1. Keeping Kids Healthy Dr. Emily Maiella Naturopathic Physician
432 Greenfield Rd
Montague MA 01351

2. Immune Support (Prevention and Acute)
Vitamin D
Probiotics
Elderberry (Sambucus)
Andrographis
Be prepared. Have medicines on hand.

3. Cold and Flu Prevention
Basic Prevention, try to have the whole family on the following….
Research backs it up!

4. Randomized trial of vitamin D supplementation to prevent seasonal influenza A (H1N1) in schoolchildren.
DESIGN:From December 2008 through March 2009 a randomized, double-blind, placebo-controlled trial comparing vitamin D(3) supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen.

5. Proves really effective!
RESULTS: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D(3) group compared with 31 of 167 (18.6%) children in the placebo group. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements and who started nursery school after age 3 y. In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D(3) compared with 12 children receiving placebo
CONCLUSION:This study suggests that vitamin D(3) supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren.
Am J Clin Nutr. 2010 May;91(5): Epub 2010 Mar 10.

6. How Vitamin D works….
In a study published in the journal Nature Immunology, researchers from the University of Copenhagen found that when a variety of white blood cells known as a T-cell comes across a pathogen (virus, bacteria, tumor, fungus) in the bloodstream, it extends a receptor in search of vitamin D. If the WBC encounters the vitamin, the T cell becomes "activated." If there is not enough vitamin D in the blood, the cell remains passive and no immune response occurs.

7. How Vitamin D works..
The body produces vitamin D upon exposure to sunlight. It can also be found in eggs, fatty fish, fortified milk and in supplement form. Once activated, (by vitamin D) a T-cell transforms into one of two kinds of cells. One type seeks out and destroys all traces of the infectious agent, while the other records information about the pathogen and transmits it to other parts of the immune system. These latter ("helper") cells help the immune system respond quickly should infection with a similar pathogen occur at a later date.

8. Can’t help but to share
Side note: all of the other conditions which Vitamin D is extremely helpful for:
Colon and breast cancer prevention
Auto-immune conditions of all types
Multiple sclerosis
Osteoporosis/osteopenia

9. Probiotics = for life

10. Effect of Lactobacillus gasseri, Bifidobacterium longum, B
Effect of Lactobacillus gasseri, Bifidobacterium longum, B. bifidum on common cold episodes: a double blind, randomized, controlled trial
The aim of this study was to investigate whether the consumption of Lactobacillus gasseri, Bifidobacterium longum, B. bifidum, during at least 3 months influences the severity of symptoms and the incidence and duration of the common cold.
METHODS:A study was performed over at least 3 months during winter/spring periods healthy adults (aged 18-67) were supplemented daily with vitamins and minerals with or without the probiotic bacteria. Cellular immune parameters were evaluated in a randomly drawn subgroup of 122 volunteers before and after 14 days of supplementation. During common cold episodes, the participants recorded symptoms daily. Stool samples were collected before and after 14 days of probiotic supplementation to quantify fecal Lactobacilli and Bifidobacteria using qRT-PCR.

11. Probiotics shorten duration
The total symptom score, the duration of common cold episodes, and days with fever during an episode were lower in the probiotic-treated group than in the control group:
A significantly higher enhancement of cytotoxic plus T suppressor cells (CD8+) and a higher enhancement of T helper cells (CD4+) was observed in the probiotic-treated group
The intake of probiotic bacteria during at least 3 months significantly shortened common cold episodes by almost 2 days and reduced the severity of symptoms
Clin Nutr Aug;24(4):

12. How probiotics help….
From the very first breath you take, you're exposed to probiotics.
On the way through the birth canal during a vaginal deliver, a newborn gets dosed with bacteria from their mother’s birth canal. This event starts colonization in the infant's gastrointestinal (GI) tract of 'good' bacteria. N
New research now shows many caesarean-section infants have less-than-optimal health after birth. This is most likely because they are not exposed to the mother's healthy bacteria in the birth canal which would then serve to populate its own GI tract.

