Fast Facts about “MONO”


by Barbara Jo Rayo, MD

Mononucleosis, which is often called “mono” or “kissing disease,” is an infection caused by the Epstein-Barr virus. It is very common and affects more than 3 million people in the US per year. It mostly occurs in people ages 14-18 but can occur at any age. It is spread by saliva…kissing, sharing a glass or food utensil with someone infected with mono or even through a sneeze or cough.

The symptoms of mono are swollen glands in your neck, tiredness, fever, swollen tonsils, sore throat, a swollen spleen and sometimes a rash. Teenagers and young adults often show these signs and symptoms but young children usually have few symptoms.

Mono usually isn’t very serious. The fever and sore throat usually will lessen within a couple of weeks but, fatigue, enlarged lymph nodes and swollen spleen can last several weeks longer.

There are blood tests to diagnosis mono. Our office can perform a monospot test. It’s great if it is positive and we can say “yes, you have mono!”. If it is negative, we still don’t know if you have it or not. That’s when your doctor may order EBV titers. This requires going to an outside lab to have blood drawn. This is the definitive test for mono.

THERE IS NO TREATMENT FOR MONO. Antibiotics won’t work because this is a virus. So… rest, drink lots of fluids and eat good, healthy foods. An over the counter pain reliever such as ibuprofen or acetaminophen can be taken for comfort. DON’T TAKE ASPIRIN. It has been linked to a life threatening condition called Reye’s Syndrome when you have a viral infection.

When should your child be seen in the office? We’d like to see your child anytime there has been a fever for longer than 2-3 days. If there are symptoms of a bad sore throat, we can look for mono or strep throat. It is wise to be seen anytime your child is ill with these symptoms and it seems more than the common cold. If your child has been diagnosed with mono and the symptoms are worsening, ie unable to eat or drink; problems sleeping due to swollen tonsils causing breathing issues; developing yellowness of the skin or the whites of the eyes; development of a very sharp pain in the left upper part of the abdomen….please have your child seen in the office right away.

What about school and activities? It’s recommended that your child stay home until feeling better. Most people feel better in 2-4 weeks. Some kids can only go to school for half days until the fatigue improves. Athletes should not return to contact sports for three weeks, until they have been examined and shown that their spleen is still not enlarged.

BOTTOM LINE…Mono is VERY common and usually resolves without any problems within 2 to 4 weeks.

Please Verify Your E-mail for the new Check-In Process

Please verify that we have your correct e-mail address today! You will be able to contact us through the patient portal for refills, questions and more.

Also, we will be contacting YOU via e-mail prior to appointments, giving you the opportunity to pre-register in our new Phreesia check-in system beginning in late January.

Phreesia will allow you to securely pre-register, update demographics, answer medical questions and complete annual paperwork on your smartphone, tablet or PC prior to your child’s visit. We hope this will make your waiting room experience much more pleasant and efficient!

Please note, if pre-registration cannot be completed ahead of time, you may be asked to arrive 15-30 minutes prior to your appointment time so you can complete info on the Phreesia tablet in the waiting room.

Flu Vaccines Still Available

It is not too late for flu vaccines.  We continue to have supply in all of our offices.  Please call to schedule a time for your child to attend one of our flu clinic sessions (an “immunization only” visit).  Remember, that if your child is under 9 years old and he/she has not had at least two previous influenza vaccines, she/he should receive two vaccines THIS year, at least 28 days apart.

Also as a reminder, it is absolutely fine to receive a flu vaccine even if your child has a minor illness like a cold or an ear infection.

Also important: egg allergy is NO LONGER a reason to defer the flu injection.  Even persons with severe egg allergy can safely receive this important vaccine.

Fever: Is It Dangerous? The REAL Story

by Amy Deibel, MD

Fever phobia is a very common cause of visits to the emergency room and late night calls to our on-call doctors. Why do parents fear fever so much? No doubt about it, a fever makes your normally pleasant child look and feel miserable. They may look red in the cheeks, cry because they feel achy, or want to lay around and sleep more. These things may look scary, but they are all a part of our body’s amazing response to fighting off infections!

