Common Illnesses

ABDOMINAL PAIN

ACCIDENT PREVENTION AND CHILDPROOFING YOUR HOME

ALLERGIC RHINITIS

ASTHMA

BITE, ANIMAL OR HUMAN

BLOCKED TEAR DUCTS

BREATH-HOLDING SPELLS

BRONCHIOLITIS

CHICKEN POX

CHOKING

COLIC

CONSTIPATION

CONTACT DERMATITIS

COUGH

CROUP

DENTAL CARE AND FLOURIDE

DIAPER RASHES

DIARRHEA

EAR INFECTIONS

FEVER

FIFTH DISEASE

FROSTBITE

HEADACHE

IMPETIGO/SKIN INFECTIONS

ITCHY OR PAINFUL INSECT BITES AND STINGS

NOSEBLEEDS

RINGWORM

SUNBURN

SWIMMERS EAR

TEETHING

THRUSH

UPPER RESPIRATORY INFECTIONS

VOMITING

SYMPTOMS:

• Pain or discomfort located between the bottom of the rib cage and the groin crease.
  
• The older child complains of a stomachache.
  
• The younger child should at least point or hold the abdomen (after 6-12 mos). Prior to 6 months, the protocol for crying should be used.

CALL YOUR DOCTOR NOW IF …

• Your child looks or acts very sick
  
• You suspect poisoning with a plant, medicine, or chemical. Notify poison control now.
  
• Unable to walk or walks bent over holding the abdomen.
  
• Pain mainly low on the right side.
  
• Pain in the testicle or scrotum.
  
• Severe pain anywhere.
  
• Pain or crying present > 2 hours consistently.
  
• Blood in the bowel movement or vomiting blood.
  
• Vomiting bile (yellow or green stomach fluid).
  
• Recent injury to the abdomen or surgery.
  
• Age less than two (2) years.
  
• Fever > 105 degrees.
  
• Intermittent pain that has lasted > 24 hours.

CALL YOUR DOCTOR WITHIN 24 HOURS IF …

• Fever < 105 degrees F
  
• Exposed to strep throat.
  
• Possible lead exposure.
  
• You think your child needs to be seen.

CALL YOUR DOCTOR DURING OFFICE HOURS IF …

• You have other questions or concerns.
  
• Abdominal pains are a recurrent problem.
  
• Associated with abnormal menses.

PARENT CARE AT HOME FOR ABDOMINAL PAIN:

If your child has mild abdominal pain and you don't think your child needs to be seen:

• REASSURANCE: A mild stomachache can be caused by something as simple as indigestion, gas pains, or overeating. Sometimes a stomachache signals the onset of a vomiting illness from a virus. Watching your child for two (2) hours will usually tell you the cause.
  
• REST: Encourage lying down and rest until feeling better.
  
• CLEAR FLUIDS: Offer clear fluids only (i.e. Water, flat soft drinks, Pedialyte, or diluted juice).
  
• PREPARE FOR VOMITING: Keep something handy in case vomiting occurs. Younger children refer to "nausea as a "stomachache".
  
• PASS A BM: Encourage sitting on the potty/toilet to try to have a bowel movement. This may relieve the pain if it is due to constipation or diarrhea.
  
• AVOID MEDICATIONS: Any drug could irritate the stomach lining making the abdominal pain worse. Do not give any medications for stomach cramps unless otherwise directed by your doctor.
  
• EXPECTED COURSE: With harmless causes, the pain is usually improved or gone within two (2) hours. With viral illnesses, pain may precede each bout of vomiting or diarrhea. With serious causes such as appendicitis the pain worsens and is constant.
  
• CALL YOUR DOCTOR IF: Pain is present > 2 hours or if your child worsens or develops any of the above "Call your doctor" symptoms.