13. Probiotics ( = for life)
As you mature, you're faced with many threats to the beneficial bacteria in your gut... from chlorinated drinking water... to overly-processed foods.The 'good' bacteria in your gastrointestinal system can only provide you with optimum health if the proper balance of different types of bacteria is maintained in your gut.
This is where probiotics can have a profound effect... not just on your GI health, but on your overall health as well.

14. The intestine is the largest immunological organ in the body and contains 70% to 80% of all IgA-producing cells. When exposed to a virus (etc) by the oral route, a secretory immune response is obtained, which is mediated by secretory IgA.
probiotics increase the number of IgA-secreting cells, which migrate from the Peyers patches to distant mucosal sites such as the respiratory glands. This is where the gut and respiratory tracts interface.
We tend to think of our digestive system in isolation with the rest of our body and yet it is actually a tube that runs right through the center of our body with the lining of the mucosal barrier encased in this secretory IgA chemical. Secretory IgA protects it against pathogens such as yeast, bacteria and viruses as well as being a control mechanism for our immune system in general. In addition to making of the surface lining of our digestive tract, the mucosal barrier also makes up our mouth, throat, and the intestines all the way through the rectum. Secretory IgA is also present in our eyes, the upper part of our lungs, nasal cavity, the urethra in men and women, and the vagina in women. So those external surfaces are also covered in secretory IgA.
IgA is the 2nd most common serum Ig.b) IgA is the major class of Ig in secretions - tears, saliva, colostrum, mucus. Since it is found in secretions secretory IgA is important in local (mucosal) immunity.

15. The Gut and EENT inteface
the mucosal barrier also makes up our mouth, throat, eyes, the upper part of our lungs, nasal cavity, the urethra in men and women, and the vagina in women. So those external surfaces are also covered in secretory IgA.
Probiotics also increase T-cell production of TNF-α in response to adenovirus exposure and influenza A (variant of H1N1) exposure

16. For your own research….
probiotics and eczema, allergies and asthma

17. RSV
Most common serious acute respiratory illness in infants and young children
Can manifest with mild cold-like symptoms
Can also be severely acute and can include coughing, quick/short breaths (fast breathing greater than 50 breaths per minute), labored breathing and lack of oxygen. Infants- want to sit up (more fussy laying down b/c they can’t catch breath).

18. COUGH/RSV
INCIDENCE
RSV affects nearly ALL infants by the age of 2, most are not acutely affected.
125,000 children hospitalized each year, 1-2 % of these will die from it.
Infants less than 1 year of age are most severely affected.
Generally seasonal between Fall and Spring of every year.
Can affect adults as well.
WHO’S AT RISK?
Spread easily by physical contact. Can live for half an hour on hands or five hours on countertops and used tissues.
Infants born prematurely, with chronic lung disease, immunocompromised or with some forms of heart disease are at a greater risk.
Exposure to tobacco smoke, daycare or carrier siblings are also at higher risk.

19. RSV SIGNS/SX Nasal congestion Nasal flaring
Cough (often croupy or barking)
Tachypnea/labored breathing or SOB
Hypoxia (cyanosis)
Wheezing
Fever
Symptoms usually appear 4-6 days after exposure
Sequela
Can be mild cold or lead to pneumonia and bronchitis can set up for damage towards asthma-
Can lead to otitis- drainage more thick mucous than other colds and viruses can lead to separate infection to ear.
Respiratory failure is a concern.
Asthma-may get asthma 6 months later not uncommon

20. RSV TREATMENT
Thyme and Eucalyptus essential oil rubbed on chest and under nose. Gaia herbs makes a really nice chest rub, formulated by Dr. Mary Bove
Quercetin powder (1/4 tsp twice a day) opens up airways mildly, mucolytic, and for inflammation, for acute cough mg 2x/day, mix it in applesauce.
Vitamin C 50mg x age in years, twice a day.
Echinacea 1 drop for every 2 lbs. body weight given every 2 hours
Composition Essence Gaia makes it- children - eclectic formula. 5 drops in warm water. Tastes sweet and warming. Put it in drinking water. Use it when things are more severe than in a mild cold.

