Pediatrics & Adolescent Medicine

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       Summer Safety Tips

       What is Asthma?:

The first steps in keeping your kids safe when swimming are adult supervision and an age appropriate flotation device.

Because of the increase over the past decade in the number of outbreaks of illness associated with swimming, you should also be aware of the spread of recreational water illnesses (RWIs) and how to prevent them.


Healthy Swimming behaviors are needed to protect you and your kids from RWIs and will help stop germs from getting in the pool in the first place.


Here are six "PLEAs" that promote Healthy Swimming:


Three "PLEAs" For All Swimmers


Please don't swim when you have diarrhea... this is especially important for kids in diapers. You can spread the germs into the water and make other people sick.


Please don't swallow the pool water. In fact, try your best to avoid even having water get in your mouth.


Please practice good hygiene. Take a shower before swimming and wash your hands after using the toilets or changing diapers. Germs on your body end up in the water.


Three "PLEAs" For Parents with Young Kids


Follow these "PLEAs" to protect your child and others from getting sick and to help keep RWIs out of your community:


Please take your kids on bathroom breaks or check diapers often. Waiting to hear "I have to go" may mean that it's too late.


Please change diapers in a bathroom and not at poolside. Germs can spread to surfaces and objects in and around the pool and spread illness.


Please wash your child thoroughly (especially the rear end) with soap and water before swimming. We all have invisible amounts of fecal matter on our bottoms that end up in the pool.


What are recreational water illnesses (RWIs)?


RWIs are illnesses that are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, lakes, rivers, or oceans. Recreational water illnesses can cause a wide variety of symptoms, including skin, ear, respiratory, eye, and wound infections. The most commonly reported RWI is diarrhea. Diarrheal illnesses can be caused by germs such as Crypto, short for Cryptosporidium, Giardia, Shigella, and E. coli O157:H7.


How are RWIs spread?


Keep in mind that you share the water with everyone else in the pool, lake, or ocean.


Diarrheal Illnesses


If swimmers are ill with diarrhea, the germs that they carry can contaminate the water if they have an "accident" in the pool. On average people have about 0.14 grams of feces on their bottoms which, when rinsed off, can contaminate recreational water. When people are ill with diarrhea, their stool can contain millions of germs. Therefore, swimming when ill with diarrhea can easily contaminate large pools or waterparks.


In addition, lakes, rivers, and the ocean can be contaminated by sewage spills, animal waste and water runoff following rainfall. Some common germs can also live for long periods of time in salt water.


So, if someone swallows water that has been contaminated with feces, he/she may become sick. Many of these diarrhea-causing germs do not have to be swallowed in large amounts to cause illness.



How can you tell if your child may have it?


You hear what sounds like a whistle when your child exhales. Or perhaps he or she seems to get easily tired when playing soccer. Maybe there’s just a persistent cough. But you wonder — could this be asthma? While asthma is a term often heard, it is frequently misunderstood.


Asthma is, unfortunately, all too common. In fact, asthma is the most common chronic disorder in children and adolescents, affecting nearly five million children under the age of 18, including an estimated 1.3 million children under the age of five. Fifty to 80% of children affected with asthma develop symptoms before they are five years old.


Because asthma affects the ability to breathe and to oxygenate the blood, it is a very serious disease. But it is a disease that can be well managed. With proper diagnosis, an action plan, and guidance from parents and caregivers, children with asthma can lead lives very similar to those of their non-asthmatic friends. Education and commitment are key.


What is asthma?

Asthma is a chronic, inflammatory disorder of the airways. That means, the tubes that bring air to the lungs are constantly swollen and inflamed. This swelling makes it more difficulty for air to move freely in and out. Those airways are also sensitive to certain triggers, and these triggers can differ from person to person. Many children with asthma have what is termed "allergic asthma", that means allergens worsen their symptoms. For these children, exposure to allergens such as dust mites, mold, animal dander and cockroaches can further irritate their "twitchy" airways causing even more constriction, the production of excess mucus and a tightening of the muscles that surround the airways.


How can you tell if your child has asthma?

Asthma can be a tricky disease to pinpoint for a number of reasons, including the fact that there are other respiratory ailments with overlapping symptoms, and some children can seem symptom free for long-periods of time but then experience intermittent asthma "attacks."


Watch for symptoms that can clue you in to seek the advice of a physician. These include:


Coughing. This could be constant or just intermittent. Not all children who have the disease exhibit symptoms each and every day.

Wheezing or a whistling sounds audible when your child exhales.

Shortness of breath or rapid breathing. This may or may not be associated with exercise.

Chest tightness.

Other symptoms can include:


Fatigue—your child may slow down, stop playing or become easily irritated.

A young child may say his chest "hurts" or "feels funny."

Infants may have problems feeding and may grunt during suckling.

Older children may avoid activities such as sports or sleepovers.

A child may have problems sleeping because of nighttime coughing or difficulty breathing.

Who develops asthma?

While there are no clear markers to predict who will develop asthma and who won’t, studies have shown that factors associated with the onset of asthma symptoms in children include:


Infants and young children who wheeze with viral upper respiratory infections.

Allergy. The relationship between asthma and allergies is very strong. If your child has allergies, be on the alert for potential signs of childhood asthma.

A family history of asthma and/or allergy.

Perinatal exposure to tobacco smoke and allergens

No two people have exactly the same asthma symptoms or outcomes. It’s a very individualized disease. The bottom line is to watch your child and listen to their observations. If you suspect asthma, get your child examined and tested by a knowledgeable physician. It can make all the difference.


Resource Websites:


Immunization Action Coaltion


America Academy of Pediatrics


Kids Growth


Wake County Smart Start


Center for Disease Control


Safe Kids of America Campaign


Pediatric Asthma Resources  


Cardiology Resources






In case of inclement weather please watch WRAL If you are experiencing a life threatening emergency call 911 or go to Wake Med Children’s Emergency Department


         Same day sick appointments available call 919-881-9440 for an appointment

 Flu Season begans in October

Basic Prevention of the Flu


Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.


  a. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.

  b. Avoid touching your eyes, nose and mouth. Germs spread this way.

  c. Try to avoid close contact with sick people.

  d. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)

  e. While sick, limit contact with others as much as possible to keep from infecting them.

  f. Follow public health advice regarding school closures, avoiding crowds and other measures to keep our distance from each other to lessen the spread of flu.

    TO PREVENT FLU please refer to this website for flu updates and information about the vaccines and prevention.



Connell Covington, MD

Valerie Rinehammer, PNP



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