Common September Health Issues for Toddlers

WRITTEN BY CLAIRE KENAMOR

Pediatrics is a truly seasonal profession. Sometimes we see twice as many patients during flu season compared to the rest of the year. Back-to-school physicals in August keep us hopping as well. Our fantastic staff gets used to the rhythm of the year. You would think our two pregnant nurses planned their births around our work schedule, as they are due within one day of each other at the end of October—our slower season. Thank you, ladies!

Back to the busy season, September is known for certain diseases commonly seen in toddlers, described below:

• Strep is a year-round infection but with kids going back to school, it tends to surge. 2023 has already seen unprecedented rates of strep and school is just starting. Impetigo is commonly seen infecting kids’ scrapes and mosquito bites, while it more commonly infects the nose and face during cold and flu season. If the area of “honey crust” infection is smaller than the size of a nickel, antibiotic ointment applied twice daily will likely cure it, but if the area is larger than that or spreading, then oral antibiotics are usually needed. Preschoolers also get “strep butt” manifesting as intense redness and pain in the perianal and prevaginal areas. This is thought to be due to close contact in daycare and the way they slide off the potty seats. Sometimes strep throat presents without a sore throat but with more headache and stomachache.

• Hand, foot and mouth disease is a common virus that causes fever and sores in the mouth along with other parts of the body (hands, feet, face, diaper area, knees). It runs its course without any treatment other than keeping the children hydrated and comfortable. The sores can be so painful that kids drool or refuse to walk on their feet, but fortunately it goes away in a few days. As with any fever, we always want to see the children if the fever lasts longer than three days. Some preschools require a note for us to help families decide when their child is no longer contagious. Typically, this is 24 hours after the last fever and once the sores are dried up.

• Stomach flu caused by enterovirus is a notorious summer and fall virus. Kids will usually start with 24 hours of vomiting followed by several days of diarrhea. Some toddlers only want water or milk when they are vomiting, but water doesn’t maintain their blood sugar enough to prevent development of ketones, making them more nauseated. Milk upsets their stomachs. Pedialyte has the ideal electrolytes but many kids over age 1 find it so salty that they refuse to drink it. In this case, we recommend Gatorade instead because it tastes better. Broths are also well received by this age group. They only need to take about two ounces per hour to keep up. If they are having at least one wet diaper every six-to-eight hours they are not dehydrated. Some kids skip the vomiting and diarrhea phase and only manifest the rash part of this virus, which comes at the end of the contagious period.

• COVID-19 is still going around. Toddlers may manifest this virus with minimal symptoms to a high fever for three days. Kids over 6 months of age are eligible for the vaccine.

• Allergies are often seen in toddlers, just as in adults. Allergies ramp up in March and wind down by November. Spring is tree allergy season, summer is grass allergy season and fall is weed allergy season, especially ragweed. Beginning in preschool, we use 24-hour nonsedating antihistamines like Children’s Zyrtec and Claritin along with Flonase. Prescription Singulair is safe and effective but has a slightly increased risk of causing nightmares or temper tantrums. Just stop the medicine if you think this is happening … I know, it’s hard to tell sometimes! All of these problems will continue up until RSV and flu season with the beginning of the holidays.

Whatever the time of year, we are always available for same-day appointments. Our Pediatric staff is ready to answer your questions and get you in to see us quickly. We pride ourselves in working together to provide comprehensive, timely and efficient care. We have lactation, pediatric cardiology and pediatric endocrinology in-house and round out the rest of the specialty offerings with visiting pediatric specialists from Billings Clinic and Logan Health.

At Billings Clinic Bozeman, pediatric walk-ins are welcome. To schedule an appointment, please call 406-898-1950 or book online at www. billingsclinicbozeman.com. Hours are Monday through Friday, from 8 a.m. to 6 p.m.

Pediatrician Claire Kenamore, MD, is a board-certified pediatrician at Billings Clinic Bozeman with extensive experience providing expert care to children of all ages, from newborns to teenagers. She has cared for children in Montana since 1998.