Back to Top

Here are some tips on "childproofing" your home and preventing in-home accidents:

• Cover all electrical outlets when not in use.
• Do not leave your infant unattended on any surface from which they may fall.
• Keep all household cleaners, medications, and other dangerous substances either locked in cabinets or out of reach from your child.
• Keep the phone number for Poison Control (1-800-848-6946) easily accessible in your home.
• Be very cautious with hot liquids/foods on the stove and countertops. Position pot handles away from the stove front in a way that your child will be unable to reach them.
• Have approved smoke detectors in all sleeping spaces in your home and check the batteries monthly.
• Inspect all of our child's toys and clothes for loose parts, such as buttons and eyes from dolls/bears, wheels from small cars, etc., which may pose choking, hazards.
• North Carolina law states that all children under age 4 must be in an approved infant, convertible or booster seat. Infant seats should be rear facing until your child is at least 20 pounds and one year of age. Children under 12 should always ride in the back seat if your vehicle has air bags.
• Your child should be in a booster seat until 8 years or 80 pounds.
• Set you water heater temperature to 120°F to prevent scalding in the tub.
• Always monitor your child when water is near by (swimming pool, ocean, lake, etc.) Drowning may even occur in a bucket of water when young children are involved. Locked fences should surround unattended swimming pools.
  
• Never leave your infant or toddler unattended in a bathtub or kiddie swimming pool.

Back to Top

Symptoms of allergic rhinitis are itchy, runny or stuffy noses, and itchy eyes. Often caused by pollen from trees, grasses or weeds, it is also known as hay fever. Other airborne substances such as dust, molds, animal fur and feathers may also cause these symptoms. Seasonal allergies are less likely under 2-3 years of age.

Treatment -

• Avoidance is the best treatment for any allergy whenever possible. Keeping doors and windows closed in your home and car is important. Removing pets from the home and dust and mold control measures can significantly relieve symptoms due to perennial allergens.
• Antihistamines may relieve many allergic symptoms by inhibiting the action of histamine on nasal and eye tissues. These are available over the counter and as prescription medications. Some preparations may cause drowsiness.
• Nasal decongestants act to decrease the swelling of the nasal tissue and the resulting feeling of stuffiness. Oral decongestants may cause sleeplessness and jitteriness. Topical nasal decongestants may cause "rebound" congestion and irritation of the nasal passages if used more than 2-3 days.
• Other medications to treat allergies are available as prescription from your doctor if indicated. Contact us if your child has persistent symptoms you feel may be due to allergies and we can discuss appropriate prevention and therapy.
  

Back to Top

ASTHMA is a very common respiratory disease in children. Of the more than 11 million American who suffer from asthma, more than 3 million, according to the Nation Center for Health Statistics, are younger than 18 years of age. While the cause of asthma is not fully understood, great strides have been made in treating this common childhood disease.

CAUSES

• Asthmatic children have airways that are very sensitive to certain irritants and allergens, going into spasm when exposed to even normal amounts.
  
• During an asthma episode the muscles surrounding the bronchial tubes constrict and the lining inside the tubes swells and produces an excessive amount of mucus.
  
• Triggers of asthma are divided into two groups, irritants, and allergens.
• The most potent (and preventable) irritant is secondhand cigarette smoke; other irritative triggers include viral infections, rapid environmental changes in temperature and humidity, ozone, smoke from a fireplace, and sometimes exercise.
  
• Allergens responsible for triggering the bronchial narrowing include dust, molds, pet dander, foods and certain drugs.
  
• Some children with asthma only have an attack when two or more triggers are present at the same time.
  
• To help control asthma it is important to identify the various triggering mechanisms affecting a child's symptoms and try to remove it from the child's environment.
  
• No one knows why some children develop asthma, but the condition tends to run in families. If both parents have asthma, at least one in three of their children may have similar symptoms. However, a considerable number of children who wheeze have no close relatives with asthma.
  
• There is some indication that exposure to certain injurious agents, such as cigarette smoke (even as a fetus), increases a child's risk of acquiring asthma.

SYMPTOMS

• The airway spasm and mucus plugging that occurs in asthma leads to a variety of symptoms.
  
• Although asthma attacks vary in severity, during an attack most children have a hard time breathing and often make wheezing sounds (whistling or squeaking sounds with respiration) in the process.
  
• Coughing is also common from irritation of the sputum.
  
• Typically the onset is sudden and the child may experience tightness in the chest, severe breathlessness, fatigue, and panic from a feeling of suffocation.
  
• No two asthmatics react the same way and not every asthma attack is an obvious one. For instance, some asthmatic children may only have a constant cough or only experience wheezing during vigorous exercise.

TREATMENT

• While there is no cure for asthma, great strides have been made in its treatment.
  
• The first approach is to identify the triggering mechanisms and try to prevent exposure to those substances.
  