21. RSV/COUGH TREATMENT Wet or dry cough formulations with antivirals
Glycyrrhiza (wet or dry)
Melissa officinalis
Lobelia (wet)
Prunus serotina
Viburnum spp.
Verbascum
Hyssop
Thymus vulgaris
Inula
Anise

22. COUGH/RSV TREATMENT
Homeopathic Treatment (Spongia, Pulsatilla, Drosera, Ant-t for barking cough) Antimonium and carbo veg (likes to be fanned)-hypoxia and blue
Humidifiers-humidifying room, and essential oils on stove in water, can get oils in air with humidifier but may get germs into air. Use hot-air humidifiers.
Hydrotherapy
Steamy bathroom
Constitutional hydrotherapy
-Wet/warming sock treatment (for warming sock treatment, go to my website for print out)

23. Syrup of Thyme and Ivy Leaves
1234 children and adolescents (623 boys and 611 girls) ages 2-17 with acute bronchitis and productive cough
Non-interventional post-marketing surveillance study
Treatment days: 0, 4 and 10
Acute bronchitis with productive cough in children and adolescents can be treated safely and effectively with the thyme and ivy syrup. A ten-day treatment using age-appropriate dosages led to a clear improvement in the symptoms or cure with very good tolerability.
Marzian O. “Treatment of acute bronchitis in children and adolescents. Non- interventional postmarketing surveillance study confirms the benefit and safety of a syrup made of extracts from thyme and ivy leaves” MMW Fortschr Med (2007 Jun 28) 149(27-28 Suppl):69-74
THANKS TO MARY BOVE FOR THE SLIDE INFO

24. Andrographis
Treatment of acute infectious viral or bacterial diseases of the respiratory, urinary and GI systems.
Randomized, double-blind, placebo controlled clinical trial
•152 Patients with acute pharyngotonsillitis
•6 grams daily for a week
•Relief of fever and sore throat
equal to paracetamol (over the counter pain reliever)
Lower doses found not to be as effective
Thamlikitkul V., Dechatiwongse T., Therapong S, et al, J Med Assoc.Thai 1991;74(10);

25. Andrographis: Acute and PREVENTATIVE
107 healthy children
200mg /day of andrographis ( 11.2mg andrographolides) or Placebo for 3 months (equals 1 gram herb)
By the 3rd month –significant decrease in the incidence of colds in the andrographis group compared to the placebo group.
The relative risk of catching cold was 2:1 times lower for the andrographis group.
(Caceres DD, Hancke JL, Burgos RZ, et al. Phytomed 1997;4 (2) )
THANKS TO MARY BOVE FOR THE SLIDE INFO

26. Andrographis
This is a great herbs to initiate for prevention if your child has a history of ear infections, chronic bronchitis
Increase the dose, triple it if on a preventive dose if child gets sick.
Andrographis treatment can significantly shorten the course and duration of the common cold
Hancke J., Burgos R., Caceres D., Phytother 1995: 9:

27. Andrographis Pediatric Dosing
Prevention use .5-1 gram powder, .5-2 mls liquid extract daily
Acute infection use 2 grams powder or 4 mls 1:2 liquid extract
Combine with warming herbs such as ginger, cinnamon, and astragalus
Safety, toxicity and contraindications;
No significant adverse effects have been noted.
High doses may cause gastric discomfort, anorexia, and vomiting.
Contraindicated in pregnancy (animal studies)
THANKS TO MARY BOVE FOR THE SLIDE INFO

28. Andrographis
Acute bacterial infections of GU, GI and respiratory systems.
Good for an alternative long term antibiotic.

29. Long used in both Chinese and Ayurvedic medicine, this intensely bitter herb has powerful antiviral activity.
Bitter tonic, immune stimulant, anthelmintic, antihepatotoxin, cholagogue and anti-inflammatory.
It can be used for colds, influenza, sore throats, Lyme disease, hepatitis and other viral infections. In India it is considered superior to quinine for malaria.
It is also used for infestations of intestinal parasites such as Giardia, Blastosistus hominis and Dientaoeba fragilis.