Parents ask me all the time, “How high is too high? When should I take them to the emergency room?”. If your child’s temperature is 100.4 F or higher AND your child under 1 month of age or has a known immune disorder, you should always call our on-call doctor or follow the plan given to you by your child’s specialist. For ALL other cases, there is no temperature that your child can reach on their own that is a medical emergency! “Dangerous” temperatures occur when a child’s body temperature is forced up by an external source ( such as being left in a hot car). When the child’s own thermostat responding to an infection, normal fevers can occasionally reach as high as 105 F or 106 F! The higher the number, the worse your child will feel, but it is not harmful or any sign that they are more ill than if their temperature was 101 F. Fever reducers, such as acetaminophen (if over 2 months old) and ibuprofen (if over 6 months old) can be used to improve a child’s comfort. They won’t necessarily bring the temperature back to normal, but that’s okay and not a sign of a worse infection. Be sure to always these medicines at the recommended dose for your child’s age and weight. Dosing charts are available in your yellow book and on our website.

So, when should you be concerned? You should decide whether your child needs seen immediately more by whether they are breathing comfortably, hydrated, and interacting appropriately with you – whether they have a fever or not. If there are other more concerning symptoms present (severe headache, abdominal pain), a call to our on-call doctor can help you decide if emergency care is needed. A fever that lasts for more than 2-3 days should be evaluated in our office to see if an infection that needs treated is present. Otherwise, some TLC, increased fluids, rest, and fever reducers for comfort are all that is needed!

The following link is very helpful in understanding fever fact versus fiction: 

Doctor Talk: Why Is My Toddler Such A Picky Eater?

The “Picky” Toddler Appetite

By Bill Long, MD

Parents often will describe their toddlers as becoming “picky” eaters. This could mean one of a couple of things, as there are several types of “picky” eating.

The first (and the most common) type is that toddlers just “pick” when they want to eat, and when they don’t want to eat.  They do this based on their natural hunger cues, and NOT necessarily on a schedule.  Since toddlers don’t have a rigorous school or work schedule, they don’t NEED to eat at each and every scheduled meal time.  We need to remember this.

The second kind of “picky” is the toddler who eats, but has a very limited selection of foods he/she will eat.  This is common in children with developmental problems such as autism, prematurity, and children with severe problems with textures in the mouth.  The following advice will not apply to those children with those special conditions.

However, in otherwise “normal” children, more often than not, we, as parents, MAKE our children “picky” eaters.

It’s a natural reaction to worry when our toddlers don’t want to eat.  But when our kids are that FIRST kind of “picky” and they don’t want to eat, we must remember two things:

  • DON’T play with, coax, argue, or try to convince your child to eat.
  • DON’T go to the cupboard or fridge to get them something else to eat or drink so “at least they have something.”

When we DO the above things, our children (with their toddler logic) think these thoughts:

  • When I don’t eat, mom and dad pay MUCH more attention to me.  I love that!  I’m might want to do that more often!
  • If I keep refusing to eat, I will get more attention AND eventually I will get what I want.  I love that too!  This is great!

The “key” to keeping our kids from becoming the second kind of “picky” is to follow these general principles:

  • Offer your toddler a variety of foods at every meal and snack.
  • If your child has no other developmental or medical conditions, he or she will know when they are hungry, and when to eat or not, based on normal hunger cues. Don’t force the issue.
  • Give them enough, but limited time to eat at each meal/snack.
  • Make meal times  (breakfast, lunch, dinner) family times—eat together.
  • NEVER coax, cajole, or FORCE your toddler to eat.
  • Show POSITIVE attention when your toddler eats well, and when they don’t eat well, stay relatively quiet, and put the food away when the meal time is over.
  • Toddlers will go through phases when they stop eating one or more foods they had eaten before.  Be patient and keep trying those foods again.
  • NEVER make meal times a battleground.  Meals should be positive experiences for the family.