• While avoidance of the offending trigger is recommended, it is often difficult, especially when a beloved pet or common substances like house dust are involved.
  
• Medication prescribed to treat and prevent asthma is usually taken orally or inhaled.
  
• Antibiotics are not helpful unless a secondary infection is present.
  
• Two main types of medications used to treat asthma attacks are bronchodilators and anti-inflammatories.
  
  Bronchodilators are medications that relax the muscles around the air tubes to relieve the attack. These drugs should be given as often as necessary but as little as needed because of side effects, including stomach upset, rapid heartbeat, and nervousness. Bronchodilators are usually inhaled agents, which offer the child increased benefits with fewer side effects. Medications can be given by a hand-held inhaler or a nebulizer, which consists of an air compressor that delivers medication as a "mist" so the drug is distributed directly where it is needed.
  
  
• In severe attacks, steroids are helpful by treating air tube inflammation. These drugs are very effective and when used in occasional short courses are safe and control asthma flare-ups unresponsive to other treatments. The child's physician should always be consulted before using steroids.
  
  
• Children with frequent asthma attacks can be started on preventative medications such as inhaled steroids or Singulair.
  
  
• Allergy shots may benefit some children with asthma under the guidance of an allergist.

CALL IF ….

A severe asthma attack is a medical emergency and parents should be prepared to call the child's physician or take the child immediately to a hospital emergency department. The following indicate potential problems:

• Blue or gray lips or flaring nostrils
  
• The child prefers to sit up and lean forward on elbows or arms
  
• The spaces between the ribs become depressed
  
• The breathing becomes rapid
  
• The child is unable to say more than a few words between breaths
  
• The child is unable to hold down liquids or their medication

Virtually all asthmatic children can lead normal lives with active physical activity and minimal inconvenience. While the child's "twitchy" airway is a life-long problem, many children indeed "out grow" their asthma as they become teenagers. For these children, the airway apparently becomes less sensitive to the different triggers that in the past set off their illness. Though childhood asthma can be a serous disease, and a frightening one for parents, it need not ruin the quality of life for its suffers. The important thing for parents to remember is that modern treatment for asthma is both effective and safe. Parents should keep a positive attitude and strive to maintain a normal life style for their child.

Back to Top

TYPES OF ANIMAL BITES:

• Bites from rabies-prone wild animal - Rabies is a fatal disease. Bites or scratches from a bat, skunk, raccoon, fox, coyote, beaver, or large wild animals are especially dangerous. These animals can transmit rabies even if they have no symptoms. Bats have transmitted rabies without a detectable bite mark.
• Small wild animal bites - Rodents such as mice, rats, miles, gophers, chipmunks, prairie dogs, and rabbits fortunately are considered free of rabies. Squirrels rarely carry rabies, but have not transmitted it to humans.
• Large pet animal bites - Most bites from pets are from dogs or cats. Bites from domestic animals, such as horses, can be handled using these guidelines. Dogs and cats are free of rabies in most areas. (Check with the local Health Department for exceptions. Stray dogs and cats are at greatest risk.) The main risk in pet bites is serious wound infection, not rabies. Cat bites become infected more often than dog bites. Claw wounds from cats are treated the same as bite wounds, since they are contaminated with saliva.
• Small pet animal bites - Small indoor pets (gerbils, hamsters, guinea pigs, white mice, etc.) are not risk for rabies. Puncture wounds from these animal also do not need to be seen. They carry a small risk of wound infections.
• Human bites - Most human bites occur during fights, especially teenagers. Sometimes a fist is cut when it strikes a tooth. Human bites are more likely to become infected than animal bites. Bites on the hand are at increased risk of compilations. Many toddler bites are safe because they do not break the skin.

Home care for the simple bite wound:

Keep clean and dry.

Call 911 if ….

• Major bleeding that cannot be stopped.
• Apply direct pressure to the entire wound with a clean cloth while awaiting EMS.

Call our office if or go to Wake Medical Emergency Room if….

