May is LYME DISEASE AWARENESS MONTH

From the Sprague School Nurse:

Lyme disease is the most prevalent tick-borne illness in the US and Europe. In 2011, Massachusetts had 27.3 confirmed cases per 100,000 people, according to the CDC. Because Lyme disease is at such an increased risk here in eastern Massachusetts, it’s important for us to review this serious health concern and take preventative action.

Lyme disease is a multi-system bacterial infection that can be cured with antibiotic therapy. The bacteria (Borrelia burgdorferi) enter the body when an infective tick attaches to the skin. To transmit these bacteria, the tick must be attached for at least 24 hours. The bacteria then cause Lyme disease, which may affect the skin, joints, nerves, and/or heart.

Not all ticks cause Lyme disease. In the northeastern US, the deer tick is responsible for transmitting the disease. (However, not all deer ticks carry the bacteria that cause Lyme disease.) The disease is most likely to be spread between late May and early autumn, when the ticks are most active.

Deer ticks cling to plants near the ground in brushy, wooded, or grassy places. The ticks can’t fly or jump; they climb onto animals and people who brush against the plants.

Symptoms of Lyme Disease

Lyme disease symptoms vary widely because Lyme disease can affect various parts of the body. Not everyone with the disease will have all of the signs and symptoms. But in general:

An early sign is often a rash where the tick was attached. The rash appears from 3 days to a month after the bite. It starts as a small red bump then spreads, clearing up in the center so it looks like a bulls-eye. (However, the rash appears only in 68% of cases, and it may present differently.) Flu-like symptoms, such as fever, headache, stiff neck, sore and aching muscles and joints, fatigue, and swollen glands, are also common during the early stage of Lyme disease.

These symptoms resolve after a few weeks, but the person remains infected. Without medical treatment, approximately half of infected people will get the rash again in different places on their bodies, and many will experience more serious problems.

In later stages (weeks to years after initial exposure) the joints, nervous system, and heart can be affected. About 60 % of untreated Lyme disease may result in arthritis, most often of the knees, elbows, and/or wrists. The arthritis may move from joint to joint and become chronic. About 10 - 20 % of untreated people develop nervous system problems, such as meningitis, facial weakness, or pain, numbness, and/or weakness in the hands, feet, arms, or legs. The heart may also be affected by Lyme disease, resulting in slowing of the heartbeat or fainting.

Treatment of Lyme Disease

Lyme disease is treated with one of several antibiotics. In most cases, the antibiotic will cure the infection. (A vaccine has been removed from the market and is no longer available.)

Prevention of Lyme Disease

A person is more likely to get the disease during the spring and summer when a lot of time is spent outside with large amounts of skin exposed. Reducing exposure to ticks is the best defense against Lyme disease and other tick-borne infections. Avoid areas where deer ticks live - wooded, brushy and grassy places - to reduce the chance of infection.

While outdoors, these precautions can reduce chances of being bitten:

• Wear long pants and long-sleeved shirts to minimize skin exposure to ticks.
• Tuck pants tightly into socks to form a barrier to tick attachment.
• Wear light-colored clothing to help see ticks on clothing.
• Stay to the middle of the path when in the woods.
• Check for ticks, looking particularly for what may look like nothing more than a new freckle or speck of dirt.
• Using tick and insect repellents containing DEET helps to protect against Lyme disease. Follow label instructions carefully, use aerosols in an open space to avoid inhalation, and use only as much as needed.
• Do not apply DEET to the hands of young children or on children less than 2 months of age. Use concentrations of 30 % or lower for older children and adults.
• Avoid using DEET products that are combined with sunscreen. The sunscreen needs to be applied more often, resulting in overuse of DEET.
• Wash treated skin with soap and water after coming inside. 

Lime Disease in Pets

Household pets can get Lyme disease. Checking pets for ticks reduces the risk of infection. If you suspect that your pet has Lyme disease, contact your veterinarian. There is no known case of a pet transmitting the disease directly to humans.

If You Are Bitten

Early removal of an attached tick is imperative because it takes at least 24 hours for an infective tick to transmit the bacteria. To remove a tick, use fine-tipped tweezers. Grasp the tick as close as possible to the skin and slowly pull it straight out. Do not squeeze or twist the attached tick. The mouth parts may stay attached, but these will not cause Lyme disease. After removal, apply antiseptic to the bite area. Do not apply mineral oil, Vaseline, heat, or other agents to remove the tick. This does not remove ticks and may actually increase your chance of infection by causing the tick to excrete bacteria.