Doctor Talk: Common Teething Questions–Answered!

Commonly Asked Teething Questions Answered

by John Toth, M.D.

Question 1.) How do I tell the difference between teething and an ear infection?

Answer 1.) Ear tugging is not a reliable indicator of an ear infection as the nerve that goes to the ear also goes to the jaw. In my experience, teething is typically preceded by several days of drooling and gnawing whereas an ear infection is usually preceded by a cold. I have found that teething may be associated with low grade temperatures (never above 100.4F) while ear infections can be accompanied by a higher fever or no fever at all. The fussiness with teething varies throughout the day and is almost always worse at night or nap time when the infant is lying in their crib in a dark room with nothing to distract them. This is in contrast to the the pain of an ear infection which tends to be present throughout the day no matter what distractions are present. Possibly, paying attention to the above can save you from an office visit for teething, but know that the combination of teething plus a cold is always going to be difficult for you to judge at home. When in doubt, please schedule a non-urgent, next day ill visit for your infant.

Question 2.) How should I treat teething symptoms in my baby?

Answer 2.) Over the years a number of “traditional” treatments have fallen out of favor. Previous generations of parents have tried rubbing brandy or whiskey on the gums to soothe teething pain; however, no amount of alcohol is considered safe for infants, so please resist any urges you have to follow in this tradition. As of September 30, 2016 the FDA has issued a warning to consumers that homeopathic teething tablets and gels pose a risk to babies and children so I would advise you to remove these from your medicine cabinet. The FDA has further warned that readily available numbing gels or creams containing benzocaine shouldn’t be used on children under age two years without the guidance of a doctor. There are two reasons for this. First is the theoretical risk that the benzocaine may accidentally numb the throat and interfere with the gag reflex. Second is that benzocaine could cause methemoglobinemia which is a serious (but rare) condition where the amount of oxygen carried in the blood drops dangerously low. Safer options for managing teething pain are chilled but not frozen teething rings or safe toys made of rubber or cotton terrycloth. Occasional use of OTC pain relievers such as Acetaminophen or Ibuprofen (in those older than 6 months) may also be helpful. If all else fails, you could always try holding your baby as you rock them or sing to them.

Question 3.) When should I worry if my baby’s teeth haven’t come in yet?

Answer 3.) The average age for a first tooth to erupt is 6 months but they can come as early as 4 months. I see a fair number of kids whose first tooth erupts at 14-15 months. If no teeth have erupted by 18 months, this probably should be investigated and possibly referred to a pediatric dentist.

Question 4.) Should I be concerned that my baby’s fang teeth are coming in first?

Answer 4.) No, this is generally not something I would worry about. If I could give you a bit of advice though, it would be to avoid exposing your infant to direct sunlight, do not put garlic in their mesh feeder/teether, and be sure to encourage their love of counting!

What if I need someone else to call or bring my child to an appointment?

We understand there are times when someone else needs to bring your child to the office or call with questions. We must have permission on file for someone other than a parent or legal guardian to ask for medical information, come to an appointment, or sign for any vaccine or tests that are indicated. This person could be a grandparent, step-parent, or other trusted adult. Please see our Forms and Policies section to download the “appointment of personal representative” form.

Please note that all patients 18 years and older must complete this form in order for our staff and physicians to schedule, exchange information, or give results to parents in accordance with privacy rules.

Doctor Talk: Why are Immunizations Important and How Do They Work?

Why Are Vaccines Important?

by Julie, Dunlea, MD, FAAP

There are few topics that spark more emotions than vaccines . At Pediatric Associates, Inc. we practice evidence-based medicine. We are always happy to discuss vaccines at your child’s well visits. It is important to understand what a vaccine does and why vaccines are important to your child, your family and the community in general.

