It is the time of year when I start to get many patients asking me if they have a cold or is this flu, and how can you tell? Well, it is usually fairly easy as you are so much sicker with the flu! Currently we are seeing tons of colds and I have YET to diagnose a case of flu, although there is beginning to be sporadic cases reported around the country.
A cold typically starts with a runny nose, or a scratchy throat, and then progresses to congestion, cough and feeling yucky. Young children may run a fever during the first day or two of a cold, and older children just "feel warm" but typically don't run much of a temperature. Despite feeling yucky you can keep going with a box of Kleenex at your side. Most children (and adults) are not bedridden with a cold.
Not so with flu, it hits you like a steam roller!! You suddenly feel sick and it all happens at once. Fever, chills, cough, congestion, sore throat, body aches all attack at the same time. From babies through teens, you can just look at them and know they are sick. The fever with the flu is usually higher and lasts longer than a cold. Flu even makes toddlers sit still and bed is usually the only place a teen wants to be. Adults just wish they could roll over and "fade away" for a few days (but parental duties continue to call, especially if the entire family gets the flu.)
A cold usually lasts anywhere from 7 - 14 days, but you feel the worst for the first few days and are then just bothered by the congestion and cough. (Read old blogs on colds). On the other hand, the flu usually lasts anywhere from 3 -7 days with fever, body aches, a terrible cough and congestion. The cough from the flu seems to go on for weeks. Children often run temperatures anywhere from 101 - 104 and are pretty miserable. Adults feel terrible with any real fever! In most cases the flu is entirely an upper respiratory virus. Occasionally a young child might vomit with the flu but that is not the typical presentation.
Although I know that flu comes every year, I cannot predict if it will last 3 days or 5 days or even 7 days until you actually begin to see cases. I can remember some years past when many children ran high fevers for 7 days with the flu during a particularly bad flu season. Best advice is to get the vaccine before we even start to see influenza! It is not an illness that you can "brush off", it sticks like glue and you know when you have it!
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You know there really isn't as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil).
Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a cosmetic problem for a baby as it looks like a yellowish plaque on a baby's scalp and is often not even noticed by anyone other than the parents.
Unlike seborrheic dermatitis in adults, cradle cap typically doesn't itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby.
These hormones cause the sebaceous glands to become over active. In some severe cases an infant's scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces.
The treatment for cradle cap is to wash the baby's scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby's eyes).
This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby's head and let it sit (I left a small amount on my children's heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily.
For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant's eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem.
As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called malessizia so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works.
I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don't like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea!
That's your daily dose, we'll chat again tomorrow.
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The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind. The perfect storm for the "allergic cascade" to inflict itself on everyone's nasal mucosa.
The best preventative for nasal allergy symptoms (allergic rhinitis) has been the use of intranasal steroids. These steroid sprays have been used for the past 15 years and clinical studies have shown that intranasal steroids are superior to oral antihistamines.
Intranasal steroids function by inhibiting the production of chemical mediators such as histamine and prostaglandin that cause inflammation and mucous production. In other words they are more of a preventative medication, while an antihistamine is treating the histamine that was released once you inhaled the offending tree or grass pollen. Intranasal steroids may also help eye allergy symptoms too.
The problem is getting young kids to let you use a nose spray on them. The same holds true for the older tween and teen crowd who complain that they "just don't have the time to use it everyday" (it must take all of 15 seconds to use on yourself!) They have been shown to be effective within 3-12 hours, although will reach their maximum effectiveness after several days to weeks of use, so using it daily and throughout the allergy season is going to give you the maximum therapeutic effect.
There are many different brands available and everyone seems to have their favorite. If one spray seems to bother your child due to scent, or intensity of the spray ask your doctor to try another brand. Many times they will have a sample and give you several to try and then prescribe the one that is easiest to get your child to use. It may be trial and error, but finding the right nasal steroid may just change your allergy season.
That's your daily dose, we'll chat again tomorrow. Oh, God Bless You!
Send your question to Dr. Sue!