If you remove a tick as soon as you find it, it is less likely that the tick transmitted the Borrelia burgdorferi bacteria because it may not have been attached long enough for transmission to occur. You should, however, call your physician, who may suggest you bring the tick in for laboratory examination. The tick bite site needs to be observed for signs of localized infection such as pain, redness, warmth, and/or drainage. And, just to be safe, monitor your health closely after a tick bite and be alert for any signs and symptoms of tick-borne illness.

An excellent source of information is the CDC website: http://www.cdc.gov/lyme/

Thank you,

Sharon Kahn RN

Sprague School Nurse

sharon_kahn@wellesley.k12.ma.us

781-263-1965

Strep Alert! Note From Sprague Nurse, Sharon Kahn

This week I have received several reports of students in our school who were diagnosed with strep throat. Please observe your children for any of the following symptoms:

• sore throat with or without fever
• enlarged tender neck glands
• pain when swallowing
• headache
• loss of appetite
• stomach ache

Strep throat is a sore throat caused by an infection with streptococcus bacteria that are passed around through nose and mouth droplets. 

It is very common in school-aged children and it is very contagious.

Basic cold symptoms usually do not accompany strep throat.

It is important that strep throat be treated to prevent possible serious complications. Antibiotic treatment for at least 24 hours is required to prevent spread of infection and to allow for school attendance.

The best way to prevent the spread of infection is thorough hand washing. Please be assured that we continue to promote this practice at school.

Please fell free to call me if you have any questions. I encourage you to refer to my website for more detailed information about strep throat.

Sharon

Sharon E. Kahn, RN, BSN, Med
Sprague School Nurse

The Flu or a Cold? When to call the Doctor?

From the Sprague School Nurse

	Flu	Cold
Onset of illness	Sudden	Gradual
Fever	High	Rare
Fatigue	Severe	Mild
Cough	Severe, Dry	Common, Mucus-producing
Sore throat	Yes	Sometimes
Headache	Yes	Sometimes
Sneezing	Sometimes	Yes
Stuffy Nose	Sometimes	Common
Appetite	Decreased	May be decreased
Muscles	Ache	Fine, slight aches
Chills	Yes	No
Chest Discomfort	Often severe	Mild

Seasonal flu Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract. The flu is often confused with the common cold, but flu symptoms tend to develop quickly and are usually more severe than the typical sneezing and congestion of a cold. The main symptoms of the flu are a cough, fever, sore throat and runny nose.

My child is experiencing symptoms, when do I call my doctor?

If your child is experiencing influenza symptoms, it’s not always necessary to see or call the doctor. Below are some guidelines to help with deciding when to call your physician.

Call your child's doctor now (night or day) if:

• Your child looks or acts very sick
• Breathing becomes difficult or fast
• Dehydration occurs (no urine in 12 hours, dry mouth, no tears)
• Your child has bluish skin color
• Your child is not waking up or not interacting
• Your child is being so irritable that the child does not want to be held
• Flu-like symptoms improve, but then return with fever and worse cough
• Fever with a rash occurs

Call your child's doctor during the day if:

• Your think your child needs to be seen
• Your child is considered high risk and has flu symptoms
• Earache or sinus pain occurs
• Fever lasts more than 3 days
• Cough lasts more than 3 weeks
• Your child becomes worse

Avoid the spread of the flu -

Influenza spreads easily. If you suspect your child has the flu, keep your child at home for at least 24 hours after the fever has ceased without the use of fever-reducing medications. A fever is defined as 100ºF. 

It is important to teach children how to reduce their risk of getting influenza and protect others from infections by teaching them to frequently wash their hands and to cover their coughs and sneezes. Please be assured that we encourage these practices here at Sprague.

Much of this information is from The Children’s Hospital in Denver, Colorado and may be accessed at http://www.thechildrenshospital.org/wellness/topics/index.aspx

********

Sharon Kahn RN

Sprague School Nurse

sharon_kahn@wellesley.k12.ma.us

781-263-1969 x 502

Important Flu Information from Sprague Nurse, Sharon Kahn

There's been a lot of discussion about flu lately in the media as communities across our state report an increase in flu-like illness and confirmed cases of influenza. The Massachusetts Department of Public Health has developed the brochure “Flu: What You Can Do – Caring for People at Home” as an informational resource.