30. SAMBUCUS NIGRA (Elderberry)
Elderberry Extract Inhibits Several Strains of Influenza
Controlled, double blind study
6 day outbreak of influenza B
Significant improvement of symptoms in 93% of group in 2 days
In vitro studies have shown inhibition of influenza types A and B
J. Altern. Comp. Med 1995

31. Sambucus/Elderberry
The fruit has always been an anti-flu remedy, but don’t forget about the flower parts too! Great fever herb.
Keeping it in mind for all chronic viral infections, herpes etc.
Start in September, end in January for prevention.

32. Anti-viral Action of Berry
Constituents neutralize the activity of the hemagglutinin spikes found on the viral surface. When these hemagglutinin spikes are deactivated the viruses can no longer pierce cell walls, enter the cell and replicate.
Influenza viruses A and B, Herpes simplex virus type 1 (HSV-1)
Zakay-Rones Z, Varsano N, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1:
Zakay-Rones Z, Thorn E, et al.Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res 2004;32:
THANKS TO MARY BOVE FOR THE SLIDE INFO

33. Elderberry
The berry helps to colonize good gut flora b/c of the phytophenols. High Anti-oxidant and anti-inflammatory qualities.
Indicated for those respiratory infections that have a lot of mucus, b/c kids swallow the mucus, and that alters the flora. And remember what happens when the flora gets altered…trouble!!

34. Not just anti-viral! 2011 Elderberry Study
Inhibitory potential of the extract on the propagation of human pathogenic H5N1-type influenza A, influenza B virus, and clinically-relevant human respiratory bacterial pathogens
RESULTS: a standardized elderberry liquid extract possesses antimicrobial activity against both Gram-positive bacteria of Streptococcus pyogenes, group C and G Streptococci, and the Gram-negative bacterium Branhamella catarrhalis in liquid cultures

35. Not just anti-viral! 2011 Elderberry Study
The liquid extract also displays an inhibitory effect on the propagation of human pathogenic influenza viruses.
CONCLUSION: elderberry liquid extract is active against human pathogenic bacteria as well as influenza viruses.
Krawitz C, Mraheil MA, Stein M, et al, Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. In: BMC Complement Altern Med (2011) 11:16
THANKS TO MARY BOVE FOR THE SLIDE INFO

36. Elderberry Dosage Minimizes those post-viral bacterial infections!
Elderberry fruit syrups- standardized to percent elderberry
Powdered extracts- 500 mg (capsule) 2-3 times daily for 3-4 days
Liquid form, dosed at one tablespoonful (15 ml) three times daily
Acute viral infections- treat at least three days
THANKS TO MARY BOVE FOR THE SLIDE INFO

37. EARACHE
Pain and or discomfort in or around the ear. An earache develops when the tissue lining the middle ear or eustacian tube swells.
Immature Eustachian tube (the tube that connects the middle ear to the throat). In infants and young children this tube is much shorter and is angled. It is therefore much easier for bacteria to migrate from the nose and throat up into the middle ear space. As the child grows this tube becomes more vertical, so germs have to travel "up hill" to reach the middle ear. This is one-reason children "outgrow" ear infections.

38. Otitis Media
Inflammation of the middle ear with the development of a bacterial infection. Immune response to this infection causes a collection of fluid in the middle ear space or a rupture of the tympanic membrane due to the fluid build-up.

39. EARACHE
Earache may be due to acute ear infection (otitis media), water or fluid in the ear (swimmers ear/ otitis externa) or inflammation/ blockage of the eustacian tube due to allergies, associated respiratory infections (eg. colds), travel (air or to higher altitudes) and sometimes accompanies teething and physiological obstructions.

