know they have symptoms of the illness. Those with mumps can spread the disease 2 days before the onset of symptoms and up to 5 days after symptoms begin. Therefore, when someone is diagnosed with mumps, they should avoid contact with others for at least 5 days.

Can you treat Mumps?

Well, unfortunately, since it is a virus, antibiotics do not help to treat mumps. For those diagnosed with mumps, the virus simply has to run its course. As with other viruses, lots of fluids, rest and medications like acetaminophen or ibuprofen can be used to help with symptoms.

How can you protect yourself and your children?

VACCINATION is key!! Children receive their MMR (measles, mumps and rubella) vaccine between 12-15 months of age and again between 4-6 years of age. These two doses of the mumps vaccine are 88% effective at preventing mumps viral illness. As you can see, the vaccine is not perfect, but it is the best protection that we have against this virus. For adults born after 1957, blood work can be done to see if you have immunity against the mumps virus, and if no immunity, then vaccination is recommended. According to the Center for Disease Control (CDC) those born before 1957 are likely to have had the mumps virus and therefore, should have immunity to the virus.

Well, why does it seem that people who have been vaccinated are getting the mumps virus?

That is a great question! As I stated above, the MMR vaccine is not perfect, but those who have received their MMR vaccines are 9-10 times less likely to come down with mumps illness if exposed to the virus as someone who is not vaccinated. Look at this example created by the CDC of a hypothetical outbreak: say a mumps outbreak affects 1,000 people. If 95% of those people have been vaccinated, that means that 50 people are unvaccinated. If 30% of those unvaccinated come down with mumps, that would mean 15 people would be sick with the mumps virus. If 3% of the vaccinated crowd got the virus, that is still 29 people who would be sick. So just by looking at the numbers (15 vs 29), there are more in the vaccinated group that have the mumps. HOWEVER, if none of those 1,000 people were vaccinated, you could expect 300 people to be sick (again with a 30% “attack” rate). It is not just the number that are affected, but more importantly the percentage of the population in question that is important.

Something else that we are learning about in regards to the mumps vaccine…it appears that over time, there might be waning immunity to the vaccine. We know that over time our immunity to vaccines may diminish which is why booster vaccines are so important (think about your tetanus booster which is given every 10 years as well as the recent push for pertussis, or whooping cough, booster vaccines). At this time, there is not a universal recommendation for a 3rd booster for the mumps vaccine, but in certain circumstances (areas with large outbreaks, for example), a third booster dose of the MMR vaccine may be recommended, since this vaccines are just one of the products people use to keep their health and there are other products that are qualified between health and beauty but are as well important as https://analbleachadvice.com/my-amaira-review/ and others.

As the mumps story of 2017 continues to unfold, stay tuned to see what, if any, new recommendations might be made. In the meantime, make sure that your children have received their MMR vaccine on time, and for those parents with soon to be college students, make sure they have received both of their MMR vaccines as well before heading off on their new college adventure!

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

Hand, Foot, and Mouth Disease

October 13, 2016 by Dr. Mindy Calandro

You know the feeling. The sign posted on the door of daycare announcing the current illness that is floating around. Oh the dreaded sign! “We want to inform you that cases of hand, foot, and mouth disease have been diagnosed here at the center.” GREAT! There are likely two questions that are running through your head: 1) So what are we going to do when our child comes down with this latest illness? and 2) What exactly is Hand, Foot and Mouth disease? Well, that first question is one that I have struggled with many times in my own household, and unfortunately, I can’t help you answer, but that second question…I CAN help with that one!

Hand, Foot, and Mouth Disease

Hand, foot and mouth (HFM) disease is a very common viral illness in children, particularly those under 5 years of age. Older children, teens and even adults can get Hand, Foot, and Mouth Disease, but it is much less common as most people have had HFM by that time and therefore have natural immunity to these viruses. This illness is typically seen in the late summer to fall, but especially here in Louisiana with our mild climate, I will see cases of HFM year round. The virus is spread through contact with droplets of someone who is infected, so it is spread by sneezing and coughing as well as the saliva that children “share” with each other on toys. It is not uncommon to see mini “epidemics” of HFM that spread through daycare centers or other child care facilities. The incubation period for HFM is 3-6 days, so I generally tell parents to be on the lookout for signs of HFM for about 1 week after “the sign” is posted at daycare.

What are the symptoms of Hand, Foot, and Mouth Disease

As with any other virus, each child may present differently, but most children will start out with fever. In the next few days, children will often develop the classic rash that really can be anywhere on the body but, as the name suggests, most commonly is seen on the hands, feet, and around and in the mouth. The rash looks like small blisters or ant bites, and you will find these spots on the palms and soles of the feet (there are not a lot of illnesses that will cause a rash on the palms and soles but HFM is one of them).