Click here to download a copy of the brochure.  

It's an excellent source of useful information for all. Please don't hesitate to call me at Sprague if you have any questions or concerns.

Thank you,

Sharon

***********

Sharon Kahn RN

Sprague School Nurse

sharon_kahn@wellesley.k12.ma.us

781-263-1965

Conjunctivities: Is it contagious? From Sprague School Nurse, Sharon Kahn RN

          Often I see students with reddened eyes at school, and the first question the teachers and parents ask is, “Is it contagious?” Here’s some information about conjunctivitis:

Conjunctivitis, commonly known as pinkeye, is an inflammation of the conjunctiva, the outermost layer of the eye, a normally clear thin membrane that covers the white part of the eye and lines the inner surface of the eyelids.  The three most common causes of conjunctivitis are: infectious, allergic, and irritant. 

          Infectious conjunctivitis is usually caused by either bacteria or viruses.  The viral type is often associated with a cold or sore throat. Ear infections may accompany bacterial conjunctivitis because similar bacteria can cause both infections. Bacterial conjunctivitis occurs more frequently in younger children and viral conjunctivitis is more common in older children and adults. Parasites and fungal infections are rare causes of conjunctivitis.

          Outbreaks of infectious conjunctivitis are seasonal in nature. They tend to occur most frequently in the winter, when children are indoors more often and in close contact with each other; outbreaks decrease during warm weather, when close contact decreases.

          Allergic conjunctivitis occurs more frequently among those with allergic conditions. It may be seen only at certain times of the year, if caused by allergens such as grass or ragweed pollen. Other allergy-causing substances like animal dander, dust mites, or cosmetics can cause year-round symptoms of conjunctivitis. Allergic conjunctivitis typically affects both eyes at the same time.

          Irritant conjunctivitis can be caused by chemicals, such as those in chlorine and soaps, air pollutants such as smoke and fumes, wearing contact lenses, dry eye, or related to the use of medications.

What Are the Signs and Symptoms?

The different types of conjunctivitis can present differently. In addition, symptoms may vary from person to person.

                             Viral conjunctivitis

¨       Watery discharge

¨       Irritation

¨       Red eye

¨       Usually begins with one eye, but spreads easily to the other eye

¨       Recent upper respiratory tract infection  

                              Allergic conjunctivitis

¨       Usually affects both eyes

¨       Itching, discomfort

¨       Tearing, reddened eyes

¨       Swollen eyelids

¨       Exposure to allergen

 

                              Bacterial conjunctivitis

¨       Thick discharge may cause the lids to stick together

¨       Swelling of the conjunctiva

¨       Redness

¨       Tearing

¨       Irritation and/or a gritty or burning feeling

¨       Mild eyelid swelling

¨       Usually begins with one eye, but spreads easily to the other eye

Severe eye pain or blurred vision that fails to clear with a blink are not typical features of conjunctivitis. Anyone with these complaints should be seen by an ophthalmologist.

Is It Contagious?

All types of infectious conjunctivitis are contagious and can spread by touching the eyes. A child can first become infected from direct contact with someone who has the infection or something that person has touched, such as a used tissue. The infectious organisms can also spread through coughing and sneezing. In addition, certain viruses spread in the summertime when children swim in contaminated water or share contaminated towels.

          Allergic and irritant conjunctivitis are not contagious.

          Treatment

          Conjunctivitis requires medical attention.  The appropriate treatment depends on the cause of the problem.  Although infectious conjunctivitis usually is not serious, in rare cases it can cause permanent damage so be sure to follow the doctor’s directions.

          For the allergic type, allergen avoidance, cool or warm compresses and artificial tears may relieve discomfort in mild cases.  In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed.  Some patients with persistent allergic conjunctivitis may also require topical steroid drops.

          Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria. 

          Like the common cold, there is no cure for viral conjunctivitis; however, the symptoms can be relieved with cool or warm compresses and artificial tears (if needed). For severe cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation.

Often, infectious conjunctivitis will go away by itself without medical treatment, but doctors usually recommend treatment because it speeds up the healing process and decreases the likelihood that the infection will spread.

          Frequent proper hand washing with soap and warm water can reduce the spread of this highly contagious infection. Additional measures include avoiding touching the face, not sharing towels or washcloths, and avoiding shaking hands.

          When Should I Call My Child's Doctor?