40. EARACHE/OTITIS MEDIA
Ear pain or discomfort, with or without respiratory symptoms
Fever
Drainage from ear if tympanic membrane bursts
Sleeplessness (ear pressure increases while lying down)
Irritability
Change in eating habits
Change in hearing
Refusal to nurse on side that hurts, pain worse when lying down.
vomiting

41. EARACHE/OTITIS More frequent in the winter
Teething- assoc. with fluid production
consumption of cows milk in early childhood
feeding position (bottles while lying down)
smoking in household
fetal alcohol exposure
genetic predisposition (eg. Children with Downs Syndrome)
Family predisposition decrease in IgG2 or IgA
prior episodes of otitis media
poor nutritional status
daycare setting
early introduction of solid foods
Underlying viral infections (RSV or Influenza),
Underlying food or environmental allergies
Association with pacifier use

42. EARACHE Have your child seen immediately if……
Ear pain accompanied with fever >105.0 F (R/O severe infection, mastoiditis)
Any fever in infants < 12 weeks old.
There is pus, blood tinged or other abnormal colored fluid draining from ear.
Pointed object was inserted into ear canal (eg. Pencil, stick, etc>) (R/O perforated eardrum)
Child is in severe pain and cannot nurse, sleep, etc.
Stiff neck or headache ( R/O meningitis)
Vomiting or Chills

43. EARACHE AT HOME
Keep child in upright position (when sleeping prop up on pillows.
Use heat to help bring circulation and soothe the area.
Warm onion treatment: cut onion in half or in very slick slice. Bake for 15 minutes or microwave for about 2 (until steaming) Wrap onion in gauze or clean cloth (should feel warm but not too hot!) Apply to ear area until relief is felt. Repeat as necessary.
Warm olive oil infused lavender essential oil or commercially prepared eardrops infused with garlic and mullein.
(Never place anything in ear if a ruptured or perforated eardrum is suspected)

44. EARACHE Keep child well-hydrated and decrease sugar intake
Give immune support teas made with herbs such as lemon balm, echinacea, chamomile, garlic, and astragalus.
Zinc, Vitamin C, Essential fatty acids (omega 3 and 6)
If antibiotics are used or have been used in the past supplement with probiotics to help restore normal gut flora.

45. Homeopathics for EARACHES
Homeopathy: Some of the more commonly used to treat ear infection include:
Pulsatilla- weepy, clingy, wants to beheld, extremely changeable mood, better in open air, fever 100 to l02, little or no thirst, refusal to drink
Belladonna- earache comes on suddenly with intense pain, may have fever up to 104, hot and flushed face, dilated pupils
Chamomilla- extremely irritable and changeable, does not know what he wants, worse in the evening, needs to be carried back and forth

46. EARACHE
Antibiotic treatment is most likely indicated if there are signs of systemic bacterial infection, mastoiditis, or other complications.
Antibiotics: risk of resistant strains, increased risk when child has been treated with antibiotics in the last 3 months. The absence of overt symptoms does not mean bacterial infection is cured.

47. EARACHE
Pain reliever and anti-inflammatories (ibuprofen or acetominophen. are often given to reduce pain and fever. But I usually recommend riding the fever out.
New research is suggesting that 80% of uncomplicated ear infections will resolve within 4 to 7 days without antibiotics.
Aspirin and salicylate containing compounds should never be given to children.

48. Myringotomies
Surgical techniques are often done to treat children who have chronic recurring incidence of ear infections.
before undergoing such extreme measures underlying causes such as food allergies or nutritional deficiencies should be ruled out.
Myringotomies can cause permanent scarring and thickening of the eardrum.

49. Playing more, Breast-feeding less
Common in early childhood, greatest risk age 2-5. b/c stop breast feeding, put everything in mouth, and increased socialization.
Increased incidence in the pre-school setting due to exposure to increased number of bacterial serotypes at a time when structurally the eustachian tube is most at risk for congestion.

