Valle Verde Pediatrics Blog

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December 18, 2013
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Coming soon.

What is bronchiolitis? — Bronchiolitis is a common viral  infection that affects a part of the lungs called the “bronchioles.” The bronchioles are the small, branching tubes that carry air in and out of the lungs. When these tubes are infected, they get swollen and full of mucus. That makes it hard to breathe. Bronchiolitis usually affects children younger than 2 years of age. In most children, bronchiolitis goes away on its own, but some children with bronchiolitis need to be seen by a doctor. The most common cause of bronchiolitis is a virus called “respiratory syncytial virus,” or “RSV.”

What are the symptoms of bronchiolitis? — Bronchiolitis usually begins like a regular cold. Children who get bronchiolitis usually start off with:

  • A stuffy or runny nose
  • A mild cough
  • A fever (temperature higher than 100.4ºF or 38ºC)
  • A decreased appetite

As bronchiolitis progresses, other symptoms may develop, including:

  • Breathing fast or having trouble breathing. In infants, the first sign can be a pause in breathing that lasts more than 15 or 20 seconds.
  • Wheezing, or a whistling sound when breathing (which usually lasts about 7 days)
  • A severe cough (which can last for 14 days or longer)
  • Trouble eating and drinking — because of the other symptoms

Should I take my child to see a doctor or nurse? Many children with bronchiolitis may not need to see a doctor. However, you should watch and arrange f/u for concerning symptoms that involve increase in difficulty breathing, including wheezing; increased congestion with problems with feeding, any signs of choking or severe gagging from increased mucus, and problems with maintaining adequate hydration and urine output.

Call 9-1-1 for an ambulance if your child:

  • Stops breathing
  • Starts to turn blue or very pale
  • Has a very hard time breathing
  • Starts grunting
  • Looks like he or she is getting tired of having to work so hard to breathe

Call our clinic if you have any questions or concerns about your child, or if:

  • The skin and muscles between your child’s ribs or below your child’s ribcage look like they are caving in and there is struggling with breathing
  • Your child’s nostrils flare (get bigger) when he or she takes a breath
  • Worsening cough and congestion
  • Your infant younger than 3 months has a fever (temperature greater than 100.4ºF or 38ºC)
  • Your child older than 3 months has a fever (temperature greater than 100.4ºF or 38ºC) for more than 3 days
  • Your infant has fewer wet diapers than normal

How is bronchiolitis treated? — The main treatments for bronchiolitis are aimed at making sure that your child is getting enough oxygen, and able to breathe well despite the increased mucus that this virus produces. To do that, your child may need to receive:

  • Moist air or oxygen to breathe
  • Medicines to help open up the airways
  • Deep suctioning of the airways

Bronchiolitis does not need to be treated with antibiotics because it is a virus, however children may develop complications from the virus including ear infections or pneumonia. If your child has a persistent fever or if he was getting better and then gets sick again, please call for an appointment.

Is there anything I can do on my own to help my child feel better? — Yes. You can:

  • Make sure your child gets enough fluids. Call our office if your infant has fewer wet diapers than normal.
  • Use a humidifier in your child's bedroom
  • Treat your child's fever with non-prescription medicines, such as acetaminophen or ibuprofen (if your child is over 6 months of age).
  • Suction the mucus from your child’s nose with a suction bulb
  • If your child is older than 12 months, feed him or her warm, clear liquids to soothe the throat and to help loosen mucus
  • Prop your child's head up on pillows or with the help of a car seat. Do not use pillows if your child is younger than 12 months old.
  • Sleep in the same room as your child, so that you know right away if he or she starts having trouble breathing

How did my child get bronchiolitis? — Bronchiolitis is caused by viruses that spread easily from person to person. These viruses live in the droplets that go into the air when a sick person coughs or sneezes.

Can bronchiolitis be prevented? — You can reduce the chances that your child will get bronchiolitis by:

  • Washing your hands and your child’s hands often with soap and water, or using alcohol hand rubs
  • Staying away from other adults and children who are sick

Adapted from






Atopic dermatitis is the most common type of dry, itchy skin known as eczema. It affects 10-20 percent of kids and from 1-3 percent of adults.

Patients may scratch uncontrollably leading to redness, swelling and cracking of the skin, with crusting and scaling, and even “weeping” of clear fluid. Patches of the affected skin may be widespread and the constant scratching can lead to skin damage, secondary infection and loss of sleep.

In kids, we often see this condition develop in the first year of life, and it develops in 80 percent of those affected before age 5. In infants, itchy patches are often noted on the scalp, forehead, and cheeks. Many of these younger children get better with time, but it may be a clue for the “allergic march”, with a risk for the development of allergy and asthma. Therefore, we carefully monitor for any associated wheezing and persistent congestion, and at times, test for associated food allergies, including milk products, nuts and shellfish. Controlling asthma symptoms and environmental allergies and hay fever will also help clear up the skin. If the condition doesn’t resolve early on, a childhood phase develops with skin involvement that usually appears on the inside of the elbows or the back of the knees. We often see this in older children and teens, and they may also show patches on the face, hands, feet, wrists and ankles, and neck and upper chest. With time, the patches may become discolored, scaly and thick, as well as emotionally distressing. Fortunately, the itchy skin tends to improve with time, but it may be a lifelong condition for those severely affected.  For example, hand eczema is an especially bothersome form of dry skin that can become chronic and interfere with everyday activities. The use of prescription ointments and creams with frequent use of moisturizers is helpful, but it is especially important to avoid harsh soaps and irritating cleansers, and even use gloves for protection. This presents a good example of the effectiveness of combining of good medical treatment with environmental control.