Especially in infants and toddlers, I will almost always see the rash in the diaper area and on the backs of the thighs as well. If you look inside the mouth, you may see ulcers on the inside of the lips or tongue as well as in the back of the throat. These blister lesions will typically continue to pop up over the first 3-5 days of the illness. After that time the rash will slowly begin to fade, and parents may even notice peeling of the skin where the blisters were located in the coming week. Finally, some children will have changes to their fingernails or toenails about 4-6 weeks after hand, foot, and mouth disease, and it may appear like the nail is “splitting” horizontally and coming off. No worries…there is a new nail under there!

Since HMF is caused by a virus, antibiotics will not make the illness or the rash go away. The mainstay of care for HFM is making sure children are drinking lots of liquids and using acetaminophen or ibuprofen to help with fever. Sometimes the throat can be so painful for children that they will not want to drink liquids, and then the concern is that they could be become dehydrated. When it comes to liquids to offer, I often say that when kiddos are sick, they can have free reign of the liquids…so that means juice, milk, popsicles, Slurpees or even ice cream. Just something that has liquid form to it! If your child is refusing to take liquids, make sure and call your pediatrician as there are some occasions where a special mouthwash can be used to help with the pain. As far as the rash goes, most children are not bothered by the rash. It doesn’t hurt or itch typically and may only cause mild discomfort when walking for those children that have their little feet covered in blisters.

Now for the last remaining question that every parent asks, “When can my child go back to daycare/school?” and the answer might surprise you. Once your child is fever free for 24 hours and tolerating liquids well, they can return to school. Unlike chicken pox, the hand, foot, and mouth disease rash itself is not contagious! The only time I would recommend keeping kids out of daycare in regards to the rash is if they have many open sores that they are itching as these could easily become superinfected with bacteria (this is not very common with HFM whereas with chicken pox, superinfections of the skin are much more common). The virus that causes hand, foot, and mouth disease can be shed through respiratory droplets for 1 week after the illness and can be shed in the stool for several weeks following symptoms, so by no means are children kept out of daycare or school for this period of time. This is again one of those times where you hope your daycare is doing a good job of wiping down toys, washing hands, and practicing very good diaper changing hygiene!

For those of you who have been “lucky” enough to experience Hand, Foot, and Mouth Disease already, you may say, “Wait a minute! My daycare told me that she couldn’t return until the blisters were crusted/gone.” Well, as I said above, fever free for 24 hours is the main criteria for return to daycare or school, but child care facilities are able to set their own return policies when it comes to infectious diseases like hand, foot, and mouth disease, so in many cases, their policy will be the “law of the land.”

So if the next dreaded sign on the door at daycare reads “Hand, foot and mouth disease,” take a deep breath as you are now armed and ready to deal with this unpleasant but all too common illness of childhood. And as with any illness, if you have specific questions or concerns about your child, please make sure and give your pediatrician a call…it’s what we are here for!

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness, parenting and living in Baton Rouge.

The six things moms need to know about the Zika virus

January 27, 2016 by Dr. Mindy Calandro

The Zika virus is currently being seen in epidemic numbers in at least 22 countries, some of which are popular tropical travel destinations. In fact, the Center for Disease Control for the first time ever issued a travel warning specifically for pregnant women last week cautioning about travel to areas where the Zika virus is rampant. Here is what you might want to know about the Zika virus.

What is the Zika virus and how is it transmitted?

The Zika virus is a mosquito-borne illness that was first discovered in 1947 in Uganda, but until 2007, the virus really was not seen in humans. The Zika virus is transmitted through the bite of the Aedes mosquito, which is also the mosquito responsible for transmitting Chikungunya and Dengue viruses as well. Unlike the Culex species of mosquito that transmits West Nile Virus and mainly likes to bite in the dawn and dusk hours, the Aedes mosquito prefers to feed on its host during the daytime hours.

What are the symptoms of the Zika virus?

It is estimated that 80% of people who are infected with the Zika virus will have no symptoms at all, and the other 20% could have a very mild illness with symptoms such as fever, rash, red eyes and joint pain. These symptoms generally occur within 2-7 days after a person is infected with the virus, and the illness likely will last a few days to a week. There is concern about a possible link between the Zika virus and Guillain-Barre Syndrome, which is an autoimmune related neurologic disease that may lead to paralysis.

So why is it a big deal for pregnant women?

