Ep 143: A parents guide to common summertime illness! Part 2 with Dr Wendy Hunter, Pediatrician

Ep 143 of Ask Dr Jessica for Part 2 continuing conversation with Dr Wendy Hunter, Pediatrician---and great ready to hear two pediatrician to share tips to help parents navigate the summertime.  In this episode, we discuss common summertime illnesses that kids may experience, including hand, foot, and mouth disease, gastroenteritis, swimmer's ear, and skin infections.  


Takeaways:

• Gastroenteritis, or stomach flu, is a common illness in children characterized by vomiting and diarrhea. It is important to keep children hydrated by giving them small sips of fluids, such as watered-down apple juice or popsicles.
• Hand, foot, and mouth disease is a viral illness that causes a rash on the hands, feet, mouth, and sometimes the buttocks. It is highly contagious but usually resolves on its own within a week. Treatment focuses on managing symptoms, such as pain and fever.
• Swimmer's ear is an infection of the ear canal that can occur after swimming. It is important to keep the ears dry and use antibiotic and steroid drops to treat the infection. An ear dryer can also be helpful in preventing swimmer's ear.
• When treating scrapes, it is important to clean the wound thoroughly and remove any debris. Keeping the wound clean and covered can help prevent infection.
• If a wound becomes infected, it may develop a yellowish crust and require antibiotics. It is important to seek medical attention if there are signs of infection.
• Parents should be aware of the signs and symptoms of common childhood illnesses and injuries and know when to seek medical attention.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody. I'm Dr Jessica Hochman, paediatrician and mom of three. On this podcast, I like to talk about various paediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Welcome back for part two of my conversation with Dr Wendy Hunter. Dr Hunter is a paediatrician and the podcast host of the paediatrician next door. On this episode, you'll hear two paediatricians share their tips about navigating through common summertime illness. You'll learn practical information about illnesses like Hand, Foot and Mouth Disease, gastroenteritis, also called the stomach flu, swimmer's ear and what you need to know about basic skin infections. And if you're enjoying this podcast, please take a moment to share this podcast with a friend. Leave a review, and don't forget to subscribe. All of this really helps get the word out about ask Dr Jessica. So for the second part of this conversation, I thought we could talk about summertime illnesses that kids experience, because now we're sort of out of the winter where we're not in flu season. We're not so much in cold season, but we do see some illnesses, yeah, especially this year, I feel like we're seeing a tonne more than in the past. Really. What are you seeing? A lot of vomiting and fever this past week, and some and lots of diarrhoea, yeah? And it's funny too, because some of it is Hand, foot and mouth and enteroviruses, but those tend to be more springtime illnesses, so I'm surprised we're seeing them this late, but I even saw a case of flu last weekend. These viruses are behaving really bizarrely. This year, I think we're seeing more illness than than typical years. I agree with you. I'm still seeing colds as well. Mm hmm, yeah, so the sports physicals have started, but I'm still seeing lots of colds. So let's talk about some of these illnesses. Just I'm hoping to give parents an idea of what to expect, what can be done about it in terms of prevention, and just anything else that we might think as paediatricians would be good tips for them to be aware of. Yeah, it's so funny that we're talking about this because we're really focusing on kids, but my friend texted me this morning that they are in Europe on their way home today, and her 22 year old son woke up with vomiting and diarrhoea last night, so she was asking me what to do about his hydration status. So you know these tips that you and I are going to talk about, they apply to all ages, if so true. All right, so first, let's talk about the vomiting and diarrhoea. Usually we call them a GE acute viral gastroenteritis. So parents would call this like stomach flu, but that's just not accurate, because it's not a flu. Flu is very different. This is gastroenteritis. That's a good point. Everybody confuses stomach flu with influenza, yeah, not the same. Okay, so in terms of gastroenteritis, you know, there are a lot of things that can cause vomiting in a kid and a lot of things that can cause diarrhoea. So vomiting is really scary, especially for myself as a former ER doctor. You know, vomiting can be pneumonia, it can be urinary tract infection, it can be lots of things. Can be appendicitis. So what's reassuring as a parent is that your child starts vomiting, and then the vomiting stops, and then they start getting diarrhoea. That's like classic gastroenteritis, right? That's right, yeah. And I think What's hard is vomiting. Nobody wants to see their kid vomit. Nobody