• Bleeding will not stop with ten minutes of direct pressure.
• Any bite, puncture, or scratch from an animal at risk for rabies (REASON: needs irrigation and may need rabies vaccine and immune globulin).
• Skin is split open or gagging (a laceration) (REASON: Needs irrigation and sutures).
• Cut or tear that goes completely through the skin (REASON: Needs irrigation). (EXCEPTION: Superficial scratches that do not go through the dermis.)
• Puncture wound (holes through skin) from cat (teeth or claws, especially on hand and feet) (REASON: 50% risk of wound infection; usually needs prophylactic antibiotics).
• Any bite or puncture wound of the face (REASON: Cosmetic risk and may need prophylactic antibiotic).
• Bite looks infected (redness, pus, or red streaks).
• You want your child seen.
• Last Tetanus shot > five (5) years ago (REASON: Needs a Tetanus booster).
• Bat contact or exposure without a bite mark (REASON: Postexposure rabies prophylaxis should be considered).

It is okay to monitor certain bites at home:

• Human bites that DID NOT break the skin.
• Animal bites that are too small to irrigate and are showing no signs of infection (EXCEPTION: Cat/dog bite to hands, feet, or face).
  

Back to Top

BLOCKED TEAR DUCTS, or dacryostenosis, is a very common condition of newborn infants, occurring in about 1 in 20 babies born. Technically speaking, dacryostenosis refers to blockage of the drainage system that carries tears away from the eye as they are formed.

Matting, tearing, and discharge from the eyes of your newborn or young infant may be an uncomplicated eye infection, usually contracted when your baby makes the journey down the birth canal. This is generally a simple matter for your baby's doctor to treat with antibiotic drops or ointment. However, persistent matting and tearing of the eyes that fails to clear up with antibiotics is most often caused by narrow or blocked tear ducts.

Normally tears flow out of the eye through the tiny pores easily visible in the corners of the eyelids nearest to the nose. Tears normally drain through the tear ducts into the nose, which explains why one sniffs at a sad movie. The blockage may be temporary, caused by old mucus and debris in the duct; or it may be more permanent, caused by narrowing of the duct or actual blockage. True physical blockage is caused by the failure of a proper channel to form ina little flap of tissue that lies right at the end of the duct where it empties into the nose.

TREATMENT …

When the eye collects yellow or green mucus and tears even though it is frequently wiped clean, antibiotic drops may be used for a suspected infection. If the antibiotic drops are to no avail and the matting continues (usually only in one eye)…

• Your doctor will tell you to lay off the drops and that the best treatment is to massage the tear sac and the duct several times daily. He or she will show you the proper technique. It may take weeks or even months to unblock the duct, but this is almost always successful. You will know you are making good progress when the eye does not seem to be matted every day.
  
  
• Every once in a while, the condition persists despite massage, and it is necessary for an ophthalmologist (eye surgeon) to probe the duct under anesthesia with a fine wire to pop open the blockage. However, eye specialists usually recommend waiting until the child is close to a year old to do this procedure. By then about 95% of kids are cured naturally, and the anesthetic risk is lower. If probing is necessary, the cure rate is about 90% for the first probing, so repeat probing is seldom necessary. A very few children will eventually require the placement of an artificial drainage tube to relieve chronic tear duct obstruction.

COMPLICATIONS of tear duct blockage are rare, but can include such things as irritation of the skin around the eye from all the ear overflow, and more serious infections of the tear sac. The tear sac lies just below the corner of the eye along the track of the tear duct. Infections of the tear sac require systemic antibiotics or even surgery. Sudden swelling and redness in the area of the tear sac should be reported to your baby's doctor right away.

Parent should remember that not all excessive tearing in infants and children is caused by tear duct blockage. Excessive tearing may also be a sign of glaucoma (increased pressure within the eye), inflammation within the eye, or external irritation such as a corneal scratch or foreign body hidden under the eyelid. Consultation with your baby's doctor or ophthalmologist is important for any case of excessive tearing which seems persistent or out of the ordinary.

Back to Top

BREATH-HOLDING SPELLS

What is a breath-holding spell?

A breath-holding spell is when your child holds his breath when he is suddenly injured, frustrated, angry, or frightened. Breath-holding spells begin between the ages of six months and two years. They occur only while the child is awake.

During a breath-holding spell:

• Your child may have 1 or 2 cries and then hold his breath in expiration until he becomes blue around the lips and passes out.
• Your child may stiffen and may have a few twitches or muscle jerks.
• Your child will breathe normally again and become fully alert in less than one minute.

What is the cause?

An abnormal reflex allows 5% of normal children do hold their breath long enough to pass out. Most children do not do this deliberately.

