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For children with COVID-19, most children have mild illness or are asymptomatic. The most common symptoms for COVID-19 are respiratory symptoms, ie fever, chills, cough, fatigue, headache, muscle pain, and sore throat. However, in the news there are now reports of possible skin findings associated with COVID-19. Rashes are a common occurrence with other viral infections in general. Reports out of China showed rashes were only noted in 0.2% of patients whereas in Italy it was reported in up to 20%. There is no specific pattern that has been associated with COVID-19 but there are some recent reports of possible associations.


One you may have heard of is “COVID toes”. This is just another manifestation of a rash that just happens to involve the toes. This presentation looks similar to Chilblains (also known as pernio), something usually seen after exposure to the cold. It can cause red, pink or purple spots on toes or the soles of the feet. For most with “COVID toes”, this presentation was associated with low severity of illness.


The other rash patterns being investigated include a flat and raised red rash (maculopapular), hives (urticaria), a lace-like or fishnet pattern (livedo), and blistering rash (vesicular). The flat and raised red rash is a common type of rash seen with viruses. Sometimes these rashes have been described as showing up before other symptoms, a few days into the illness, or later in the course of the infection. There is still limited data on these types of rashes and if they are a manifestation of the illness versus the body’s reaction.


In the news there has been a lot of mention about Kawasaki syndrome and multi-system inflammatory syndrome associated with COVID-19 (MIS-C). These are very rare presentations for COVID-19. It is occurring in older children than what is typical for Kawasaki and may present in a different way than typical Kawasaki syndrome. Kawasaki’s typically presents with persistent fevers (5 or more days), red eyes without discharge, red, cracked lips and/or tongue (strawberry tongue), rash with red swelling of hands or feet (sometimes peeling), swollen neck lymph nodes. If your child has fever (100.4) and at least 2 of the above symptoms and fever please contact us immediately.


If your child has fever, abdominal pain/diarrhea/vomiting, rashes, trouble breathing, has confusion or seems overly sleepy, or your child appears very ill please contact us immediately.

For more information about MIS-C check out: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/covid_inflammatory_condition.aspx



We are here for you if you have concerns about your child’s health.


Trying to find ways to keep your children (and yourself) active during the shelter at home orders can be difficult. This week I was surfing the web trying to find different activities to do with my kids because they are growing bored of our daily walks. The current recommendations for physical exercise for children by age: (https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_PhysicalActivity.pdf)


  • 1-3 years: at least 60 min of unstructured (free play) physical activity, at least 30 min should be structured (planned by adult)

  • 5-21 years: 60 min of physical activity each day, most of that time should be moderate or vigorous intensity aerobic physical activity. 3 days per week should be vigorous, 3 days a week should be muscle-strengthening and bone-strengthening activity


Here are some ideas:

Fun family fitness article:






Workout apps:


Free workout websites:


Lets keep our kids healthy!

Nicole Abdy, MD


For those interested in how COVID-19 has been affecting children, here are some statistics from the CDC.


As of April 6th, the CDC released data on how children in the U.S. have been affected. 1.7% of laboratory confirmed cases occurred in children under the age of 18 years. However, we must realize that given the screening recommendations, this percentage may be underestimated. Furthermore, the proportion of patients for which data like symptoms (9%), underlying conditions (13%), and hospitalization status (33%) was relatively low. 91% of children with known exposures were from the community or household.


The most common symptoms found were:

  • Fever, cough, OR shortness of breath (73% compared to 93% of adults)

    • 56% had fever

    • 54% had cough

    • 13% had shortness of breath

  • Headache (28%), sore throat (24%), body aches (23%), diarrhea (13%), nausea/vomiting (11%) and runny nose (7%)


Demographic data:

  • Ages: of all reported cases

    • 32% were aged 15-17 years

    • 27% were aged 10-14 years

    • 15% were aged 5-9 years

    • 15% were aged <1 year

    • 11% were aged 1-4 years

  • Of those for which data was known, 5.7-20% of kids were hospitalized. 0.58-2% were admitted to the intensive care unit

    • Children < 1-yr accounted for highest percentage of hospitalized patients


Underlying conditions:

  • 23% had at least 1 underlying condition. The most common were:

    • Chronic lung disease (including asthma)

    • Cardiovascular disease

    • Immunosuppression

Kids don't just get sick Monday through Friday.  So we are excited to offer telemedicine sick visits on weekends from 9-11am and 3-5pm both Saturday and Sunday.  This gives families with sick kids the option of checking in with one of the doctors at Mesquite Pediatrics without waiting for Monday to come around.  It allows people to get care from a pediatrician they know and trust instead of only having the option of going to a retail-based clinic (i.e. Minute Clinic) or urgent care center where they would likely see a nurse practitioner who doesn't know their child and doesn't have access to their medical history.  To use this option, just go to our home page and click the telemedicine link near the top.  Then click on the "Weekend Waiting Room" to connect to the telemedicine site.  The doctor will connect with you shortly!

April 08, 2020
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At this unprecedented time we have taken drastic measures to help keep our patients and staff safe.  That has meant canceling a majority of patient visits to our office.  One of the results of that change has been that, as a business, we are suffering greatly.  Our physicians are no longer taking a salary and our staff has had their hours cut.  Still, at this rate we may be unable to pay our staff at all within the next few months.  Therefore, we find it necessary as a small business to look for new ways to generate revenue.  So beginning Monday, April 6, we will start charging when your physicians answer telephone calls or portal messages.  Many insurance companies were already paying for these services and that has expanded with the crisis, so it is likely that most patients will not have to pay out of pocket.  Any insurance plans that do bill families for this probably do so based on the decision of the employer providing the insurance (so talk to your HR department).  We also recognize that a lot of our families are suffering financially as a result of this crisis, so we encourage anyone receiving a bill from us for any service who feels paying the bill will be a hardship to call and speak with our office manager about delayed payments and payment plans.

Some things to know about how this works:

  • The amount of the charge is based on the length of the call or the time it takes to answer the portal message, with the charge based on rates set by the federal government
  • Most will be charged at the lowest time category, which will be $22 for phone calls and $23 for portal messages
  • These charges will usually be steeply discounted by the insurance companies so the actual payment will be significantly less
  • If the communication is about an office visit within the last 7 days or leads to a visit in the next 24 hours, then there is no charge
  • Only 1 phone call per week will be billed for any specific issue

Again, we regret having to make this change at this time but we find it necessary to help ensure that we can stay open and continue to provide our patients with care when they need it.

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