wants to vomit. I think Nausea is a really tough symptom to deal with. I like pointing out to families that usually the vomiting part will go away first, and then the diarrhoea part will be the last part to go away. Yeah. It's interesting, though, that you mentioned nausea, because you know, you'll tell me, I feel nauseous. But your three year old, even your seven year old, isn't going to say, Mom, I feel nauseated. But what they might do is just not eat or not drink well, so you're like standing there like you need to drink. We need to get you hydrated, and they don't want to drink. And the truth is, they're done vomiting, but they're nauseated. So then we got to address that too, right? Yes, yes. So let's talk about that. So if a child comes in and they're feeling these symptoms, they're having diarrhoea, they're vomiting, they're not feeling good. What advice do you give to parents for their child to feel better? Is there anything that parents should do to help their child? Well, I know you know this too. It's it's challenging because your child is actively vomiting, but you do still need to give them fluids. So even though they're vomiting, you do still want to give them little zips to drink, because they will absorb something before they vomit again. So, and that goes for young kids too, right? Like, even in your bottle fed infants, you can start them on PD, like, just give them five millilitres at a time. I mean, I think the big picture here is that we know that the virus will likely pass, but the problem that kids can get into is they can get dehydrated, which can have some serious consequences. You know, what my favourite rehydration fluid is is watered down apple juice, so half water, half apple juice. So that's been shown in studies to be a good rehydration fluid. I like the others, though. What else do you use? I recommend popsicles, honestly, because I think popsicles are an easy way to get a little bit of fluid at a time, and I find that, as you mentioned, if the stomach is already irritated, if they if they drink a little at a time, they seem to keep it in, but if they drink a lot at a time, they might throw up again. So I go for things like popsicles. I do like diluted juice, because I find that. Kids want to drink juice. So even though, typically, paediatricians, you know, we we frown upon too much juice. In this situation, absolutely some some water with some juice. I think is perfect. Juice is a medicine, is what I say, because you can use it for constipation. You can use it for rehydration. I love popsicles too, because, like you said, you can't guzzle a popsicle, right? Or ice chips. Stretch out your stomach. Ice chips are great, too. Yeah, yeah. I like ice chips. Really. Anything a child's interested in drinking, I feel like, is okay, you know, I try to stay away from things that are too sugary, like sodas. But otherwise, whatever they'll drink, I'm happy about even Gatorade, so sugary, so I'd water that down. I like coconut water. Oh, that's a good one. Child likes it good electrolytes, fluids in that's all that really matters. Oh, and I'm curious, what do you think about Pedialyte? Oh, gosh, it's, it really is very high in sugar, but I don't think it even tastes very good, no. And so, you know, for young infants, all use Pedialyte, but I always warn parents that under 12 months, babies really prefer unflavored, which is foul and disgusting, but the unflavored Pedialyte is a go to for the young infants. Oh, that's a good point. I just find there's, there's usually other things that we can do first, and it's less expensive, more palatable, and kids do just fine. Yeah, I keep Gatorade powder at home in the cabinet because my kids don't get sick that often. But you know, you they inevitably get sick when you have nothing available to drink. And I'm not running out to the store at 2am so I'll keep the powder in my my cantery, because you can just do it pretty dilute and give them Gatorade. So it's more than just losing water from the body. When you have diarrhoea, you're also losing electrolytes. So Gatorade so nice because it's fluid, but it's also with electrolytes. So you're replenishing what the body's losing. You lose a lot of potassium when you poop, when you have diarrhoea, yeah? So potassium is a good one. So that's one of the reasons that we like bananas. It's coconut water too. Yeah. And coconut water too high in potassium. That sounds like I love the fun facts that we have in our brain, like potassium and diarrhoea. Oh, the joy, the fun of being a paediatrician. Okay, so we talked about rehydrating with fluids. What about what are your thoughts on antiemetics or medicines to help kids not feel nauseous? I'm curious what your perspective is, because I know paediatricians have different thoughts on when to give an anti medic like Zofran. Probably people are familiar with the word Zofran. I just love Zofran. It is very, very safe, and it's truly I call it a miracle pill that other antiemetics really have some pretty bad side effects. So I would warn against them. So if you have reglan lying around your house, I wouldn't