Holding the breath (when frustrated) and becoming bluish without passing out is such a common reaction in young infants that it is not considered abnormal.

How long does it last?

Breath-holding spells usually occur from 1 or 2 times a day to 1 or 2 times a month. Children usually stop having breath-holding spells by the time they are 4 or 5 years old.

Breath-holding spells are not dangerous, and they do not lead to epilepsy or brain damage.

How can I take care of my child?

• Treatment during attacks of breath-holding….
  • These attacks are harmless and always stop by themselves. Time the length of a few attacks, using a watch with a second hand.
  • During an attack, do not hold your child upright. Instead, he should lie flat. This position will increase blood flow to the brain and may prevent some of the muscle jerking.
  • Put a cold wet washcloth on your child's forehead until he starts breathing again.
  • Don't start resuscitation or call a rescue squad - it is not necessary.
  • Don't put anything in your child's mouth because it could make him choke or vomit.
  
  
• Treatment after attacks of breath-holding….
  
  • Give your child a brief hug and go about your business.
  • A relaxed attitude is best.
  • If you are frightened, do not let your child know it.
  • If your child had a temper tantrum because he wanted his way, do not give in to hIm after the attack.
  
  
• Prevention of injuries….
  • The main injury risk of a breath-holding spell is a head injury.
  • If your child starts to have an attack while standing near a hard surface, go to him quickly and help lower him to the floor.

What can I do to help prevent breath-holding spells?

Most attacks from falling down or a sudden fright can't be prevented. Neither can most attacks that are triggered by anger. However, some children can be distracted from their breath-holding if you intervene before they become blue. Tell your child to come to you for a hug or to look at something interesting. Ask him if he wants a drink of juice.

If your child is having attacks every day, he probably has learned to trigger some of the attacks himself. This can happen when parents run to the child and pick him up every time he starts to cry, or when they given him his way as soon as the attack is over. Avoid these responses and your child won't have an undue number of attacks.

When should I call my child's health care provider?

Call during office ours if….

• More than one spell occurs each week.
• The attacks change.
• You have other concerns or questions.

Back to Top

BRONCHIOLITIS is an infection of the small breathing tubes (bronchioles) of the lungs. It occurs most often in infants. (The term bronchiolitis is sometimes confused with bronchitis, which is an infection of the larger, more central airways.)

CAUSES

• Bronchiolitis is almost always caused by a virus, most commonly the respiratory syncytial virus (RSV).
  
• Other viruses that can cause this condition are parainfluenza, influenza, measles, and adenovirus.
  
• The infection causes inflammation and swelling of the bronchioles, which in turn, blocks the airflow through the lungs.
  
• Most adults and many children who are infected by RSV get only a cold. Infants, however, the infection is more likely to lead to bronchiolitis. This happens because their airways are smaller and are more easily blocked when infection or inflammation occur.
  
• Almost half the infants who develop bronchiolitis go on to develop asthma later in life. We do not know why these youngsters are more susceptible, but it is likely that the RSV infection is the first trigger for the airway reaction.
  
• RSV infection is the most likely cause of bronchiolitis from October through March. It is spread by contact with secretions from an infected person. It often spreads through families, child-care centers, and hospital wards. Careful handwashing can help prevent this.

SYMPTOMS

• If your infant has bronchiolitis, it will start with signs of an upper respiratory infection ( a cold), runny nose, mild cough, and sometimes fever.
  
• After a day or two the cough becomes more pronounced, the child begins to breathe more rapidly, and with more difficulty.
  
• He may dilate his nostrils and squeeze the muscles under his rib cage in efforts to get more air in and out of his lungs.
  
• He will use the muscles between the ribs and above the collarbone to help him breathe.
  
• When he breathes he may grunt and tighten his abdominal muscles.
  
• He will make a high-pitched whistling sound, call a wheeze, each time he exhales.
  
• He may not take fluids well because he is working so hard to breathe that he has difficulty sucking and swallowing.
  
• As his breathing difficulty increases, you may notice a bluish tint around the lips and fingertips. This indicates that his airways are so blocked that an inadequate amount of oxygen is getting into the blood.

CALL IF ….

If your baby shows any of these signs of breathing difficulty, or if his fever lasts more than three days (or is present at all in an infant under three months), call your pediatrician immediately.

