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INFLUENZA VACCINE

We We have received some of our supply of influenza vaccine. Those of you who prereserved the flu vaccine or who received one her last year, should have received a postcard advising you that the vaccine is here and to call and make an appointment.

Ple Please be aware that your account will be charged for failure to use the reserved vaccine.

MONONUCLEOSIS

Mo Mononucleosis (mono) is a viral illness, caused by a virus called Epstein-Barr virus (EBV). The symptoms of mono in the acute pha phase include sore throat, swollen red tonsils with pus, swollen lymph nodes, especially in the neck area (commonly termed sw“"swollen glands") and fever. The virus is transmitted via saliva, such as kissing, sharing water bottles or other drinking vessels or pro prolonged contact with coughing and sneezing. Mono is actually not as contagious as many other infectious diseases, such as strep. p. It is most contagious while a fever is present. There is still a small amount of virus carried in the saliva for up to six months. The abo above symptoms last for about a week. Following that, most children and adolescents have varying degrees of fatigue. Once the acu acute phase of the illness is over, your child can return to school as long as they are not too fatigued. Some children need to ret return to school for short periods at time at first.

Although mono occurs most commonly in people ages 15-25, it can occur at any age. We have been seeing children much younger than that with the illness. The diagnosis is made by a blood test. We either do a screening test by fingerstick in the office or send the child to the lab for more comprehensive testing.

The complications of mono are dehydration in the acute phase of the illness secondary to the pain and swelling of the tonsils and throat, and an enlarged spleen. The risk of having an enlarged spleen is important because when the spleen becomes enlarged, it is at risk of being injured or ruptured. We therefore have your child avoid contact sports and other sports which could cause injury by being hit with a ball or bat or racket, until 3-4 weeks after the diagnosis is made. If there is left upper abdominal pain during any point in the illness, you should call us.

Because mono is a viral illness, there is no medication which treats the virus directly. The treatment is mostly symptomatic relief with acetaminophen or ibuprofen for pain and making sure your child is drinking enough fluids. Sometimes if we see that the tonsils are so enlarged and the patient is not drinking well, we will treat him or her with a short course of oral prednisone to decrease the swelling.

W We then usually recheck the patient weekly until they are better.

CONSTIPATION

We frequently receive calls regarding constipation. Constipation is painful, hard stools, inability to pass stools or very infrequent stools (more than 4-6 days apart).

Infants may often seem to be in pain while attempting to pass stools. They may grunt, pull up their legs and become red in the face. This is because their abdominal muscles are not very strong and it takes more effort to push out a stool than it does for an older child. It is also more difficult to pass stool lying down than sitting or squatting. These signs do not mean the baby is in pain or constipated.

Constipation is often caused by a diet without enough fiber or fluids. Excessive milk intake can also cause constipation. In an older child, especially during toilet training, it can be caused by holding in the stools. This leads to hard painful stools, which can then create a vicious cycle of holding even more. There may then be leaking of stool, called encopresis.

The initial treatment for constipation should be dietary management. Try increasing fiber and fluids and decreasing constipating foods (bananas, rice, excess milk). For infants who are not yet on solid foods, you may add extra water. For older infants and children, add fruits, vegetables and juices. For even older children, add bran or wheat products.

If your child is stool-holding, try to establish a regular pattern of sitting on the toilet and call us if there are still difficulties. If this occurs during toilet training, you may need to stop the toilet training for a while.

Sometimes the constipation may be severe enough to cause an anal fissure, which is a small tear in the anal area, canal or skin. You might then see streaking of blood on the stool or on the toilet paper. Usually resolving the constipation and using a healing ointment such as A & D will resolve this. However, if it continues or if there is a lot of blood, you should call the office.

If dietary measures do not help, we might suggest that you use a medication called Miralax. This recently became available over-the-counter, but you should call us for instructions. Often an enema or suppository will be necessary first.

PINWORMS

Pinworms are thin, small white worms that look like a piece of thread or lint. They usually appear in the anal area, but also can be found in the vaginal area in girls. They are not a serious ailment but are very irritating. They cause severe itching and can be difficult to get rid of.

They usually itch most at night, which is also when they can be seen. If you suspect that your child has pinworms, the best time to look for them is during the night while he or she is asleep. If you don’t see the worms, you can perform a test to look for the eggs. You can use Scotch tape or get a test kit from the laboratory or our office. If you suspect that your child has pinworms, we can instruct you how to perform the test and then treat (by a prescription medication) if necessary.

Pinworms are contagious. Family members may spread them; however, most children get them from other children. Children contract them by swallowing the eggs. To prevent or reduce this spread, clean your child’s hands and fingernails well, especially after he or she uses the bathroom, and vacuum the house, especially the bedrooms, well. You also need to clean all bedding and clothing which has been worn. Normal machine washing will be enough to kill the eggs. If your child is diagnosed with pinworms, we usually recommend that the entire family be treated.

44 Godwin Avenue, Midland Park, NJ 07432 (201) 444-8389

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