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Sepsis happens when a person's body reacts too strongly to an infection. Usually, our bodies fight infections with help from our immune system. But with sepsis, the body fights too hard, and that can be dangerous. Dr. Julianne Wilke, Pediatrics and Critical Care Medicine, examines pediatric sepsis's causes, symptoms and treatments and provides tips on preventing this potentially fatal condition. Most Common Causes Pediatric sepsis is a particularly concerning form of sepsis that can occur in children and infants. Therefore, it is vital for parents and caregivers to be aware of the indications of pediatric sepsis and to understand the causes. Bacterial infections are the most common cause of pediatric sepsis, accounting for over 80% of cases. Common Bacterial Causes: Staphylococcus infections (including Methicillin Resistant Staphylococcus Aureas - MRSA) Streptococcal infections (including those causing pneumonia and group B strep) Escherichia coli, or more commonly; E. coli Klebsiella and Pseudomonas infections Viral Infection Causes: Respiratory syncytial virus (RSV) Influenza Parainfluenza Adenovirus Human metapneumovirus Coronaviruses (including COVID-19) Other Causes: Fungal infections (but are relatively rare) Parasites, such as Giardia lamblia Pediatric Sepsis Symptoms Parents and caregivers need to be observant of sepsis symptoms in children and can include: Fever Extremely fast heart rate Rapid breathing Lethargy Pale or discolored skin Low blood pressure Confusion Slurred speech Abdominal pain Diarrhea & Vomiting Decreased urination Difficulty breathing Use the acronym SEPSIS: S – Slurred speech and confusion E – Extreme shivering or muscle pain/fever P – Passing no urine all day S – Severe breathlessness I – “I feel like I might die.” S – Skin mottled or discolored If any of these symptoms are present, seeking immediate medical attention is imperative.

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Respiratory syncytial virus, also known as RSV, is a common respiratory virus that impacts the lungs and breathing pathways. The virus can be dangerous for infants and young children and is also concerning for older adults. While most older kids and adults only experience cold-like systems and recover in a week or two, an estimated 58,000-80,000 children younger than 5 years old are hospitalized due to RSV each year, and in 2022 healthcare organizations across the country are experiencing higher infection rates than in years past.  "We are experiencing a strong RSV season and do not expect it to go away anytime soon," said Dr. Kris Wilson, Division Chief of Renown Children's Primary Care. "Infants who are infected with RSV almost always show symptoms of runny noses and cough. Call your healthcare provider immediately if your child is having difficulty breathing, is not drinking enough fluids, or is experiencing any worsening of these symptoms.” Symptoms of RSV: Runny nose  Decrease in appetite/inability to drink Dry diapers, an indication of dehydration  Cough, which may progress to wheezing or difficulty breathing Irritability (most common in very young infants) Decreased activity (most common in very young infants) Decreased appetite (most common in very young infants) Apnea, pauses in breathing for more than 10 seconds (most common in very young infants) What to do if you think your child has RSV: Call your pediatrician! If you suspect your child might have RSV, consulting their healthcare provider is the best first line of defense. From here they will help you build an appropriate treatment plan for child. Keep in mind that many pediatrician offices offer 24/7 call lines.  If your child is experiencing retracted breathing (when the area between the ribs and in the neck sinks in when a person attempts to inhale), dehydration (not drinking and decrease in wet diapers) or apnea (pauses in breathing for more than 10 seconds) please call 911 or go to the closest emergency room.

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Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs.  Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health.  PrEP and PEP  Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months.  Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days.  PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location.   HPV Immunization  All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime.  The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never!  STI Testing  Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year.   Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you.  Prostate Exams  Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old.  These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened.  Pap Tests and Pelvic Exams  Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer.  Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings.  Mammograms and Breast Exams  People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual.  The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project.  Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.

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According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new sexually transmitted infection (STI) cases in the United States each year, with rates continuing to increase.  What you may not know is most STIs are preventable. We talked with Renown Adolescent Medicine Specialist, Caroline Barangan, MD to learn more about STIs.  How Can You Get an STI?  The CDC (Center for Disease Control) says that STIs are acquired through sexual contact. There are bacteria, viruses or parasites that can cause an STI which may pass from person to person in blood, semen, vaginal and other bodily fluids.  How Do You Know if You Have an STI?  STIs can have a range of signs and symptoms such as:  Warts, bumps or sores on or near the penis, vagina, mouth or anus Swelling, redness or severe itching near the penis or vagina Discharge from the penis Vaginal bleeding that’s not your period Painful or uncomfortable sex Vaginal discharge that has an unpleasant odor, causes irritation or is a different color or amount than usual  Weight loss, diarrhea or night sweats Aches, pains, fever and chills Jaundice (yellowing of the skin and whites of the eyes) Painful or frequent urination  Sore throat if you engage in oral sex It’s important to know that the majority of people who have an STI commonly have no symptoms at all, which is why it’s important to get regularly tested once you have had any sexual activity. Young people less than 25 years of age should be screened on a yearly basis at minimum.