Call the pediatrician if your child develops any of the following signs or symptoms of dehydration, which also can be present with bronchiolitis:

• Dry mouth
  
• Taking less than his normal amount of fluids
  
• Shedding no tears when he cries.
  
• Urinating less often than normal

Lastly, if your child has any of the following conditions, notify your pediatrician as soon as you suspect that he has bronchiolitis:

• Cystic fibrosis
  
• Congenital heart disease
  
• Bronchopulmonary dysplasia (seen in some infants who have been on a respirator as newborns)
  
• Low immunity
  
• Organ transplant
  
• A cancer for which he is receiving chemotherapy

TREATMENT

• There are no medications you can use to treat RSV infections at home. all you can do during the early phase of the illness is ease your child's cold symptoms.
  
• You can relieve some of the nasal stuffiness with a humidifier, nasal aspirator, and perhaps some mild salt-solution nasal drops prescribed by your pediatrician.
  
• Make sure your baby drinks lots of fluid during this time so he does not become dehydrated.
  
• He may prefer clear liquids rather than milk or formula.
  
• Because of the breathing difficulty, he also may feed more slowly and may not tolerate solid foods very well.
  
• If your baby is having mild to moderate breathing difficulty, your pediatrician may try using a bronchodilating drug (one that opens up the breathing tubes) before considering hospitalization.
  
• Unfortunately, some children with bronchiolitis need to be hospitalized, either for breathing distress or dehydration.
  
• The breathing difficulty is treated with oxygen and bronchodilating drugs, which are inhaled periodically.
  
• The dehydration will be treated with a special liquid diet or by fluids given intravenously.

The best way to protect your baby from bronchiolitis is to keep him away from the viruses that cause it. When possible, especially while he is an infant, avoid close contact with children or adults who are in the early (contagious) stages of respiratory infections. If he is in a child-care center where other children might have the virus, make sure that those who care for his wash their hands thoroughly and frequently.

Back to Top

CHICKEN POX is a common viral disease of childhood that causes a blister-like rash on the surface of the skin and mucous membranes. After exposure, symptoms may develop 1 ½ to 3 weeks later. Children are contagious 1-2 days before the lesions develop until the last lesion is crusted over (usually 1-2 weeks)

Chicken pox usually begins with mild fever for 1-2 days, followed by the blister-like rash which typically starts on the trunk and face, then spreading to the rest of the body (including scalp, inside the mouth and ears, etc.) Generally, this is a mild illness in children, however, can be deadly in person who have a weakened immune system such as those with leukemia or people on chronic steroid therapy.

TREATMENT …

Since chicken pox is a viral illness, there is no specific treatment available to otherwise healthy children. Here are some suggestions to help minimize discomfort:

• Aveeno or baking soda baths
  
• Calamine lotion to alleviate the itching
  
• Keep fingernails short to minimize scratching and help prevent secondary infection of the lesions
  
• Benadryl may relieve itching
  
• Tylenol or Motrin as needed for fever and discomfort; Aspirin should never be given to children with chicken pox or any other viral infection
  
• If any of the lesions or involved skin is intensely red, swollen, warm to touch, or draining pus, contact us as soon as possible

In the last ten years the American Academy of Pediatrics has recommended the use of Varivax for the prevention of chicken pox. It is greater than 95% effective in preventing chicken pox and is given at 12 months of age and a booster shot is given at age 5 (or later as a catch-up immunization). In North Carolina, children born on or after April 1, 2001 are now required to receive one done of Varicella vaccine on or after age 12 months and before age 19 months.

Back to Top

Inhaling or swallowing an object may cause choking in an infant or child. In the first five years of life, more children die secondary to choking than any other home accident.

SYMPTOMS OF CHOKING …

• Inability to breathe or cry
  
• A high pitched noise while breathing
  
• Ineffective coughing
  
• The face/lips turning blue

PREVENTIOIN OF CHOKING …

• Always monitor your children while eating
  
• Cut foods like hot dogs, fruits, and vegetables into small bite sized pieces
  
• Foods that are more likely to cause choking are nuts, sunflower seeds, orange seeds, cherry pits, watermelon seeds, gum, hard candies, popcorn, raw carrots, raw peas, raw celery, and tough meats. Do not give to children younger than four (4).
  
• Balloons are also a major risk factor for choking. Please do not allow your child to pay with deflated balloons or chew on them.
  
