Attacking asthma before it attacks you!

   Those of you whose kids are moderate to severe asthma sufferers probably dread the fall and winter months and all of the viruses and upper respiratory infections that go along with the cooler weather. Back to school is code for "cesspool of germs" when your child is asthmatic because the schools are the perfect breeding ground for germs where  many children are packed into tight areas all day long. 


   This blog is probably sparking you to say, "I had better start up my child's preventive asthma inhaler and allergy medications again." When really, your child should be on asthma medications year-round if prescribed by the doctor as such. But, most parents become complacent during the warmer months when viruses and other infections are less likely. Their kids seem to be doing well, not using their rescue inhalers and can play alongside friends without difficulty.  This however, is a facade! 


   An asthmatic's lungs are always asthmatic, not just when there is an infection present. So why does a child seem fine sometimes, even when they are off of all medications? The answer lies in the fact that an asthmatic lung that is not stressed by exertion, exercise or illness does not need to use the parts of the lung that are farthest out from the bronchial tree for day to day activities. So, a child will seem to feel fine and will not wheeze. The problem is that inflammation continues throughout the entire lung, but especially in the lower or more distant airways that are very small. When an illness hits, and the entire lung capacity is needed to oxygenate the blood, the already severely inflamed small airways are not able to help and the larger airways have to work overtime. The larger airways at that time become more and more inflamed, and bronchospasm occurs which means that the muscle running around the airway constricts, making an even smaller passage for air to move in and out. 


   This is when your child hits the point that you will realize they need both the preventive medication as well as rescue medication such as Albuterol or Xopenex every 4 hrs or so. Now, it is too late. The path has already been set into motion and the only way to fix it is to start systemic steroids, give rescue treatments very frequently and perhaps need an admission to the hospital for even further intervention. This whole process could have been prevented by continuing preventive asthma medications (inhaled steroids) year round as prescribed by the doctor. Be sure to talk to your child's doctor before the next asthma attack to see if this is necessary for your child.


See this following diagram borrowed from the Contemporary Pediatrics Magazine in the July 2011 issue, Vol. 28, No. 7

Abdominal Pain in Kids - When to Worry

Every child at some point has complained of abdominal pain, but it is when a child keeps complaining that parents rightfully become worried. The sources of abdominal pain can be many including a virus, a urinary tract infection, strep throat, constipation or even more worrisome, possible appendicitis or obstruction. So, how do you know when to seek medical attention?

 The most worrisome symptoms include severe abdominal pain, especially when it is in the right lower quadrant of the abdomen, abdominal pain with persistent vomiting and no diarrhea, pain with walking or movement, abdominal pain associated with bloody stools, or abdominal pain with high fever just to name a few. These symptoms always warrant urgent medical attention and often require further testing to determine the cause. 

Less worrisome symptoms include mild or intermittent abdominal pain, pain that only occurs when a child does not want to do something, or pain that is associated with constipation. Constipation is the most common cause of recurrent abdominal pain in children and can cause significant pain. Often, a child will have a bowel movement every day or two, so parents don't think of constipation. However, if asked, the child will likely describe painful or bulky bowel movements or sometimes they will complain of leakage of loose stool. Leakage of loose stool sounds like diarrhea, right? Well, often, it can be a sign of a large stool ball in the left colon that is not going anywhere, so loose stool will leak around, often causing incontinence of stool. So, if you suspect your child is constipated, try the standard dietary changes that include increasing fiber (prunes are a great source of fiber), increasing water intake, decreasing milk and cheese intake and decreasing the junk food. If these measures don't help, or the pain worsens, this warrants medical attention.