Vaccines are given to protect against infections that have a high likelihood of severe consequences, including death. When you receive a vaccine, you are receiving a piece of the bacteria or virus, or in the case of a live vaccine, an altered version of the virus which does not cause disease. This causes an asymptomatic infection, spurring the immune system to create “memory cells” which stick around the body. It is the memory cells which confer immunity. Think of the vaccine as a “Most Wanted” poster for the immune system. If that particular villain tries to invade the body (measles, diphtheria, polio, etc) the immune system reacts immediately and shuts it down before it can cause trouble.

After receiving a vaccine, your child may feel sore and tired, and may even develop a fever for 1-2 days. The immune system is doing its job creating those memory cells. In true child fashion, most children have very few, if any, side effects. They go on playing, with a good story to tell and a sticker to show for it.

It is easy to see why a vaccine benefits the individual receiving it. However, the benefits go beyond just one person. Once someone is immunized, they are much less likely to spread that disease to someone else – for instance, a newborn baby, or a grandparent, or a child with cancer. In fact, when enough people in a community are vaccinated, even those who aren’t immunized are protected. This is called herd immunity.

We realize that there has been a glut of misinformation in the popular media. Millions of dollars have been spent studying vaccine safety. Scientific studies have proven , time and again, that vaccines are safe and effective.

In closing, we want you to know that here at Pediatric Associates, Inc, we not only talk the talk, we walk the walk. All of our children are fully vaccinated, and vaccinated on the well-studied schedule set by the AAP and the CDC. We protect our children, we protect our community. Be a part of that with us.


Doctor Talk: Why I gave my own children the HPV vaccine

Why I Gave My Own Kids the HPV Vaccine

As a mother of 4 children in addition to a pediatrician, I understand the worry about what we expose our kids to. From the foods they eat to the toys they play with, we want only the best, safest, healthiest things for the most cherished gifts in our lives.

I think about what I want for my own children’s future when counseling parents about HPV vaccination.  Despite the differences that make us all unique families, the one thing we all have in common is the desire to see our kids develop into happy and healthy adults.  And a critical component to helping our kids achieve their dreams is giving them the immunizations necessary to prevent life threatening vaccine preventable disease.  Make no mistake about it.  Every one of our kids is at risk for death and severe disability from HPV associated cancer.  80% of unvaccinated adults have HPV infection.  And HPV is the cause of almost all cases of cervical and oral and throat cancers.   These cancers kill.  And when they don’t, they maim.   Young women with cervical cancer must have their cervix removed to save their lives. No cervix means no babies for your daughter.  Oral and throat cancers are treated with radiation and surgery often involving the voice box.  This frequently leads to permanent loss of the ability to speak.  If you survive the cancer at all.   Regardless of religious or political affiliation or cultural and racial background, regardless of age, education or socio-economic status,

I am absolutely certain that no parent wants that future for his or her child.

So ultimately the decision for most of us comes down to vaccine safety.  If we can be assured that prevention of such atrocities is safe, of course we would choose to protect our children from these horrible and deadly diseases.  We don’t hesitate to vaccinate our children for various forms of meningitis, as babies and again as teenagers, because we know non vaccination can result in loss of limbs, brain damage and death.  And decades of experience with these vaccines have shown them to be exceptionally safe, with lifesaving benefits far outweighing the risk of minor annoyances like pain and swelling at the injection site.    The safety data for HPV is equally as good as that for the meningitis vaccines.  That’s worth repeating.  The HPV vaccine is one of the safest vaccines ever produced.  And it has been in use both in the US and in Europe for decades so long term outcomes is well studied.

Why is this so different than what you have heard? Consider your source of information when making your decision about vaccinating your own children.  The media does not use scientific evidence based study to evaluate risks and benefits of medical procedures. The medical literature is very clear about the safety profile of this vaccine.  Trust your pediatrician in his or her recommendation not only to vaccinate your sons and daughters but in their decision to vaccinate their own children.   Together we can work to provide a happy, healthy future for all our children.  Because what parent doesn’t want that?

Kate Krueck MD

Medical Director

Pediatric Associates, Inc.