• Inspect all toys and clothes for loose parts, such as buttons and eyes from dolls/bears, wheels from small cars, etc.
  
• Do not leave small items in the vicinity where children may play (ie peanuts and hard candies, coins, tacks, paper clips, balloons, wrappers, etc.)
  
• Inspect your child's pacifiers for loose nipples or guards which pass through his/her lips

IF CHOKING OCCURS …

• Immediate emergency action is needed - call 911 or the emergency medical system in your area
  
• If you child can breathe but is coughing or wheezing, there may be a partial blockage, DO NOT give a drink, slap their back or hold them upside down; these maneuvers may cause complete blockage - call 911

It is important to learn basic life support techniques for choking and other medical emergencies. For more information, contact your local chapter of the American Heart Association or the American Red Cross. These organizations offer classes in choking emergencies, as well as CPR and other life saving techniques.

Back to Top

COLIC is a term used primarily to describe the condition of an infant who eats well but is unusually fussy, is hard to burp but passes gas, and cries excessively, mostly after feedings. The baby seems uncomfortable and constantly moves his arms and legs. His knees are often pulled up to his abdomen, then stretched out straight. His back will arch. Happy, contented babies fall asleep after a feeding. Colicky infants start crying immediately after eating, or sleep fitfully for a short while and then cry for an hour or more. Colic is medically defined as "spells of unexplained crying lasting longer than three hours per day, three days per week, and continuing for more than three weeks in otherwise healthy infants younger than three months old."

Many people have tried to explain the reasons for colic, and even more remedies have been suggested. The problem is that no one or two remedies works for all babies. Parents often blame themselves for the obvious pain their baby is having. If mother is breast-feeding, she is sure her milk is of poor quality. Father is sure the baby is allergic to something. When grandparents start giving advise, family pressures increase and create often unbearable tensions for the new parents. The colicky infant can stir up quite a controversy!

Colic has been around for centuries yet the cause remains a mystery. What is known is that the condition is not related to the baby's sex, birth order, maternal age, or whether the newborn is bottle or breast-fed. Many different theories have been proposed: Spasms in the intestines, mild protein allergy, lactose intolerance, immature gastrointestinal tract, air swallowing, trapped intestinal gas, and almost anything else well-meaning relatives and strangers suggest.

A nervous or anxious mother does not produce a colicky baby. Understandably, the experience of hearing her baby cry inconsolably will cause any mother to feel inadequate, especially when everything she does fails to comfort her newborn and Aunt Marilyn tells her that a "healthy" baby would never cry so loudly. If the mother of a colicky infant is anxious, it is the crying and the self-blame that produce the nervous mom, rather than the other way around.

TREATMENT

There are no surefire cures for colic yet everyone has an opinion. Give a pacifier, don't give a pacifier. Give the baby more water, try some mild tea, let the baby cry it out, hold the baby more, use peppermint water!

The following are some suggestions that occasionally help soothe-at least temporarily-the colicky baby.

• Make an appointment to see the child's pediatrician to make sure that the baby is healthy and has nothing more than colic.
  
• Feeding time should be quiet and unhurried. The baby should be fed slowly in an upright position with frequent burping. Make sure the infant isn't hungry and is getting enough to eat by reviewing the diet with the pediatrician.
  
• Milk allergy. Formula fed infants occasionally benefit by changing a formula class (for example, to a soy-based formula). Breast-fed infants frequently get relief when the mother makes a change in her diet. Common culprits mom should eliminate include milk and milk products (including cheeses), and gas producers such as broccoli, cabbage, and caffeine (in coffee, tea, or colas).
  
• Remove cigarette smoke from the colicky infant's environment. Newborns exposed to passive cigarette smoke are three times more likely to suffer from colic.
  
• Some physicians will recommend simethicone drops (Mylicon) when excessive gas is suspected.
  
• Movement: gentle rocking motions are found to be soothing to some colicky infants, as parents find out when they take their colicky baby for a ride in the car. An enterprising father developed a gadget called "SleepTight" that attaches to the crib and gives the infant the sensation produced by a car traveling at 35 mph (it even emits an automobile-like noise)! Any motion, from rocking the cradle to walking the baby in a stroller, is often a magical antidote for a colic attack.
  
• The crying infant's mood might change dramatically in hearing new, repetitious sounds, such as the noise of a vacuum cleaner or clothes dryer.
  
