Dr. Barry Dworkin

Originally published in The Ottawa Citizen October 8, 2002
Original Title: Daycare Part II: Run, Run, Run, as Fast as You Can

Part I – Why children fight one cold after another
Part III – Childhood rashes hard to diagnose at first

Last week, the effects of the common cold and ear infections topped the list of the more common child and infant infections. School and daycare still have more to dish out.

There are several types of pink eye or conjunctivitis: infectious (bacterial and viral) and allergic.

The infection primarily involves the eyelids and whites of the eyes. The inner lining of the lids become red and inflamed. Depending upon the source of the infection, parents can determine whether the infection is bacterial or viral. Both types easily spread by rubbing the eyes. The infection transfers to the hands. The child then touches another’s hands. When their hand rubs their eye, the infection finds a new home.

Viral conjunctivitis causes the eyelids to redden and occasionally swell. It accounts for ten to 15 percent of all infant pink eye infections. The fluid that leaks from the eye during the day is usually clear and watery. The eyelashes look normal. The whites of the eyes can be a flushed pink with fine blood vessels on its surface.

The eye can feel irritated, burning, sandy, or gritty. The infection usually spreads to the other eye within 24 to 48 hours. In the morning, upon awakening, a yellow crystalline accumulation in the corners of the eyes is common. Often this substance is confused for a bacterial infection. A soft damp cloth can wipe the crusts away.

Anti-inflammatory eye drops will help ease the discomfort. The infection lasts about five days. Children are contagious for the first five to seven days. Antibiotics will not help alleviate viral conjunctivitis. The symptoms generally get worse for the first three to five days, and gradually resolve over the following one to two weeks. Once the discharge stops, children can return to school or daycare.

The bacterial version of pink eye can appear differently. Accounting for 80 percent of childhood pink eye, thick yellow-green-white pus collects on the eyelashes and lid margins and drips out of the eye throughout the day. The area surrounding the eye is usually smeared with crusty yellow dry pus. After a night’s sleep, the child’s eyelids are stuck together because of all the dried discharge. The inner eyelids and the whites of the eye can be very red.

Streptococcus pneumoniae and Haemophilus influenzae are responsible for most cases of bacterial conjunctivitis in children. Treatment consists of antibiotic drops for five days, soft warm damp cloth wipe-downs of the eyes and isolating the child from other children. Children can return to school or daycare one to two days after starting antibiotics.

Allergic conjucntivitis accounts for 2 percent of all pink eye in children. They often have itchy, red eyes without morning crusting or difficulty opening the eyelids. The treatment includes avoiding the allergy causing substance and applying topical antihistamines, or anti-inflammatory drops. The symptoms quickly resolve (minutes to hours) after using the drops.

From runny eyes to runny bums, diarrhea spreads like wildfire. The Norwalk virus causes most school and daycare-based cases. Rotavirus tends to affect infants. Soiling of clothes, lack of handwashing and close physical contact are fertile breeding grounds for this disease.

The Norwalk virus can cause either a mild fever with watery diarrhea or a more severe fever with vomiting, headache, muscle ache and fatigue. Once infected, the virus will incubate about 24 to 48 hours before the symptoms begin. Stomach cramps and nausea are the first to appear starting gradually or hit full force. Vomiting follows thereafter. A low-grade fever of 38.3 to 38.9ºC (101 to 102ºF) occurs in approximately one-half of cases. The infection lasts about 48 to 72 hours. Recovery is usually rapid.

Foremost on any parent’s mind is dehydration. A quick means of determining the severity of a child’s dehydration status is by weighing them. It is crucial to weigh the child as soon as possible in order to establish a baseline weight. Fluid loss can be difficult to determine. Weight loss is a good substitute measure. For example, a child who loses two pounds from their pre-illness weight of 20 pounds has lost ten percent of their fluid volume.

Dehydration in children is classified as mild, moderate, or severe depending upon the percent loss of body weight: less than five percent, six to ten percent, and over ten percent, respectively. Moderate to severe dehydration warrants an emergency room visit particularly for infants and toddlers.

For those who were unable to weigh the child prior to their diarrhea, the clinical signs of illness become important. As dehydration worsens, the hands and feet become colder because of poor circulation. The eyes, nose and mouth become dry. There is no pool of saliva under the tongue. Children do not urinate as much and their heart rate increases.

Getting the child to eat solids during the illness is less important than getting them to drink…lots. After two to three days parents can start feeding their children the B.R.A.T. diet (bananas, rice applesauce and toast) and boiled potatoes, noodles, crackers, yogurt, soup, and boiled vegetables.

The series wraps up next week with the common rashes and several vaccine preventive measures.