give that to my child. Zofran is great because it dissolves under the tongue, so it gets directly into your bloodstream and you don't have to digest it, so it works quickly. But that is one way you can really get rid of nausea. So even in that kid who's no longer vomiting but won't drink, Zofran will take away their nausea and they'll start drinking. Yes, I agree. I like Zofran when children are first vomiting, I I feel like the body's having them vomit for good reason. In the beginning, they're probably agree, don't give someone Zofran. If they vomited one time, you need to let them vomit a few times. Yes, kind of get all that out of their system, and then, and then, if they're vomiting, if they're dry heaving, they're still nauseous, there's nothing left in them, then I agree. I think Zofran is a great option. I travel with it. I have it in my house. Good for you. Yeah, that's the one thing I don't want to be caught away from home without. I bet we, I bet we have similar medicine cabinets at home. Oh, for sure, yes. I mean, sometimes I worry about giving it too early, also, because you don't want to mask a symptom, like, like, as you mentioned, sometimes appendicitis, for example, can present with vomiting. So sometimes I like to see initially, how things, how things are evolving with the illness, and then once it's clear that it's gastroenteritis, I think Zofran is a really good idea. Yeah, that's a great point. Okay, so you also mentioned Hand, Foot and Mouth, which I agree. I have been seeing a lot of that this week in my office as well. A lot of parents panic when their kids when they find out that their kid has Hand, foot and mouth. So let's talk about that for a minute. What advice do you give in general for parents when they find out their kid has Hand, foot and mouth? That is kind of funny, because the truth is, if your kid is like, 18 months or two years old and they have Hand, Foot Mouth, you're like, thank God, because we want it now, not later, right? Let's get this over with. Now, why do you say that? I'm curious. Because you know, if you've had older kids with it, or a parent, they often are even sicker, like they feel awful. Your kid is a net, your your child is going to get Hand, foot and mouth. I mean, I can't think of a kid who hasn't had it at least once. Just so contagious. Yeah, it's so contagious and but typically, people usually only get it once. I mean, I haven't seen that pattern recently, but in the past, people usually get it once and they're done. So maybe get it out of the way. I don't know. Paediatricians call it Hand, foot, mouth and butt, because there's also a butt rash, right? Oh, all the time, all the time. If. I think we should rename it to hand, foot, mouth and butt. Yeah, I think we should, too. The whole nation should know. I don't know. Parents really are very worried. I don't know if it's a scary name, or if they just know it's a long illness, and kids don't like to eat because their mouth hurts, but gosh, the range of symptoms is just phenomenal. I mean, you have a kid who you can't even tell they have it, and then you have a kid who's just, like, covered in rash and happy as can be. And then you have a kid who has no rash and has like, three mouth sores and they're dying. Yes, no, I agree with you. I think that's what's so hard about it. The range of symptoms is tremendous. So you'll meet a lot of people that might be asymptomatic. They'll have no symptoms whatsoever, are very, very mild symptoms. And then you'll meet some people where they feel very sick. They'll get a fever, they'll have trouble eating, they'll feel a lot of pain in their throat. They feel a lot of malaise, very uncomfortable, especially, as you pointed out, the rare parent that gets it is miserable. So I do agree that's what's so tricky about it. Yeah, I love it because it's a slam dunk diagnosis most of the time. And we know it gets better. I really don't see many complications from it, but yeah, if you see one tiny.on the hand or on the palm or on the sole of the foot, you've got your diagnosis. Yes, you're right. So this is a great point. So the rash, what's different about it? There's not that many rashes where you actually get spots on the palms of the hand and the soles of the feet. So if you see that along with a child who's got a fever doesn't want to eat, it's probably Hand, Foot and Mouth, hand foot mouth and butt. Yeah, Hand, foot, mouth and butt. And I like it, because there are so many times parents come in and I'm like, Well, it's a virus. I don't know which one. I don't know how it's gonna last. I don't know anything. But this one, I know what it is. It's true, and I think just to, just for for people to be aware, it's caused by viruses. They're called enteroviruses, and within that, they're different groups. Some of you may have heard of Coxsackie or adenovirus enterovirus, but they all pretty much cause the same symptoms. And so that is, typically, we'll expect a kid to have a fever in the beginning. Maybe they don't want to eat. Maybe, maybe parents notice that their child's drooling more, and then, if it a