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Bacterial meningitis is probably the last thing on your mind as you help your child prepare for college. Buying books and stocking up on necessities may top your list, but it’s a good idea to ensure your student is up-to-date on their meningitis vaccine. How Bacterial Meningitis Spreads According to the Centers for Disease Control and Prevention, people living in close quarters are more likely to spread this illness to one another. For example, you may have heard about the higher risk of meningococcal (or bacterial) meningitis for new college students. The risk is so serious that many colleges and universities require proof of a vaccine for new students moving into campus housing. This includes the University of Nevada, Reno. To clarify, all incoming freshmen under 23 years of age must show proof of their up-to-date meningitis shot. “Bacterial meningitis is considered a medical emergency, and anyone with the signs and symptoms should be evaluated in the emergency room immediately,” says Vanessa Slots, MD, Renown pediatrician. Symptoms of Bacterial Meningitis Fever Nausea Vomiting Irritability Headache Confusion Back pain Stiff or painful neck Leg pain Light sensitivity Rash on the torso or lower extremities It’s important to know many of these symptoms for both bacterial and viral meningitis are the same. However, the viral type is more common, often clearing up in seven to 10 days without complications. Nonetheless, you should go to the emergency room to be looked at, as the signs are similar for both illnesses. Why is Bacterial Meningitis Dangerous? This illness moves quickly, and in some cases, it can seem like the flu or severe strep throat and take a few days to develop. Or, it can hit in just hours. “Bacterial meningitis has an overall death rate of 10 to 15 percent despite treatment with antibiotics,” Dr. Slots warns. Another critical point is problems after recovery can also be severe. Frequently these include brain damage, amputations, infections around the heart, seizures and shock.

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Immunizations (vaccines) save the lives of thousands of children and adults annually, protecting us from illnesses that can lead to disease, hospital stays, life-long complications and even death. Not only do immunizations protect the persons receiving the vaccine, but through herd immunity, vaccines protect children that are unable to get vaccines due to illness or age and our elderly community members whose immunities may have declined. Vanessa Slots, M.D., offers insight on the importance of immunizations. Immunizations Your Child Needs (and when) Birth to 6 Months Hepatitis B: Shortly after birth, first vaccine dose Diphtheria, Tetanus, and Pertussis (DTaP), Polio, Haemophilus Influenza (HiB), Pneumonia, Hepatitis B and Rotavirus: Ages 2, 4 and 6 months, boosters and vaccines One Year to 18 Months MMR and Varicella (chickenpox) vaccine: Age 1, first vaccine dose Hepatitis A, HiB and Pneumonia: Age 1, booster DTaP: 15 months, fourth vaccine dose Hepatitis, second dose: 18 months Flu Vaccine: 6 months and older, annually* *In the year after receiving their first dose, an infant will need a booster one month later. Four Years Old MMRV, DTaP and Polio, final dose: Four years of age Pre-Teen and Beyond Tdap and Meningitis: Before starting middle school, children receive these vaccines. They are also old enough to start the HPV vaccine, an essential vaccine for all young adults to protect against cancer, genital warts and cervical dysplasia.

