Chapter 8: Avoiding Panic

AVOIDING PANIC WHEN YOUR CHILD IS ILL

It’s human nature for parents to worry about their kids, fearing the worst with each illness or injury. Although extremely few pediatric illnesses are serious, it’s hard for Moms and Dads not to be anxious. Signs and symptoms of minor ailments are often mistakenly attributed to serious illnesses, creating panic. Pediatricians spend a lot of time reassuring parents, explaining that very few tummy aches are appendicitis, very few headaches are brain tumors and stiff necks are almost never meningitis.

Where in the world did you hear?

He’s got a bad tummy ache. It’s probably his appendix.

Sound Advice

Tummy aches are, without doubt, the most common complaint brought to pediatricians.   No other symptom brings more concern and speculation. No other complaint has so many possible causes.

Yet most acute abdominal complaints are related to minor illnesses such as stomach viruses, colds, and “strep” sore throats. When tummy aches seem to recur, constipation, excessive acid, food intolerance, or irritable bowel are the usual causes. And some complaints are merely attention-getting devices or excuses to avoid school.

In an otherwise healthy child, the single most common cause of recurrent tummy aches is constipation. This condition, often unrecognized by parents, accounts for more abdominal pain than all other causes combined. Many children are so used to passing large, even adult-sized stools that their family mistakenly considers this pattern to be normal. Worse, many parents, although suffering from constipation themselves, don’t have a clue about the stool habits of their toilet trained children. Kids who are constipated often have severe, crampy abdominal pains, especially after meals. They fail to have daily bowel movements, the stools are large, sometimes resulting in toilet stoppage, and they have a great deal of flatulence. If left alone, constipation may worsen with time, resulting in fecal soiling, embarrassment and needless guilt. Constipation should not be ignored. Ideally, all children should pass at least one soft stool every single day.

Remedies include dietary changes, fiber, stimulants, softeners and agents which add liquid to the stool, such as propylene glycol (Miralax.) Parents must become aware of variations or delays in stooling and, even in the absence of tummy complaints, must occasionally ask to peek at the stool before the toilet is flushed. The pediatrician can be a big help in guiding the parents through the frustrating maze of treatments. At times, it’s necessary to enlist the help of a Gastroenterologist but parents should not be discouraged since almost all constipation can be cured.

How will we know if abdominal pain is caused by something more serious than a virus or constipation?  How do we tell if the child has appendicitis?  There are no sure fire signs that clearly indicate a hot appendix but most kids with appendicitis have steady pain which doesn’t go away , most commonly felt in the area around the belly button or the lower right side of the abdomen.  The pain is often severe enough that walking upright is difficult.  Don’t count on fever, vomiting, or diarrhea to suggest a diagnosis since stomach viruses can cause the same symptoms. However, vomiting which comes right after a burst of pain is suspicious. When in doubt, a visit to the doctor for an abdominal examination is a wise move, If the doctor is suspicious, lab tests or even a CT scan may be necessary.  Happily, the vast majority of children with abdominal pain don’t end up in the operating room.

The Conclusion

Most tummy aches in children are caused by common conditions which are easily treated. Appendicitis is relatively rare. Don’t ever panic. It doesn’t help. Be sure to consult with your child’s doctor when tummy aches persist. A visit to the doctor’s office may be in order.

Where in the world did you hear?

 A stiff neck may mean meningitis.

Sound Advice

A complaint of a painful neck will almost always land a child in a doctor’s office. No matter how well the child appears, the specter of meningitis materializes as soon as the words “my neck hurts” are uttered. I can’t tell you how many times a frightened mother has brought her playful, but complaining, child into the office worried that this may be the beginning of a serious illness. The fears are unfounded. Meningitis, an infection of the lining of the brain and spinal cord, does not present itself in this manner. Patients with meningitis almost never complain that their necks feel stiff.  They’re just too sick. Most children with this scary condition are “out of it,” barely able to lift their heads, usually running high fever and having vomited at least once, perhaps many times. Children with meningitis look gravely ill, not just flu-like. The stiff neck of meningitis is actually an involuntary resistance encountered only when the physician performs a neck flexion maneuver, not a complaint by the patient.