50. Side note….swimmers ears
Otitis externa: inflammation of the ear canal secondary to loss of protective cerumen, contact dermatitis, underlying otitis media, staph or pseudomonas infection.
Swimmers ear prevented with drops of vinegar and 70% ethyl alcohol

51. TX/MANAGEMENT Encourage breast feeding
Avoid cow milk dairy in the preschool population
Treat/avoid known food sensitivities
Treat/avoid environmental allergens

52. Avoid second hand smoke
Careful dental hygiene especially when a tooth is lost
Ear lavage to remove impacted cerumen (wax)
Cod liver oil (tsp.)-to decrease ear wax and prevent formation
Bioflavonoids and a multi vitamin with zinc
Vaccination: HIB- has brought number of fx’s down, including conjunctival infections.

53. General Immune Support
Vit C-50mg X age in years given every 2 hours during illness.
Esberitox: echinacea tablets full dose when sick,
NAC-mucolytic: dose > 2 years old mg 2-3 times a day
Thymactive (homeopathic thymus gland and homeopathic echinacea)

54. General Immune Supports
Herbs: glycerite or tincture tolerated: echinacea, astragalus, sambucus, thyme (if baby under a year of age and still nursing, treat through mom). You can use Glycerites in the ear directly, as they pull water from the middle ear, thereby decreasing pressure.

55. Local treatment for pain relief
Warm Garlic-mullein oil based drops daily before bed drops per ear for 3 days. Tx with both ears put in cotton ball and lie down soon. 4 cloves of garlic mashed into olive oil make it at home. Some oil will come out. Rinse with H2O2 in the morning to visualize ear drum. Do not put in drops when rupture is diagnosed or suspected.
Baby Tylenol PRN-best if don’t have to. Add a drop of aconite tincture to the ear oil and that cuts pain right away.
Ear drops for pain relief: allium, calendula, hypericum, verbascum, lavender, vitamin E in an oil base.
Thyme and eucalyptus oil rubbed behind the ears.

56. Earache/Otitis at Home
Tilt up head of med or mattress
Onion ear muffs prn (as needed) for pain and antimicrobial treatment when TM ruptured-draws out pain and inflammation.
Cranio-sacral therapy with mobilization of the temporal bone

57. Manual Therapies Warming socks-use it in all kids, wet socks.
Contrast hydrotherapy over ear.
Warm applications to ear including hair dryer
Lymphatic drainage

58. Earache follow up
Continue treatment for 24 hours after child stops complaining of pain
If not better in hours, adjust treatment
Return to doctors office after resolution to visualize membrane-make sure they are better
Children with frequent recurrent AOM or chronic effusion should have their hearing assessed to prevent language delay-3 months of continuous effusion have hearing tested.

59. Propolis and Acute Otitis Media Clinical Study
Efficacy of a propolis and zinc suspension in preventing AOM
122 children aged 1-5 years with a documented history of recurrent AOM
3month trial
Prospectively, blindly, randomized 1:1 to receive the suspension plus elimination of environmental risk factors or elimination of environmental risk factors only
THANKS TO MARY BOVE FOR THE SLIDE INFO
Marchisio P, Esposito S, Bianchini S, et al. Effectiveness of a propolis and zinc solution in preventing acute otitis media in children with a history of recurrent acute otitis media. Int J Immunopathol Pharmacol (2010 Apr-Jun) 23(2):567-75

60. Propolis and AOM Clinical Study
The administration of a propolis and zinc suspension to children with a history of rAOM can significantly reduce the risk of new AOM episodes and AOM-related antibiotic courses, with no problem of safety or tolerability, and with a very good degree of parental satisfaction.
THANKS TO MARY BOVE FOR THE SLIDE INFO
Marchisio P, et al. Int J Immunopathol Pharmacol (2010) 23(2):567-75

61. Echinacea Herbal Blend Effectiveness of an herbal preparation
Echinacea 50mg, propolis 50 mg, and vitamin C 10mg in preventing respiratory tract infections in children:
A randomized, double-blind, placebo-controlled, multicenter study.
during a 12-week winter period
430 children,
aged 1 to 5 years, two-times per day dosing

62. Echinacea Herbal Blend Effectiveness of an herbal preparation
A preventive effect of the product containing echinacea, propolis, and vitamin C on the incidence of respiratory tract infections was observed.
(Cohen HA Varsano I Kahan E Sarrell EM Uziel Y.,: Arch Pediatr Adolesc Med (2004 Mar) 158(3):217-21

63. Probiotics and Gut Flora
Probitocs, REALLY one of the most important tonic medicines for children.
Astragalus, helps to build SIgA
High phyto-phenols, helps to build the microbiota.
Astragalus, slippery elm, marshmallow
Chronic cycle with child, if can get to take andrographis, that’s really great.

