"She has Scarlet Fever"

It started with a low-grade temperature, sneezes, and general fatigue on Thursday. She did mention a sore throat (which made me think Strep throat right away). I kept my daughter home from preschool. Each time I measured her axillary (under armpit) temperature it was normal, but her tactile temperature felt much warmer. She even looked flushed. In the afternoon, it actually was 98.9 degrees F (at or above 99 is considered a fever). I didn't quite trust the digital thermometer because she still felt warm and she kept saying she was cold. By the way, KidsHealth offers a terrific summary of fever in children. My daughter was actually very whiny and looked ill. I offered her chewable acetaminophen (generic Tylenol) tablets to help her rest better (note, I expected her to refuse). She took all 3 tablets and actually liked it. After a while, she took a nap. I kept asking her if her throat still hurt, and she kept denying it. So much for my strep theory. She also slept through the night.

The next morning, she asked for more acetaminophen, but she clearly did not need it. She claimed that her throat hurt a little. After she drank some water, she said it was better. Maybe because I kept offering to take her to the pediatrician if her throat still hurt. In any case, she looked 100% better and was jumping, singing, and dancing. I wondered if I should let her go to school, but it was suggested that she go because she's turned around. "Does your throat hurt?" "Just a little." Later, "no." She was fine the rest of the day; just one or two sneezes. There was a case of strep reported in the 3's class. Since she didn't ever have a fever, I kept it on the back burner. What my daughter has is probably just viral; the common cold.

Saturday morning, my husband noticed a rash on her cheeks. He relayed that to me, but I must not have heard him. Her throat hurt in the morning, but then it didn't. We went to a ballet performance and then a late lunch/early dinner. No sneezing. She ate like a champ. In the evening, though, when I gave her a bath, I noticed a rash on her back, her trunk, and her pelvic area. There were a few blotches of red, but the rest were small and skin colored. They felt like sandpaper. They reminded me of goose pimples. We thought she might have fifth disease, which is caused by parvovirus. She did develop the rash 2 days after the "fever" and she was flushed (slap cheek). Since she didn't have a fever, I decided to wait until Monday to bring her to the pediatrician to take a look. In 5th disease, once the rash breaks out, the child is no longer contagious. Here is a good collection of skin rash photos.

On Sunday, she developed a few little red lesions around her mouth, but otherwise fine. We ran errands and all was well. The red lesions on her body were fading in color, but the sandpaper rash was still there.

On Monday, the lesions around her mouth were still there. She woke up a little later than usual, but was chipper. I brought her to school and then was able to schedule an appointment with the pediatrician. When I brought her in, he took one look at the rash and said, "She has scarlet fever." He then looked at her throat and took a sample for a throat culture. She was started on cefdinir (Omnicef) twice a day for 5 days. Sure enough, the culture was positive for strep in less than 24 hours. I should have trusted my initial instinct.

Cefdinir liquid is white and tastes bitter (not like the acetaminophen chewable tablets), but I explained to my daughter the rationale for taking this. I let her eat a piece of gummy candy and then drink from the medicinal spoon. We repeated this a few times. I even diluted the remaining volume (1 mL with water), but she quickly asked if she had to drink it all. Next time I will not dilute it with so much water. This morning, she refused to take it, but I gave her a freeze pop to numb her tongue and to cleanse her palette after each swallow. It worked like a charm.

We're home for a couple of days because scarlet fever is highly contagious. She will be allowed to return to school after being fever-free for 24 hours and after taking a full day of her antibiotic. The nurse also told me to change her toothbrush after 48 hours of starting her antibiotic. We're expecting some peeling later on in the week, but she' recover. Scarlet fever is not as life-threatening as it seems if treated in a timely manner with appropriate therapy. I'm glad I brought her in.

Get ready for flu season 2009-2010

This week, the CDC released a new guidance to help minimize the spread of any flu virus in child care and early childhood programs during the 2009 and 2010 season. This toolkit contains resources for providers and parents, including action steps for parents to protect your child from the flu, action steps for parents of children at higher risk for flu complications; action steps for parents if children are sick, or if the child care/early childhood programs are closed, and must stay home; and action steps for providers regarding daily health checks for children, staff recommendations, and decision-making about closures. These can be found at the CDC website.

General tips from the CDC to protect you and your child include:

1. Get you and your child vaccinated for seasonal flu AND H1N1 flu (when available); caregivers for children under 6 months should consider vaccination
2. Stay home if you or your child is sick for at least 24 hours until after a fever breaks (temperature is < 100 degrees Fahrenheit or < 37.8 degrees Celsius) or there are no more feeling of chills, feeling warm, flushed appearance, or sweating
3. Practice good hand hygiene with proper handwashing using soap and water or an alcohol-based hand sanitizer
4. Cover the mouth and nose with a tissue when sneezing or cough/sneeze into elbow or shoulder, not hands
5. If someone at home is sick with the flu, children in the household should stay home for at least 5 days from the time the first person got sick
6. Keep your child home for at least 7 days if your child is sick, even if they are ready to run and play before that. If your child is still sick after 7 days, keep him/her home until 24 hours after the symptoms have completely gone away.
7. Seek urgent medical attention if one or more of the following signs are noticed:

fast breathing, trouble breathing, shortness of breath, or stopping breathing;

bluish, purplish, or gray skin color especially around the lips and the inside of the mouth, or around the nails;

not drinking enough fluids, refusing to drink;

not urinating, decreased number of wet diapers, or no tears when crying;

severe or persistent vomiting;

not waking up or not interacting (e.g., unusually quiet and inactive, no interest in playing, no interest in favorite toy);

being so irritable that the child does not want to be held, or cannot be consoled;

pain or pressure in the chest or stomach;

sudden dizziness;

confusion; and

flu-like symptoms improve but then return with fever and worse cough.

Don't wait on managing preschooler's weight

I have a 40-pound preschooler, but she's been steady at this weight for almost a year. She is also very tall for her age. Still, I need to make sure she eats right and stays active so that she does not become a statistic quoted by the CDC: 1 in 7 children ages 2 to 4 years is obese. Obese preschoolers are at risk for developing diabetes, high cholesterol, and asthma later in life. Don't wait on managing the little one's weight. Reduce the risk of obesity by avoiding sugary drinks and high-calorie snacks and encouraging fruits, vegetables, and maintaining an active lifestyle (no more than 2 hours of television per day). Breastfeeding is also recommended, but I also have a 30-pound toddler, so I have some work ahead of me. Here are some tips on how to help your child maintain a healthy weight.