If you think your child has conjunctivitis, it’s important to contact your child's doctor to determine what is causing the conjunctivitis and the best form of treatment.

If the conjunctivitis does not improve after 2 to 3 days of treatment, or after a week when left untreated, call the doctor again. Other serious eye conditions can mimic infectious conjunctivitis, so schedule a visit to an ophthalmologist if your child complains of severe pain, changes in eyesight, or sensitivity to light.

If you notice increasing swelling, redness, and tenderness in the eyelid and skin around the eye, especially if your child also has a fever, it may mean the infection has spread to the tissues around the eye, which would require antibiotic treatment and close follow-up.

Thank you, 

Sharon Kahn RN

          Sprague School Nurse

          sharon_kahn@wellesley.k12.ma.us

          781-263-1965

Annual Hearing and Vision Screenings at Sprague

From the Sprague School Nurse:

         I have started conducting the mandated annual hearing and vision screenings at Sprague. These screenings help identify barriers that would impede a child's ability to learn because much learning is accomplished through vision and/or hearing.    

        Early identification of hearing and vision problems can prevent problems that relate to speech and language development, social and emotional development, academic achievement, and/or permanent vision loss. The Massachusetts Department of Public Health has established guidelines regarding screening procedures and referral criteria for school-age children.

Vision screening checks for

• problems in acuity (sharpness)
• amblyopia (reduced vision in an otherwise healthy eye)
• binocular function (one image using both eyes)
• hyperopia (farsightedness - problems seeing close images)
• myopia (nearsightedness - problems seeing at a distance)
• strabismus (eyes not properly aligned)  
• stereopsis (three-dimensional vision) grades K-3

This helps identify students who may have an unrecognized vision problem that could lead to the development of permanent vision loss if not detected early.

        Hearing screening checks for response to tones in the frequencies most used for spoken communication. A hearing impairment interferes with normal speech development; school age children with even minimal hearing loss are at risk for academic and communication difficulties. Early detection and proper medical treatment insures a better chance of successfully correcting any hearing problems.

        School screening tests are not diagnostic in nature. They are designed to identify students who need further evaluation, with the goal of early detection, diagnosis and treatment of hearing and vision problems before they can interfere with a child's academic success.  Each year here at Sprague the students undergo the mandated screenings. I then contact parents of those children who do not pass the screenings, to refer for further evaluation by their physician.

        Please call me at 781-263-1969 x 502 if you have any questions or concerns.

        Sharon Kahn RN

        Sprague School Nurse

Headaches in Children: From the Sprague School Nurse, Sharon Kahn RN

What causes children's headaches?

Children of all ages experience headaches and may even have them on a recurrent basis.  A number of factors, singly or in combination, can cause your child’s headache. These include:

—        Genetic predisposition: Headaches, especially migraines, tend to run in families.

—        Illness and infection: Headache is a frequent symptom of common childhood illnesses, including ear infections, strep throat, sinus infections, and colds.

—        Head trauma: Most head bumps are minor, but seek medical attention quickly if your child has dizziness, nausea, vomiting, blurred or double vision, ringing in the ears, any memory loss, poor coordination or emotional instability (anger, crying, anxiety) or has a steadily worsening headache after a bang on the head.

—        Environmental factors: Weather changes, odors, loud noises, bright light, and secondhand smoke can all cause headaches.

—        Emotional factors: Depression, stress, or anxiety, which may be affected by peer pressure, school problems and family concerns, can lead to headaches.

—        Certain foods, food additives, and beverages: MSG (in foods like bacon, bologna, hot dogs) and caffeine (in soda, chocolate, coffee and tea) are known to trigger headaches.

—        Sleep deprivation: Overtiredness or a change in routine or sleep pattern may cause headaches in children.

—        Inadequate hydration or skipping meals: Lack of fluids or food can cause headaches.

—        Eyestrain: If your child complains of headache and/or dizziness when reading and writing schedule an eye exam.

What kind of headache does your child have?

Headaches are typically hard to describe, especially for children. Some are related to stress, while others are the result of an illness or injury.  Headaches are classified into two main categories — primary and secondary. Primary headaches develop by themselves rather than as a result of illness or injury. This category includes:

—        Tension-type headache. Often stress related, the most common of children's headaches; the child may complain of a tightening or pressure in the head, neck and skull muscles.