day or two, and all of a sudden, you'll notice the rash on the hands, the feet, mouth and butt, right? So Hand, foot and mouth and butt is caused by an enterovirus. So sometimes you will see vomiting because it is a GI bug. Oh, that's a good point. I always thought it was the vomiting came from. I wasn't sure why enter a virus, yes. And the other thing I've learned is, as you mentioned, it's very I used to tell parents that they weren't going to get it, that it was really just a child illness, because that's typically what we see, not intentional, big liars, but yes, yes. Wasn't accurate. But usually we see this in preschools. I think just because it's so contagious and it's hard to keep kids hygienic, to be honest, so it passes very easily amongst preschool aged kids. As you get older, you see it less and less. So it is rare to get it as an adult, but it is possible. Yeah, sorry if I told you you weren't going to get it now, and what about prevention? What do you tell parents? Like, I know you had mentioned, of course, we're all going to get it. But is there anything if a parent asks you, how do you keep it from getting from child to child? What would you tell them? Oh, gosh, well, in particular, for hand, foot, mouth, it's past, you know, orally, you know. So you stick your hands in your mouth and you've got the bacteria. So washing hands, but in general, for preventing all illnesses, we all talk about hand washing super important. There also is some evidence that keeping your mucous membranes moist and not inflamed is preventative for getting respiratory viruses, your mucus membranes are inflamed, you're going to let bacteria in better. And there's actually some evidence too that xylitol, either nasal spray or chewing gum with xylitol, helps prevent viruses from attaching to the insides of your body. So I know parents are always looking for just desperate any way they can keep their kids in school and not missing preschool and not missing work. And when do you tell parents that it's okay to send their children back to school? Oh, God, I think you and I both as doctors, we send kids back probably earlier than the preschools are comfortable with. Because you know, the truth is, your child is more contagious right before their symptoms start, for any illness than once their symptoms start. So the damage is done. The damage is done. Yeah, once they're all snotty or, you know, they're they're just not as contagious. And so for hand, foot and mouth, we tend to send kids back once their lesions are crusted over and they have no fever. Yes, yes. So I agree. I say when the lesions are crested over. So even though the child may look like they're still contagious, because they still have rashes all over once they have crusted over, that's the time when they are allowed to go back to school. Now it's hard because it may not be perfect. They may still be a little bit contagious, because some of the virus does stay in the stool for some time. So. It's still a good idea to make sure you practice good hand hygiene, not sharing secretions, so saliva. But yes, once the I agree with you, once they're feeling better and the lesions are crusted over, they can go back to school. And in the cases where parents aren't really sure if they can go back or not, sometimes they'll say they need to be eating and drinking pretty normally, because if you need to be next to them, making them drink all day, they can't go to school yet. Yes, don't you think that's true that for so many paediatric illnesses, the time when they can go back to school is when they're just acting normally? Yeah, when they're driving you crazy at home, it's time. I had a mom yesterday say she knew when it was time to send her son back to school because he was first he was acting sick, and then the second, he started being mean to his sister. She knew he was back and she could send him back to school. That's brilliant. I love that. Soon as they're mean to their siblings, okay, she's like, my son's back. I'm adding that to my list. I don't know if you mentioned this yet, but while kids are sick with Hand, Foot and Mouth, what do you tell parents to do in terms of treatment? I know that it's self limited, meaning that it will go away eventually on its own. It's a virus, so it doesn't need antibiotics. But what do you tell parents to do in terms of helping their children while they're not feeling well? A lot of times, pain medicines help if they're not eating well. So I would say focus on pain control, and then, you know, drinking cool liquids or warm liquids, whichever feels better, but ibuprofen or acetaminophen for the pain, and then just monitoring their rash for signs of secondary infection, which these lesions don't often get infected. They look horrible, but they don't usually. Yes, I agree, and I find too that it's really the mouth lesions that bother the kids. I noticed that the lesions on the hands and the feet and the rest of the body don't seem to bother them too much. They look bad, but the real pain and discomfort from Hand, Foot and Mouth comes from the mouth lesions. Yeah, so keeping