Tearful complaints of “stiff necks”are common in kids who are not sick, but suffering from torticollis, painful spasm of the muscles on one side of the neck, something like a “Charlie horse.” The children are very uncomfortable, having to keep their heads tilted to one side until the pain subsides. But they’re not ill and usually require no more treatment than local heat, ibuprofen and about 48 hours of taking it easy.

And viral illnesses too, especially the Flu (Influenza) can result in painful muscles, including the neck. Parents sometimes panic when their feverish child complains of muscle pain near to the shoulder or the neck. But these kids, although sick with the virus, are not seriously ill. Any alert child who can voluntarily complain about pain in the neck area does not have meningitis, as proven by the physician when he gently, but successfully, flexes the patient’s neck. And one more sign that’s most important: kids who have meningitis don’t smile.

The Conclusion

Don’t panic. Stiff or painful necks in an alert, active child is never a sign of meningitis.

Where in the world did you hear?

If your child gets headaches, maybe it’s a brain tumor.

 Sound Advice

Kids get lots of headaches, but tumors, thank goodness, are very uncommon. Hardly a day goes by without the pediatrician dealing with headaches. In fact, studies have shown that, by the time children reach 15 years, as much as 82% have experienced headaches.

In the pediatrician’s office, the most common causes of simple headaches in children are viral illnesses, with or without fever. The parents may not even be aware that theft child has fever until there is a complaint of a headache. These headaches always respond to tylenol and fluids. Certainly no cause for alarm.

Recurrent headaches can be debilitating and depressing. By far, migraine headaches are the most common cause of recurrent pain, causing 44% of all chronic headaches in children. Migraine headaches, usually one sided, pounding and often associated with vomiting have been estimated to affect almost 10% of the pediatric population by the age of 15. Migraine is a family thing. It’s almost a certainty that other relatives suffer from the same problem. Although it’s likely that these headaches will continue into the adult years, there are effective medications to both prevent as well as treat attacks.

Muscle tension-type headaches account for another 30% of children’s headache. These headaches, described as crushing or pressure, usually located in the front and radiating to the back of the head, are not genetic and appear to be emotionally or behaviorally based. Although there is no true hereditary link, tension-type headaches are often seen in one or both parents. Treatment is with simple analgesics and, when needed, behavior modification.

Would it surprise you to know that chewing gum is the culprit in a large percentage of children with headaches? Parents are usually amazed to find that incessant chomping on chewing gum is a frequent cause of both ear pain and chronic head pain, especially in the sides of the head above the ears. The cure for this headache is obvious: stop the gum.

And then there’s caffeine. Kids can develop headaches from drinking Coke, Pepsi or ice tea. This diagnosis is confirmed when symptoms are relieved after discontinuing all caffeine containing products for at least one week. And don’t forget MSG, often found in Chinese food: some kids are intolerant to this additive and will get pounding headaches after a good bowl of Won Ton soup.

A unique problem encountered by the pediatrician is dealing with conditions that are falsely associated with headaches. “Eye strain” is very popular but, in fact, is no more a cause of headache than a wart on the foot. Most pediatric ophthalmologists will tell you that poor vision or even muscle imbalance does not result in headaches, and, although it’s important to correct any existing eye abnormalities, don’t expect any effect on head pain. Perhaps the most popular incorrect diagnosis is “sinusitis.” Sinus infection as a cause of headaches is mostly a myth. Infections of the paranasal sinuses can cause chronic daytime coughing, purulent drainage from the nose and occasional pressure and tenderness of the cheekbones, the teeth or the areas above the eyes but they do not cause headaches! Despite the fact that many physicians treat “sinus” headaches with antibiotics, there is no medical basis for such an approach and the use of antibiotics for headache is inappropriate and potentially harmful.

Brain tumors certainly do cause headaches but I am happy to report that they are quite rare. Most pediatricians will see a child with this serious illness only once every 10 years. Children with this serious condition will usually awaken from sleep with a severe headache and some vomiting, and neurological testing will be abnormal. Diagnosis is usually made by CT scan or an MRI. Most kids with headaches do NOT have a brain tumor.

The Conclusion

Although there are many reasons for children to have headaches, they are rarely serious. Headaches should never be ignored, however, and it always in the best interests of the child to have him seen by his pediatrician to determine the cause.

Have any questions? Please contact Dr. Mesibov

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