—        Migraine. Approximately 5 percent of school-age children experience migraines. Before children reach puberty, migraines affect about the same number of boys as girls, but in the teen years, girls tend to have migraines more often. A migraine may be disabling, causing not just pain but nausea, vomiting and extreme sensitivity to light and sound. Children may also have all of the signs of a migraine with no head pain, known as an abdominal migraine. Unlike tension-type headaches, migraines often occur during nonstressful or recreational times.

—        Cluster headache. This is the least common type of headache in children. It's usually disabling and involves a sharp, stabbing pain on one side of the head.

Secondary headaches result from some underlying condition, such as fever, cold virus, strep throat, head trauma, sinus or ear infection, medication side effects, meningitis, temporomandibular joint disorders (TMJ) or other jaw-related problems.

Preventing children's headaches - 

Measures that promote general good health will prevent all but the occasional headache in a child:

—        Adequate rest. Children need plenty of sleep on a regular schedule, at least 9 hours.

—        A healthy diet and fluids. Your child needs to eat breakfast, lunch, dinner and nutritious snacks throughout the day. Be sure your child drinks enough water, particularly in hot weather and after strenuous activity.

—        Take steps at the first sign of a headache. When your child develops a headache, encourage him or her to take a nap — if possible, in a dark, quiet room.

—        Keep a headache diary. Note times and places that headaches occur.  Describe any thoughts, behaviors or events that occur with headaches. Information from the diary will help to identify possible headache triggers. Wait for the child to volunteer that he or she has a headache rather than asking.

—        Avoid stressors. Be alert for things that may be causing stress in your child's life, such as difficulty doing schoolwork or strained relationships with peers.

—        Exercise. Regular aerobic exercise, such as walking, swimming or biking, can help reduce the frequency and intensity of headaches.  Exercise relieves stress, relaxes your muscles and increases the levels of the body's natural stress relievers.

When to Call the MD?

Seek your pediatrician’s advice if your child has recurrent headaches or any episode of head pain severe enough to keep him/her out of school or other activities.

Assessing Medical Complaints of Children

From the Sprague School Nurse, Sharon Kahn RN

             Sometimes parents apologize to me when I notify them that their child is ill and requires dismissal, I feel there’s no need to apologize, since we aren’t able to predict that our children may become sick.  When your child has a good night’s sleep, eats breakfast and tolerates it well, and doesn’t have a fever or other objective signs of illness, then the child should attend school. Some mornings he or she may complain of nonspecific discomfort, but we all know these complaints usually resolve as the child participates in the daily routine. On the other hand, if your child was clearly ill the previous day or evening, required fever-reducing medicine in the preceding 24 hours, had interrupted sleep, vomiting or diarrhea, or is unable to eat breakfast, it is advisable to keep him/ her home from school.

            At school when a child comes to the nurse I make an assessment according to the specific complaint - for example, if a student complains of a sore throat I visualize the throat using a flashlight and palpate for enlarged tender neck glands. I listen to the quality of the voice, ask if he or she ate breakfast (or snack), and check for a fever. I provide a drink of water and watch for signs of pain with swallowing. Often I am told if family members are home sick with a similar complaint.

            If the child does not have a fever or any objective signs of illness, I recommend a return to class. I suggest comfort measures, such as increasing fluids, telling the student, “Keep your throat wet today - be sure to drink lots of water.” I ask what his/her after school plans are and if the child says he feels fine to go to soccer practice, I send him back to class, since he clearly is okay. Please be mindful that if I do make a call to you, your child has already been through this evaluation process.

            This is where I can use your help. If your child has a complaint in the morning before school, it is useful for me to know. I appreciate a heads-up call with a message saying your child complained of a stomachache or headache (or whatever) in the morning, but seemed fine to come to school. Then I know to call you if your child comes to see me complaining of not feeling well at school. Otherwise, I would likely send your child back to class.

            Sometimes a child is not feeling well but doesn’t have a fever or other easily measurable sign of illness. Obviously if I see a child four times in a morning or if the student is clearly unfit for the classroom, I will call a parent or designated caretaker.  As a parent myself, I know I would want to be informed if my child was having such a bad day.

            This is another way you can help. It is essential that we have the correct phone numbers to reach a parent or designated caretaker. If you change your work, cell, or home number, or have a new babysitter, please be sure to let us know here at Sprague so we can keep your information current and reach you or your designee quickly.

            Please call me if you have any questions.  

 

          Sharon Kahn RN

          Sprague School Nurse

          sharon_kahn@wellesley.k12.ma.us

          781-263-1965