There has been an alarming increase in a birth defect known as microcephaly, or babies being born with abnormally small heads, in countries where the Zika virus is very common. Infants born with microcephaly may also have abnormalities of their brain because of incomplete development. Brazil, in particular, has seen more than 3,800 cases of microcephaly since October 2015, which is more than a 25-fold increase in the rates of microcephaly when compared to previous years. There is also concern that the Zika virus could cause loss of pregnancy. Scientist are feverishly working to determine just how strong the link between the Zika virus and microcephaly and pregnancy loss is, but the trend is concerning enough that health officials have taken notice.

Is this the first virus that can cause problems for developing fetuses?

No. Viruses causing birth defects are nothing new. Viruses such as rubella, cytomegalovirus, parvo B19 and even chickenpox can be transmitted from a pregnant mother to the fetus and can cause a host of problems in a baby ranging from hearing loss to anemia to small size of the baby. However, most women have had either been vaccinated against (think MMR and chickenpox vaccine) or have had these virus by the time they reach childbearing age, and therefore, already have immunity from these illnesses. Since the Zika virus is just emerging and there is no preventative vaccine, we do not have any protection from this virus.

Have there been any cases of the Zika virus here in the US?

No…and yes! 234 pregnant women in the US have been diagnosed with Zika virus, acording to the CDC. The CDC hasn’t disclosed where any of these women were infected with the virus, or how they came in contact with it. So far, three babies have been born in the US with Zika-linked birth defect microcephaly. The defects were also seen in three other pregnancies that ended. All the cases are connected to travel to areas with outbreaks of the mosquito-borne virus, primarily Latin America and the Caribbean. There’s been no local spread of Zika in the U.S.

What should expectant mommies do?

If you were planning a trip to one of the areas on the CDC travel advisory list, I would put those travel plans on hold! We spend 9 months doing everything in our power to protect our growing little bundles of joy possibly giving up our favorite raw sushi roll, our morning extra venti caffeinated latte, or foregoing your next skydiving adventure (not sure that I would ever be brave enough for that one honestly). There is so much about pregnancy that we cannot predict, so in my opinion, we should try to limit those things that are known risks. Until more is know about the Zika virus and how it may specifically affect a growing fetus, I would encourage pregnant women to err on the side of abundant caution and avoid travel to those areas inundated with the Zika virus.

If travel to one of the countries with a Zika outbreak is unavoidable, how can women protect themselves?

You must make sure to take precautions against mosquito bites. Use either a DEET or Picaridin containing mosquito repellent at all times (remember, the Aedes mosquito likes to bite during the day and not only dusk ‘till dawn like other mosquitoes). Also, wear lightweight long sleeves and pants and even clothing that is permethrin-treated to cover as much of the skin as possible. Finally, if your lodging is open to the outdoors, make sure to have a mosquito bed net over where you will be sleeping.

I am not usually one to “sound the alarm” before I have a wealth of data and information in front of me, but the Zika virus and its possible association with a severe birth defect warrants our attention. While a change to travel plans is not convenient (especially when you have been looking forward to crystal blue water, a beach chair and a virgin pina colada), the beaches will still be there in a few months and scientist will have had the time to further research how a tiny virus from a pesky mosquito could cause lifelong problems for your still growing baby.

“Ask the Experts” is a series on Baton Rouge Moms where local experts share their thoughts, opinions and answer questions relating to health, wellness and parenting. If you have a question for one of our experts, please leave it in the comments below to be featured in an upcoming article.

Ask the Experts: Concussion – Symptoms, Causes and Treatment

September 2, 2015 by Dr. Mindy Calandro

“Ask the Experts” is a series on Baton Rouge Moms where local experts will share their thoughts, opinions and answer questions relating to health, wellness and parenting. If you have a question for one of our experts, please leave it in the comments below and they might just answer in an upcoming article.

Now that September is here it means there’s just one question on everybody’s mind: “Are you ready for some football!??!?” Whether you are most excited for the Friday night lights of high school football, Saturday nights in Death Valley (or Kyle Field for my Fightin’ Texas Aggies out there), or “Who Dat” Sundays in the Superdome, I know many people have been (not so) patiently waiting for the past 8 months for football season to start once again. But outside of the excitement of the return of the gridiron, as you’ve likely seen, there has been increasing media coverage over the past few years in regards to sports injuries. Our favorite players, whether they be our sons and daughters on the local peewee or high school teams, or the pros in the NFL, everybody seems to be getting bigger, faster, & stronger at all levels and, in heavy contact sports like football, that means bigger hits and therefore more potential for brain injuries and concussions. So as we prepare for the greatest season of the year (i.e. football season ), here is what parents need to know in regards to concussions in their young athletes.

What exactly is a concussion?

