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By contactus@kidsfirstpediatrics.net
October 22, 2015
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Nosebleed (Epistaxis)

It can be very frightening when blood is flowing from your child’s nose.  Nosebleeds are very common and rarely serious.  They are usually caused by dry air (cold outside air/air conditioned air/dry heat) or by nose picking.

The inside of the nose has lots of blood vessels that are close to the surface so it’s easy for these blood vessels to be irritated or injured, resulting in a nosebleed.

Nosebleeds can occur during a cold or with allergy symptoms when the nasal tissue has become raw and inflamed.  Other times nosebleeds happen after any injury to the face, perhaps after a fall.  Rarely are nosebleeds caused by a serious medical problem.

Medications that are used as blood thinners can cause nosebleeds but these medications are seldom used in children.

Certain nasal sprays that contain steroids can have nosebleeds as a side effect.  These nosebleeds are usually mild and resolve if the spray is discontinued for a week or two.

Nosebleed Care

With the right care most nosebleeds stop on their own.  Here’s what you should do:

  1. Have your child sit bending forward at the waist.  Do not have them lie down or tilt their head back.  This might cause them to swallow blood and can lead to nausea and vomiting since blood is very irritating to the GI tract.
  2. Grip the soft part of both nostrils at the bottom of the nose and apply pressure.
  3. Squeeze nose for at least 5 minutes.  If you release the pressure before 5 minutes the bleeding may recur and you will need to hold for another 5 minutes.
  4. You may also apply a cold compress to the bridge of the nose.  This will help the blood vessels to constrict and slow the bleeding.

If you follow these steps and your child’s nose continues to bleed, repeat all steps and apply pressure for up to 30 minutes.  If the bleeding continues after this then emergency care is needed.

If your child’s nosebleeds are very frequent or prolonged there might be an underlying problem. There might be a large blood vessel near the surface of the nasal tissue.  If this is the case the bleeding is often from only one side of the nose.  In this case a referral to an Ear, Nose and Throat specialist might be needed.  These specialists have the equipment to visualize the upper part of the nose to locate and treat the offending blood vessel.

Another less common problem causing prolonged frequent nosebleeds is a bleeding disorder called “Von Willebrand’s Disease”.  In this case the bleeding should be from both nostrils and there might be a family history of nosebleeds or heavy periods in female relatives.  This disorder can be diagnosed with a blood test, preferable at the time of the bleeding.  Patients with this disorder are referred to a hematologist (blood doctor) for treatment and do very well with medication.

Nosebleed Prevention

Here are some measures to try to prevent nosebleeds:

  1. Use a humidifier in the bedroom, especially in winter when the dry heat is turned on.
  2. Keep inside of nose moist using nasal saline spray or gel or applying Vaseline to inside of nose at bedtime.
  3. Avoid nose picking and keep fingernails short

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics


By contactus@kidsfirstpediatrics.net
June 03, 2015
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Spring is finally here!  Sunny warm days, flowers, green grass, budding trees and “Achoo!!”, allergies.  Yes, spring is beautiful but some children find it difficult to enjoy due to allergy symptoms.


What causes allergy symptoms?

Allergy symptoms occur when your body comes in contact with an allergen.  An allergen is a normally harmless substance such as pollen or animal dander that some people are oversensitive to.  When a susceptible person is exposed to an allergen, his or her immune system overreacts and goes into action.  This produces the symptoms of an allergic reaction.  There are many types of allergies and allergic reactions but we will focus on the reactions typical of spring time allergies, allergic rhinitis and allergic conjunctivitis.


Who is at risk for allergies?

Allergies can develop at any age but they most commonly show up during childhood or early adulthood.  It has been estimated that between 10 to 30 percent of adults and children have allergic rhinitis (hay fever). Allergies tend to run in families.  A child with one allergic parent has about a 25% chance of developing allergies; if two parents are allergic then the risk increases to about 60%


What are the symptoms of springtime allergies? 

Red, watery, itchy eyes; puffiness around eyes; sneezing; runny itchy nose; post nasal drip; nasal swelling and congestion; itchy ear canals, itching of the mouth and throat; dry cough; hives; headaches; irritability.


How can you help your child find relief of these symptoms?                  

If you know your child’s triggers for allergy symptoms then avoiding them when possible is ideal.  If your child has been outside, showering and changing as soon as they come in will help.  Also, rinsing your child’s nose with a saltwater rinse (available over the counter) can help. Artificial Tears can provide relief from eye irritation, especially if refrigerated, and can help decrease eye rubbing.  You can also try over the counter antihistamines.  Allegra, Claritin and Zyrtec are safe if used as directed.  These antihistamines are less likely to cause sedation than Benadryl which works very well for allergy symptoms but might cause your child to fall asleep in school.  Over the counter decongestant nasal sprays should be avoided since they can be “addicting” and can cause worse congestion when stopped.