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If you’re a parent, you’ve probably been there — the sometimes-nightly struggle to get your little ones off to bed. Elaina Lantrip, an APRN with Renown Pediatrics, offers some tips and explains how your child’s electronics may be getting in the way of a good night’s sleep. These days, kids are consuming media from a very early age on all types of devices — from tablets and phones to TVs. While they can benefit from some media use, it can have a negative impact on bedtime. We asked Elaina Lantrip, an advanced nurse practitioner with Renown Pediatrics, for some advice on downloading a better bedtime routine. What are the most important practices for parents to establish for their children’s bedtime routines? I often have parents tell me that their child won’t go to bed — or to sleep. Parents frequently ask for tips on bedtime routines that work. My first question is whether their regular bedtime routine involves television, iPad, tablet, phone or anything with a screen. It’s very important that bedtime includes a bath, reading a story, talking, singing and bonding with young ones, rather than using any devices. Why shouldn’t children have a device at bedtime? A growing body of research supports that screen time at bedtime contributes to delays in a child’s falling to sleep; overall inability to reach the important REM, or deep sleep; waking up during the night; nightmares and night terrors. For older youth, engaging with social media before bedtime can bring up stresses, emotions and relationship issues with peers that don’t exactly create peaceful bedtime thoughts. Bedtime should be a screen-free, stress-free, peaceful time of day. It’s a great time for parents to promote self-esteem, talk through things going on in the child’s life, to encourage and build them up. Children grow up fast — bedtime is a great the opportunity with younger children to cuddle up and read a story or sing a lullaby. What are other major considerations in making bedtime smooth and relaxing for kids and their parents? Another factor that contributes to positive sleep habits includes children getting enough activity during the the day so they’re genuinely tired at night. Also helpful are ambient noise makers, peaceful music, avoiding sugar two hours prior to bedtime, consistency in bedtime routine, comfortable pajamas and comfortable temperature in the home. Is it important to keep the child’s bedroom dark? Dimming the lights is important, regardless of the time of year. This is another reason to ban screens, as they emit light that stimulates wakefulness.

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We get it – the entire world has been overwhelmed with COVID-19 vaccine information, questions and celebrations around vaccines developed to combat COVID-19 induring the past several months. It’s hard to know where to start in digesting all this news and information. But one thing is clear: healthcare experts agree that the authorized COVID-19 vaccines are safe, effective and recommended to help end this pandemic. If you are passionate about stepping up in your community to encourage the vaccination efforts, we’re offering a few ideas on how you can be an ambassador. Find the Facts Content on the vaccine is abundant, but and there’s a few resources that we can all rely on to help digest the information: The Centers for Disease Control (CDC) updates its website content around the vaccine regularly, and also offerings information in Spanish. Health departments across the U.S. are leading the way in distribution logistics planning, and partnering with other providers, like such as hospitals and pharmacies, to distribute give people doses. Their websites are great resources to understand options where you live. Locally, check out washoecounty.gov/health/programs-and-services/environmental-health/covid-19-guidance for vaccine updates in Washoe County. Many providers like Renown Health and other providers are sharing content around their recommendations for the vaccine. Get answers about the vaccine types from one of our pharmacists, read common concerns addressed by experts and view videos from many doctors and other specialists on our YouTube Channel.

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Dr. Max J. Coppes, Physician-in-Chief Renown Children’s Hospital, and Nell J. Redfield Chair of Pediatrics, UNR Med, talks about how much is too much when it comes to teens and social media. Social apps (Facebook, Instagram, Twitter, WhatsApp, Snapchat, TikTok, etc.) have become an integral part of most people’s lives. In contrast to traditional media — where one source goes to many receivers — social media operates in a dialogic transmission system. Many sources interact, sometimes simultaneously, with many receivers and provide for superior interactivity between its users. Not surprisingly, it also plays a significant role in our children’s lives once they are old enough to understand how to access and use these apps. On average, children start exploring social media at around ages 10 to 12. They rapidly discover that electronic communication allows for unique and personalized ways to make and keep friendships. They also use it to develop and expand family ties, get help with homework, share music, art, and experiences, and learn and discover the world. Social Media and Teens Surveys suggest that more than 90 percent of teenagers use social media. Additionally, approximately 75 percent have at least one active profile by age 17. Access to social media is greatly facilitated because more than two-thirds of teens have their own mobile devices with internet capabilities, a substantial change relative to previous generations. The use of social apps can have many positive aspects. But we now also recognize that it can also have negative impacts. The use of hazardous sites or the inherent risks of using social media (identity theft, being hacked, cyber-bullying, etc.) are indeed damaging to children. Any use of hazardous social apps is too much and carries serious hazards. But what about the use of “normal” and/or “safe” social media? Well, data suggest that too much use of “non-hazardous” apps can indeed affect health. How Much Do Teens Use Social Media? First, some basic data. For example, how much do normal teenagers use social media? A study from Pew Research found that more than 50 percent of 13- to 17 year-olds go online several times a day. This quickly increases during the teenage years to more than 70 minutes per day. Teenage girls have the highest usage at just over 140 minutes per day. It is important to recognize that non-school related use of the internet and social media is often beheld by teenagers as important for developing their self-esteem, their acceptance among peers, and their mental health in general. As parents, we recognize that the use of social media can indeed contribute, in many positive ways, to our children’s growth. At the same time, we also worry about them spending too much time online. We worry about their ability to communicate effectively in face-to-face settings or in writing. Many of us also feel and/or worry that our children are addicted. Social Media and Addiction Recent studies suggests that the overuse of social media indeed mirrors addiction. Reports now show that teenagers and college kids experience anxiety when deprived from their connected devices and consequently feel a compulsion to access their social applications. The emotional symptoms they experience are very similar to those seen in substance abuse. In fact, the American Psychiatric Association is considering making internet addition a bonafide diagnosis. Pediatricians therefore encourage limits on the use of social media, a recommendation more easily suggested than accomplished. So when should a parent consider seeking help? Aside from unhealthy use of these apps (cyber-bullying, sexting, online users asking for sexual relations, etc.), which should always trigger concern, the use of social media for more than 120 minutes per day should trigger parental concern. If you feel unable to address the overuse of social media, contact your pediatrician for help and guidance. Renown Children’s Hospital Whether it’s seeing a pediatrician, getting a sports physical or looking for advice, our care is centered around supporting and nurturing patients and families at our many locations. We have pediatricians dedicated to children who have experience recognizing children’s illnesses. They also have knowledge about tests and treatments for young ones to ensure your child gets the best care possible. Explore Children’s Services