A concussion occurs when there is an injury to the brain that causes disruption of normal brain function. This mechanism of injury typical occurs after a blow to the head. In other words, your hard skull meets another object (someone else’s head, the floor, a ball, etc) that causes the brain to jostle around inside the skull. In sports, we hear the most about concussions in those contact sports such as football, hockey, rugby, and the like, but concussions are also common in sports such as soccer when players’ heads collide, in basketball when a player falls and hits their head on the hardwood, or in cheerleading when a flyer isn’t caught appropriately. It is also common to see concussions after things like car accidents, ATV accidents, boating sports like skiing, wakeboarding, and tubing or even with the occasional nasty fall around the house. In reality, anytime there is a significant enough blow to the head, a concussion is possible.

What are the symptoms of a concussion?

Just as every child’s brain is different, the exact constellation of symptoms of a concussion can vary as well. The most common symptoms include headache, dizziness, blurry vision, light or sound sensitivity, a “foggy” feeling, difficulty concentrating or remembering things, and large alterations or quick swings in mood. While symptoms will often appear immediately after the blow to the head, some symptoms may take hours or even days to appear. Less than 10% of children who suffer a concussion have a loss of consciousness – so don’t automatically assume that if they weren’t “knocked out” that they haven’t had a significant brain injury.

How is a concussion diagnosed?

First and foremost, a child who has sustained a serious blow to the head should be evaluated by a medical professional to determine if they have sustained a concussion. There is no single test that can diagnose a concussion. There are several screening tools available that focus on what symptoms the child is having that can be used in conjunction with a general medical evaluation to determine if a concussion is suspected. Most children who have sustained a concussion do not need imaging of their brain such as a CT scan or MRI. However, only a medical professional can determine if there are worrisome signs following an injury that would warrant taking a look at the brain.

What is the treatment for a concussion?

The most important treatment for a child that has been diagnosed with a concussion is both physical and mental rest. There is no debating the fact that an athlete who suffers a concussion should remain out of sports or any physical activity until 100% symptom free. Returning to sports before one concussion has resolved puts athletes at risk for “secondary impact syndrome” which can lead to more permanent brain damage. Where a bit of discussion comes about in the medical literature centers around the need for rest from all mental activities as well (i.e. schooling). While a few days away from school or reduced cognitive workload for a short period of time may be needed for certain cases of concussions, the latest research is indicating that complete mental rest may actually cause more harm than good. There are certainly more studies ongoing at this time to try and determine the best course of action when it comes to school attendance. However, one thing when it comes to mental rest that is for sure…avoidance of TV, video games, smartphones and other electronic devices is recommended along with the related social media & internet activities that accompany these things (And yes, I can almost hear the universal groan from all of those teenagers out there who read or hear this).

When can children return to sports following a concussion?

Since every brain is different, the amount of time that each brain needs to heal following an injury will also be variable. Many children may have concussion symptoms lasting 1-2 weeks after the injury, but it is not uncommon for these symptoms to linger to some extent for up to 6 weeks. Athletes should be held out of their sport until 100% symptom free at rest. Once symptom free at rest and cleared by a medical professional, a stepwise return to play should be initiated. Most high schools and colleges have a specific 6-step return to play plan of action. In the end, the most important thing to remember is, “When in doubt, sit them out!”

So what about these “baseline concussion screenings” being offered by some schools and physical therapy offices?

Now, here is where we get into the current debate in the concussion world. Should all athletes, particularly high school, college and professional athletes, be required to have a pre-season, baseline concussion screening test? There are several testing tools available, most now computerized, that are aimed at providing an objective measure of brain functioning. The idea here is that by knowing the baseline brain functioning of an individual, those results can be compared to the results when the test is given after suffering a concussion. While I think such testing can provide objective data, it should be remembered that no one single test can determine if a child has either sustained a concussion or has fully recovered from a concussion.

For parents, understanding the signs and symptoms of concussions as well as the importance of rest for a child recovering from a concussion is of utmost importance as we strive the keep our children’s growing brains healthy. What was previously referred to as “getting your bell rung,” we now understand as an injury that can have long term and potentially permanent negative mental effects especially if not allowed to heal properly. So as the countdown clock to kickoff continues to tick away, remember that when it comes to a potential concussion with your young athletes, make sure and get a medical professional involved to assess the situation and follow their recommended course of action. Be prepared to allow the proper time for mental and physical rest critical for healing the brain, and don’t get back to any athletic activities until your athlete is 100% symptom free. And if there’s ever a question, remember the phrase, “When in doubt, sit them out!”

Everyone have a safe and incredible football season, Gig ‘Em Aggies, Geaux Tigers, and Who Dat!