While the treatment and control of atopic dermatitis may be challenging, it is very rewarding to see patients improve when we educate them and their families about controlling the condition. I recently attended a medical conference with lectures from a noted dermatologist who taught us that the use of bleach scrubs for certain challenging cases is helpful, and I’ve had some good success with this treatment. By working together with patients and their families, we look to identify and avoid allergen and environmental triggers, and develop an effective long-term treatment and prevention plan, including the use of approved corticosteroid creams and ointments, breaking the itch cycle with non-sedating antihistamines, and the use of aggressive moisturization. We can make a difference and stop the “itch cycle” in our patients with eczema.


Adapted from the pamphlet:

Eczema/Atopic Dermatitis, a 2009 publication of the American Academy of Dermatology.

November 07, 2012
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Hives, or urticaria, are localized pink swellings on the skin that are produced by histamine, a chemical released into the skin from the mast cells that lie along our blood vessels.  They are usually itchy, and may occasionally burn or sting. They vary in size and are quite common in children. Up to 10-20 percent of the population will have at least one episode in their lifetime, and fortunately, most resolve quickly, but some may last for days, weeks or even longer. Occasionally, they may be severe enough to require an emergency visit for associated problems with severe facial swelling with trouble swallowing, wheezing and trouble breathing, severe abdominal pain or severe joint pain/swelling.

By definition, acute hives last less than 6 weeks, and oftentimes, a trigger can be identified and eliminated. Common foods like milk, berries, eggs, tomatoes, shellfish, nuts and chocolate may cause hives.

Any of the over the counter medications can cause hives, and a common cause that pediatricians see involves an allergic reaction to antibiotics, like penicillin and sulfa drugs. We also see hives related to bee stings, viral upper respiratory tract infections, hepatitis and occasionally from bacterial and fungal infections.

Hives that last longer than 6 weeks are considered chronic and are much rarer. It is usually much harder to identify the cause and a referral to a dermatologist or allergist may be needed, with additional blood tests or skin biopsy for diagnosis.

Other physical causes may produce hives, including sensitivity to cold, heat, exercise and pressure. Some healthy patients may even develop hives from firm stroking or scratching of the skin, and though recurrent, these causes tend to be self-limited.

Most patients respond to a short course of daily non-sedating antihistamines, but occasionally a longer course of treatment combining the use of two antihistamines may be needed, as well as the use of steroids, or even an injection of epinephrine in more severe cases. We counsel our patients that the best treatment remains working together to identify an underlying cause and eliminating it whenever possible.


Adapted from the educational pamphlet: Urticaria-Hives

A 2005 publication from the American Academy of Dermatology

November 07, 2012
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Concussions in Children

Nathan Rendler, MD

Valle Verde Pediatrics


An increasing concern seen in our office is the growing number of concussions in sports. By definition, the concussion is considered a type of mild traumatic brain injury caused by a bump, blow or jolt to the head that may or may not be associated with a loss of consciousness. At times, the concussion may also occur from a body blow that causes the head to move rapidly back and forth. The athlete often presents with headaches, dizziness, light sensitivity, weakness, lethargy and abnormal mental function, including difficulty with concentration. Unfortunately, even what appears to be a mild injury may be serious, and needs careful evaluation and follow-up. Oftentimes, since the athlete wants to return to competition as soon as possible, he/she minimize the symptoms so that the history may be unreliable, and may not provide enough of a guide as to when it safe to return to play.

Over 300,000 sports-related concussions occur each year at the high school level or below, with 60% of these injuries involving high school football players. Recently, nearly 3,000 former players and players’ family members are in the news for suing the National Football League, claiming the league knew about the dangers of head trauma and concussions and failed to disclose the risks and appropriately manage the consequences. A diagnostic challenge is that concussions are not specifically seen on x-ray, MRI or CT scan, and these tests are used primarily to rule out skull fracture or an intracranial bleed. Therefore, it is recommended that any concerning signs and symptoms be evaluated promptly by a physician.  

In our office, the physician first performs a careful neurological exam to assess the extent of the injury. Complete rest for at least 48 hours after the injury is usually very helpful and may help with an overall quicker recovery. We also work closely with our clinical psychologist, Dr. Jeff Daly, who uses the most-widely accepted concussion evaluation system, called ImPACT testing. It is a standard test that has been used by many professional sport leagues, as well as amateur organizations in college, high school and even elementary schools.

ImPACT testing takes about 30 minutes to complete and measures multiple aspects of cognitive function in the athlete. It is a scientifically validated computerized evaluation system that looks at attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving and reaction time. It is most helpful when it is administered as a baseline before the concussion occurs, but it remains helpful if the results are abnormal since it may be re-administered at a later time to help determine the extent of injury and the steps needs for recovery. This helps us to improve our ability to manage the recovery process and provide a better assessment for the athlete, parents and coaches as to when it is safe to return to play.

We look forward to helping our patients recover from concussions and focus on their safety and their long term well-being. As always, prevention is the best medicine. Some helpful tips are to teach and practice safe playing techniques, and to encourage athletes to follow the rules of play and to practice good sportsmanship and avoid unnecessary harmful contact. Properly fitting protective equipment is essential and should be well maintained, fit properly and be worn consistently and correctly.

We encourage parents, coaches and athletes to work together as a team to help increase concussion awareness, leading to prompt treatment and improved safe recovery. Please contact us with any concerns you may have. We will schedule an appointment for you quickly and look forward to helping you.