them hydrated, keeping them comfortable, that's all you can do. And wait and wait. And typically, what do you see? I tell parents to give it a week, and then they'll start to feel better, right? And when we say a week, we mean really seven days like this is a fairly long illness. This isn't a three or four day thing. Yes, I think the worst symptoms are in the beginning, when the fevers there and the and the throat pain is the worst, but correct it can be a week or even a little longer. Yeah, those really bad cases. Anything else that we left out about Hand, foot and mouth? I think that's a pretty good summary. I think it's good too. Yes, all right, now let's move on to swimmer's ear. Let's talk about swimmer's ear. This inevitably comes up quite often the summer, because, as the name suggests, kids feel uncomfortable in their ears because of swimming. Yeah, I see so much of this because I have so many swimmers and water polo players in my practice. So it's like year round. I think that I have a second degree in treating swimmer's ear. So really this, yeah, I've got some tips that. Because, you know, most of the time we talk about, well, I know you're gonna, you're, you're gonna agree with this too. Like you can diagnose a swimmer's ear because the ear hurts when you move it. So if you wiggle your ear or push on that little flap of skin at the front of your ear, if that hurts, you probably have a swimmer's ear. So swimmer's ear, as I'm sure you would share, too, is an otitis externa, meaning, you know, inflammation and infection of the canal of the ear, which is totally different than an inner ear infection. So we need to treat the canal. So it's easy, because you can use topical things, right? Yes, and I'm so glad you brought this up, because I think it's, I think it's a good tip for parents to know how to when to think about otitis externa or swimmer's ear, because you're right. If you touch the outer ear and it hurts, that is not that is different from the typical ear infection that I think a lot of parents are familiar with where you take antibiotics quite often to to resolve those to help resolve those ear infections, we treat it totally different, because, as you mentioned, it's a infection of the ear canal. We treat them by putting drops in the ears. So the drops that I usually use, they have antibiotics and a steroid in them, because the steroid helps to reduce inflammation. So So tell everybody why. Why does swimmer's ear actually happen beyond, like, I know a lot of kids go swimming and they never get swimmer's ear. Do you know why swimmer's ear happens? Like, what's the pathology? Why does it actually, why do kids actually have pain in their outer ear? I don't know if I know. So I hope you know, but I assume it's because water sits in the ear and it doesn't dry out. And so maybe I'm a big liar here too, but I tell families when they're worried about earwax, I'm like, Oh, just go ahead and leave the earwax alone if it doesn't bother them because it protects their ear canal. Is that true? Okay? So actually, I agree with you. I do not like to touch ear wax, but I what I've learned is that for some kids, they tend to get ear infections if they if you know your child is that kid where, every summer, inevitably, they're going to get an outer ear infection, the ear canal, because it's a dark, damp place, sometimes it can trap bacteria, particularly if kids scratch the inside of the ear. That scratch can be an itis or an area for bacteria to enter. And so a lot of Ents, for those particular kids, will actually clean out the earwax so that they have an easier time getting the drops in, yeah. And so trap water too, I suppose, right, yeah. So dark, damp place, yes. So I think the earwax, as you mentioned, is protective, but for kids that tend to get outer ear infections, Ents will recommend keeping the ear clean and free of earwax, so that when they do they do have preventative drops, like swimmers eardrops over the counter, and they want to make sure those drops actually get into the canal. That's a great idea. Yeah, those swimmer's eardrops work wonderfully. And the other thing for prevention that's we use a lot around here is a ear dryer. So it's literally like a little mini hairdryer you can keep in your bag. Oh, really loud. It's like$50 you can buy them anywhere, an ear dryer. Yep, that's a good tip. Thanks for teaching me that. I totally get a lot of swimmer's ear around here. So you know what's interesting too about swimmer's ear is that most of the time it does get better if you use the antibiotic drops, as long as the drops are touching the walls of the canal where you need the treat. And so sometimes we can't get the drops in because there's too much swelling or there's too much wax. But I've had some times where it's not a bacterial infection, it turns out to be eczema of the ear canal. Oh, wow, it's a steroid drop. Oh, that's really interesting. So as you mentioned, the treatment for outer ear infections, we do often use an antibiotic and a steroid drop combined in one one medication. The examples I use, we use a lot of ciprodex or