Other allergy medications include steroid nasal spray (Flonase, Rhinocort, Nasacort). These medications were formerly available only by prescription but now are OTC (over the counter).  These medications are safe if used correctly although they can cause nosebleeds if used for prolonged periods. Other nasal sprays are also available (Nasalcrom, Atrovent, Astelin).  These are not steroid preparations and each works in a different way to control allergy symptoms. Singulair, an oral medication, is used for asthma and allergies.  It is a leukotriene modifier.  Leukotrienes are chemicals that your body releases when you breathe in an allergen.  These chemicals play a key role in causing allergy symptoms.  Singulair works to inhibit leukotrienes, thus preventing allergy symptoms.


Antihistamine eye drops are also available for children with severe allergic eye symptoms. Many of these medications are available over the counter.  Eye drops that claim to “get the red out” should be avoided, since they can have serious side effects.

Most children will find significant relief with the over the counter medications by themselves or in combination with prescription allergy medication.  If your child continues to be miserable despite all of these therapies then your child’s pediatrician might suggest an appointment with an allergist.


Article written by Sue Gaston, M.D.

KidsFirst Pediatrics

By contactus@kidsfirstpediatrics.net
January 23, 2015
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 Winter has really arrived, lots of snow and freezing temperatures.  Days are short and sunlight is rare.  This lack of sunlight can affect our  mood and our health.

One problem with the cold weather and cloudy days is our minimal exposure to sunlight.  This is a health concern since almost all of the vitamin D in our bodies comes from exposing our bare skin to the sun.  Most foods only contain small amounts of vitamin D.  The exception to this is cod liver oil, which contains 680 units of vitamin D per ½ tablespoon.  That’s great to know but, truthfully, who will take ½ tablespoon of cod liver oil daily?

The other problem with cod liver oil besides the taste is that it contains very large amounts of vitamin A and excessive vitamin A can be toxic.

             Other foods with naturally vitamin D are:

  • Fish (Salmon 360 units in 3.5 oz.; Mackerel 345 units in 3.5 oz.; Tuna, canned in oil 200 units in 1.75 oz.; Sardines 250 units in 1.75 oz.)
  • Milk Vitamin D fortified (nonfat, reduced fat and whole) 1 cup has 98 units
  • Egg, 1 whole (Vitamin D is in yolk) has 20 units
  • Liver, beef 3.5 oz. has 15 units
  • Ready-to-eat cereal, fortified 1 cup has 40 units


So how much vitamin D do we need to stay healthy?

Here are thelatest recommendations for daily vitamin D intake:

                     * Infants:     400-600 units

                     * Children:  600-1000 units

                     * Adults:      600-1000 units (some experts recommend even higher amounts)

           The Vitamin D Council recommends taking the vitamin D3 form rather than vitamin             D2.         

            Vitamin D3 is the type of vitamin D that our bodies produce in response to                                      sun exposure while vitamin D2 is not.

          So, why do we need vitamin D?  Most people know that vitamin D is essential for strong bones.  There is also some evidence that deficiency in vitamin D causes poor growth, fatigue and irritability.  More recently, associations have been made with vitamin D deficiency and Type 2 diabetes, some cancers and rheumatoid arthritis.  Vitamin D deficiency might also be a factor in autoimmune disease.  Research is ongoing in these areas.

Are there instances when a person should not take vitamin D?  Yes.  Patients taking certain heart medication and hypertension medication should check with their physician before starting vitamin D supplements since these medications might interact with vitamin D.  Other conditions where vitamin D might be a problem include, certain cancers, kidney disease and high blood calcium levels.

In summer it might be possible to make adequate amounts of vitamin D just by sun exposure.  The amount of time necessary to generate 600 units of vitamin D varies by skin type and location as well as amount of skin exposed.  Very fair skinned people need less sun exposure to make the same amount of vitamin D as dark skinned people.  The general rule is to get half the sun exposure it takes for your skin to turn pink.  So, if your skin becomes pink after 20 minutes in the sun then 10 minutes is enough time to get a good dose of vitamin D.  Sunscreen is still necessary to avoid sunburn.  It’s important to use common sense to get the right amount of sun exposure (and vitamin D) without injuring your skin.

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics

By contactus@kidsfirstpediatrics.net
November 11, 2014
Category: Uncategorized
Tags: fever   sick  


Most parents have experienced waking in the middle of the night to find a child hot and flushed with fever.  This can be pretty scary since most children with fever are usually very fussy and just look miserable.  It’s helpful to realize that, in healthy children, fevers usually don’t indicate anything serious.  Fever itself causes no harm and can actually be a good thing—it’s often the body’s way of fighting infection.  Not all fevers need to be treated.  High fevers can, however, make a child uncomfortable and worsen problems like dehydration. 