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Many factors are contributing to the rise of early onset puberty in girls. Learn what they are below and how you can support your daughter. The number of girls experiencing early puberty has increased dramatically over the last few years and continues to grow. More and more girls in the U.S. are starting to show signs of development before the age of 8. Recent studies show that up to 10 percent of Caucasian girls and 23 percent of African American girls are showing signs of puberty by age 7. What’s Contributing to Early Puberty in Girls? Determining the exact cause is difficult. But experts agree that several factors may be contributing to these growing numbers. Increasing rates of childhood overweight and obesity. Excess body fat alters the levels of hormones responsible for the acceleration of pubertal timing. Physical inactivity may decrease melatonin levels, which can also trigger pubertal development. Increased animal protein intake. Higher total protein, animal protein and meat intake in children ages 3 to 7 have been associated with earlier onset of menstruation. High protein intake elevates IGF-1 levels and promotes growth, which could accelerate the onset of puberty. Poor diet. Children with lower-nutrient diets tend to enter puberty earlier. A diet rich in processed foods and meats, dairy, and fast food is disruptive to normal physical development. Exposure to EDCs (endocrine-disrupting chemicals). EDCs are synthetic chemicals found in plastics, pesticides, fuels and other industrial chemicals that inhibit or alter the action of natural hormones. Because EDCs accumulate in the fatty tissues of animals, animal foods contain higher levels of these chemicals than plant foods. Exposure to BPA (bisphenol A). BPA is an industrial petrochemical found in a variety of products including plastics, tin-can linings and even cash register receipts. Because it acts as a synthetic estrogen it may speed up pubertal development. Soy products. Soy contain isoflavones which are converted to phytoestregens in the body, and are similar to the hormone estrogen, Dr. Chelsea Wicks says. “Soy consumed from natural food sources is likely safe and will not cause abnormal hormones levels. However, when consumed in large amounts, such as with soy supplements or in more processed foods, there have been links to chronic medical problems due to elevated estrogen levels. I feel a good answer to this is to continue working on eating fresh foods and trying to avoid the processed, packaged foods as this will be best for overall general nutrition as well,” she adds. What You Can Do While some genetic factors play a role in the early onset of puberty, parents can help lessen environmental causes of the condition. Encourage and help your child to maintain a healthy weight with proper nutrition and exercise. Avoid exposure to hormones such as estrogen and testosterone that may be found in hair products, medications and nutritional supplements. Avoid exposure to EDCs and BPA. Offer your child a diet centered around whole plant foods rather than animal foods, which will help keep protein intake within a safe range and reduce consumption of EDCs. Create a supportive environment for your daughter. Avoid commenting on her appearance and instead focus on her achievements, academic successes or artistic talents. Speak to her openly and honestly about the physical changes she’s experiencing — that although these changes are normal, she’s simply developing early — and that ultimately her peers will undergo the same changes. Encourage your daughter to continue participating in social activities and pursuing her interests, and reassure her you are always open to discuss any questions or worries. If you are concerned that your child may be going through these changes before expected, speak with your pediatrician. Sources: Early Puberty: Causes and Consequences When Is Puberty Too Early? Precocious Puberty (Early Puberty) Precocious Puberty

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