Neomycin, Polymyxin, B, I don't know what you use, the one I use the most. Yeah, yes. So the steroid works great, because the outer ear or the ear canal gets swollen, so the steroids great at reducing the inflammation, the swelling, and then the anti it helps the antibiotic get in there and treat the infection, right? So you want to have the child lay down and let those ear drops soak in for a little while with their bad ear up, yes, and then switch sides. If it's both, then switch sides. Do you find kids don't like getting the drops put in? Do you I sure don't. Sometimes kids complain that it's too cold, and so I'll tell the kids, I'll tell the parents just to warm the drops with their hands. That's a good tip, yeah. But the drops are very effective. Kids should be feeling better pretty quickly, within a day or two, I find Yeah, yeah. So if you're listening and you're a parent out there who has a kid who tends to get outer ear infections, just make sure, after they're done swimming for the day, to keep the ear dry. I think that's the best way to prevent the infection. So you can get an ear dryer, which I might be buying after this podcast. You can put in swimmer's eardrops, which is basically just alcohol, and it'll keep the ear dry. Anything else that I'm leaving out about swimmer's ear. I don't, can't think of anything. And then, okay, and then lastly, to close, I thought we'd talk about common skin infections that we see over the summer, because a lot of kids are out and about. They're very active. They scrape their knees. They scrape their elbows. What advice would you give to parents for just basic first aid care with scrapes, you want to clean the wound. You always want to clean well and get any debris out of your wounds. You know, kids do heal very well. I do see a lot of infections, but I think there are probably they're the tip of the iceberg. There's a lot more scrapes that we don't see, and they don't get infected anything that has a crust to it that's sort of yellowish coloured. We worry about that having a secondary infection, which we call impetigo, and that usually needs antibiotics. So I'd look for that kind of, what we call honey coloured crust. Yes, tell everybody about this, because this is something that can make people feel pretty uncomfortable. And I think it's good to bring awareness to it, because there's a pretty good treatment for it. Yeah, it's really easy. If you catch it early, you can treat it topically. And yeah, so it'll look like a yellow, crusty lesion on top of your scrape. Can be pretty oozy, can have some different appearances. I've definitely seen some that look like they have blisters on them. And if it's widespread, we need to use oral antibiotics. We have to recur antibiotics. Yeah, so we always have bacteria on the skin, so if you get cuts or scrapes, there is that risk of getting a secondary infection. I agree with you. It's I think it's good to be aware that if you get a yellow crusted rash, especially, I notice them a lot in the nose. I see them a lot on the face, yes, that we can treat them pretty easily. So upper lip and nose. One special wound I like to mention are splinters. I have the hottest tip for removing a splinter. Oh, tell me so I learned this as a camp doctor. There is a device called splinter out. I'm just obsessed with this thing because, like, get rid of your needles. They're never going to work. As well as this tiny little metal thing that makes you able to flick out splinters so easily, they're like painless, and they come in like, a 10 pack or something. But I have those all over the place. I use those do keep them at home too. Oh yeah, this is great work. I have them in my drawer at work because we don't have anything else to remove splinters, and they just look like a magician. And when I get a splinter out, and they work better than tweezers, so much better. They're magical. I don't know. I can't quite describe what it looks like. It's like a little Lancet. Yes, yes, quicker, yeah. Anytime you get a puncture wound and you get debris that remains under the skin, those are more likely to get infected. You got to get out the debris. So if you puncture your foot, even if you feel like the entire thing that punctured came out lots of times, that tough skin on the bottom of your foot will scrape off dirt and debris, and it'll stay under the skin, trapped, and that gets infected really easily, so sometimes we have to open that up. But I would say, pay special attention. I would pay special attention to cleaning out wounds on the foot. Thank you for that. This has been so much fun. I love picking the brain of a smart, kind paediatrician, same Dr, Jessica. So thank you so much for being here. This was a lot of fun. Thanks. I would love to do this again. Absolutely, absolutely topic. I agree. I agree. It was a great pleasure. Thank you so much for listening to this week's episode of Ask Dr Jessica. I'm going to take a two week summer break from the podcast, but when I return, I have some fun episodes lined up for you. Have a wonderful Fourth of July, and I'll see you in two weeks. You.