So, let’s talk more about what fever is and why it happens.  Fever occurs when the body’s internal “thermostat” raises the body temperature above its normal level.  This thermostat is found in the hypothalamus (part of the brain).  The hypothalamus is responsible for maintaining a normal body temperature.  This “normal” temperature can fluctuate during the course of the day.  Our body’s temperature is usually a little lower in the morning and a little higher in the evening or when we exercise.

Sometimes the hypothalamus will “reset” the body’s temperature to a higher degree in response to an infection/illness.  It is believed that increasing the body’s temperature is a way of fighting the germs that cause infections. Fever is not an illness, it is usually a symptom of an underlying problem. 


Fever is usually caused by infection but can also be caused by overdressing (especially in infants).  Immunizations can cause fever.  Fever can be caused by the environment (think of being in a hot car without AC in the summer)



When do you need to worry about fever?

This depends on the age of your child.  If your child is younger than 2 months of age and has a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher you need to call your doctor or go to the emergency department immediately. This is because newborns are exposed to bacteria during the birth process. These bacteria could possibly cause problems up to 2 months later. Newborns have difficulty fighting infections and become seriously ill rather quickly.  Tylenol or other fever reducers should not be given to an infant younger than 2 months. 

Fever in children with chronic medical problems can also be serious and these children’s parents need to contact their doctor immediately if they have a fever.  A few examples of these problems include sickle cell disease, kidney disease, cystic fibrosis and leukemia as well as many others.

So how do you know if your child’s fever is due to a serious infection?  The illness is probably not serious if your child:

---is still interested in playing

---is eating and drinking well

---is alert and smiling at you

---has a normal skin color

---looks well when his/her temperature comes down

It’s also important to realize that most children with a fever don’t want to eat.  Don’t worry, as long as they are drinking and urinating normally. It isn’t dangerous to eat less for a few days. 

You should also know that the height of a fever has nothing to do with the severity of the illness.  A simple cold or other viral infection can cause a fever up to 104 degrees F while a serious bacterial infection might not even cause a fever.

Children with fevers often breathe faster and have a faster heart rate.  Unless this is extreme it is usually not a problem, just an effect of the fever.


So next time your child has a fever, don’t panic.  If he/she looks uncomfortable, give them the appropriate dose of Acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin---only give if over 6 months of age).  Do not give your child aspirin unless instructed by a doctor.  Encourage your child to drink lots of fluid and have them rest in cool quiet area.  If your child appears very ill after this then call your doctor.  If your child appears much better after fluids and fever treatment then continue to monitor and follow the advice given above. 


Article written by Sue Gaston, M.D.

KidsFirst Pediatrics

By contactus@kidsfirstpediatrics.net
October 10, 2014
Category: Uncategorized
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Fall is just around the corner with its crisp cool mornings, blue skies and colorful leaves.  Fall is also a time for allergy symptoms to start or worsen.

Some allergies are easy to identify but others are not.  Here are some symptoms that,  if present frequently, might point to an allergy:

  • Runny Nose
  • Stuffy Nose
  • Cough
  • Sneezing
  • Throat clearing
  • Nose rubbing
  • Sniffing
  • Itchy, watery eyes
  • Snorting             



Allergies that are present all year may worsen in the fall/winter when we spend more time inside.  These allergies include dust and pet allergies. 

Mold allergies are especially bothersome in the fall since mold is present in decaying vegetation and fallen leaves.

How can you help your child control allergy symptoms?

The best solution is to limit or avoid contact with allergens.  If your child has a mold allergy he/she should not play in piles of fallen leaves.  If your child has a dust allergy it is important to limit dust-collecting items in the bedroom, such as stuffed animals, and to dust/vacuum twice a week.  Special pillow and mattress covers are available to limit exposure to dust mites.

Many over the counter medications are available and often work well. These include: Claritin (loratadine), Zyrtec (cetirizine), Allegra (fexofenadine) and Benadryl (diphenhydramine).  If your child has no relief with these medications there are several prescription medications available that might help.  Check with your child’s pediatrician for advice.

The fall can also be a difficult time for children suffering from asthma.  The airways of children with asthma are inflamed and hyperactive which makes them overly sensitive.  When they come in contact with an asthma 'trigger' (something that causes an asthma attack) the airways overreact by constricting (getting narrower) and becoming inflamed.  Many different things can 'trigger' an asthma attack.  These include exercise, cold air, viruses, air pollution, food allergens, certain fumes and tobacco smoke.  Approximately 80% of children with asthma also have allergies. 

Children with asthma often use 'controller medications' to prevent their asthma symptoms.  These medications include Singulair (monteleukast) and inhaled steroids.  These medications are sometimes discontinued in the summer when most children with asthma have fewer symptoms.  It is usually a good idea to restart these medications once school starts, before asthma triggers cause problems.

Finally, influenza is a potentially serious infection for all children; especially those with asthma so don’t forget your flu shot!    


Article written by Sue Gaston, M.D.

KidsFirst Pediatrics


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