64. CONJUNCTIVITIS Viral, bacterial or allergic
discharge: viral or allergic
swelling and redness of the lids: bacterial
if chronic, consider food allergy or allergy to dust, chemicals or pollen

65. Viral or bacterial?
Bacterial 50% of cases with Hib and Chlamydia (neo-natal) as the most common cause in developed countries. Bacterial infections are the most common in preschoolers, and are often accompanied by earaches)
Viral 20% of cases (adenovirus pink eye seen in older school aged kids and are usually accompanied by sore throats)
Culture negative, allergic 30%

66. Conjunctivitis Bright red conjunctiva Edema (swelling) Hemorrhages
Discharge, watery, stringy or purulent with matting of the lashes
Itching and stinging
Photophobia
Allergic shiners

67. Conjunctivitis Tearing Foreign body sensation
Preauricular (in front of ears) lymph nodes may be painful or swollen
Sore throat and fever associated with adenovirus
Herpetic vesicles (did mom or dad touch a Herpes lesion and touch the baby)
Conjunctival papillomas (warts) associated with HPV

68. TX/ MANAGEMENT FOR CONJUNCTIVITIS
Prophylatic erythromycin
Systemic treatment with erythromycin for infections caused by Chlamydia.
Breast milk lavage. It is powerful medicine.
Compress with black tea bags or Stellaria (chickweed)
Lavage with Chamomile, Hydrastis or Calendula. Wiping from inside to outside, with a clean cotton ball every time. Use a few drops in the eye or lavage.

69. CAVITIES
Dental caries (tooth decay) is caused by a specific group of cariogenic bacteria, like Streptococcus mutans, which convert dietary sugars into acids that dissolve the mineral in tooth structure.
Another significant contributing factor is the imbalanced flora in the mouth (and to some extent the gut)
This occurs when carbohydrates (or sugars) break up into sugars and bacteria act on it. Watch out for those teething biscuits and other carby snacks!
Look into gut flora and try probiotic mouth rinses.

70. 3 factors interrelated to cause caries
susceptible tooth surface
the presence of caries-inducing bacteria
a substrate capable of maintaining bacterial growth
the main bacteria responsible for caries is Streptococcus mutans and the favorable environmental bacterial growth is acidic
dental plaque (made of polysaccharides, bacteria and salivary glycoproteins) accelerate the development of caries by acid production as well as by resisting the buffering and remineralization attempts of the saliva
sugary foods are implicated in causing caries (they lead to an acidic oral milieu) esp. if they are sticky (ie fruit leathers, dried mangos, prunes, raisons…)

71. Licorice root and cavities
Taste nice and traditionally used in pediatric medicine.
Great compliance
Not only an incredible anti-viral (one of our best…)
Study with dental caries and tooth decay caused by strep mutans

72. Licorice Root for Dental Caries
(Glycyrrhizol A), an active compound of licorice roots, has strong antimicrobial activity against cariogenic bacteria
Two pilot human studies indicate that a brief application of these lollipops (twice a day for 10 days/21 days) led to a marked reduction of cariogenic bacteria in the oral cavity among most human subjects tested.
Licorice herbal lollipop could be a novel tool to promote oral health through functional foods and these sugar-free lollipops are safe and their antimicrobial activity is stable
SM numbers were reduced for 22 days after the last lollipop
Hu CH, He J, Eckert R, et al. “Development and evaluation of a safe and effective sugar-free herbal lollipop that kills cavity-causing bacteria.” Int J Oral Sci (2011 Jan) 3(1):13-20
THANKS TO MARY BOVE FOR THE SLIDE INFO