• Physical contact: increasing physical contact makes the baby feel warm and secure. A hot-water bottle, filled with warm water and placed on the baby's stomach might help. There are several infant holders that allow more contact and let the parents do chores or take care of other children. Holding a colicky baby too much will not spoil him.
  
• Parents should get all the help they can. Ask a relative or neighbor to take over for a while to care for the baby. Lack of sleep will cause a new mother to ose her strength and confidence, and a tired mother should not feel guilty about leaving her newborn for a while. Having a grandmother take the infant out in a stroller for an hour each day can make a world of difference. This will help her regain the strength necessary to live with a colicky baby until the ordeal ends on its own.

While the bad news is that there is no surefire cure for colic, the good news is that colic always goes away. Furthermore, colicky babies grow up to be just as happy and cheerful as children who did not have colic as infants. It is important to think that colic is something that an infant "does" rather than a reflection of something an infant "has". The best treatment is to "hang in there" and throw a party when the child finally outgrows their colic!

CALL IF…

• Remember that all crying is not colic.
  
• If your baby has a sudden onset of prolonged crying especially if it seems related to poor feeding.
  
• Vomiting
  
• Fever
  
• Any unusual behavior

Back to Top

CONSTIPATION is hard, formed, clay-like stools, associated with painful or difficult passage. Children with constipation often feel a strong urge to pass a bowel movement (BM), but have discomfort with passage, or unable to pass a stool after straining and pushing. If stools are infrequent but soft, this is not constipation.

TREATMENT OF INFANTS (0-12 months)

• After the second month of life, breast-fed babies may stool as many as 5-8 times a day or as little as every 3-5 days. However, a newborn baby should have multiple stools a day and an office visit is needed if your new baby is not needing frequent diaper changes.
  
• If your baby is formula fed, and is having hard balls of stool, try 1 teaspoon of dark Karo syrup twice a day
  
• If over 2 months of age, 1-2 ounces of white grape juice or prune juice daily may be used.
  
• In babies over 4 months of age: oatmeal tends to soften the stools. You may also give strained foods that are high in fiber such as apricots, prunes, pears, green beans, peas, plums, peaches, or spinach.
  It is normal for a baby to turn red and grunt with bowel movements. However, it is not normal for them to cry.

TREATMENT

Stooling patterns can result from toilet training issues. Do not force a child to sit on the potty. If he or she dies have constipation, ask your child where they would like to poop and offer the diaper for stooling. Encourage regular stooling by sitting toddlers on the potty for 10 minutes after meals. If your child is having difficulty with potty training, please call the office for advice during business hours.
Encourage your child to drink lots of water

• Make sure your child eats fruits or vegetables at least 3 times each day. (Avoid any food that your child may choke on, such as raw vegetables.)
  
• Increase fiber, shredded wheat, graham crackers, oatmeal, brown rice or whole wheat bread
  
• Decrease constipating foods such as milk and cheese, bananas, peanut butter, and chocolate
  
• Maple syrup or Karo syrup - 1 tsp to 1 tbsp 2-3 times per day - can help soften stools
  
• Children older than 4 years of age may respond to a tablespoon of Milk of Magnesia give at bedtime

CALL OFFICE IMMEDIATELY IF …

v Your child develops severe rectal or abdominal pain
v Call during regular business hours if your child does not have a bowel movement after 3 days of changing the diet or if you have other questions or concerns.

Back to Top

CONTACT DERMATITIS is a condition in which the skin reacts to an irritant from the environment. The sap from the leaf of poison ivy, certain chemicals found in cosmetics or metals are examples of such irritants. The rash occurs at the site of the contact and may react as early as six hours after exposure, or as late as two to three weeks of exposure and may last a total of three weeks.

The rash is usually red and elevated and there may be multiple blisters with intensive itching. Different areas of the body react differently to the same irritant. For example, the skin of the face (especially around the eyes) and genitals is very thin and may react more intensely than the thicker skin of the palms and soles. Sap from the plant leaf may come in direct contact with skin by handling the plant, or by handling clothing that has been in contact with plants. It can even be spread by handling pets that have rubbed against the plant. Sap on one area of the body may be transferred to other areas of the body and cause further outbreak. It becomes important, therefore, to wash skin and clothing immediately after contact. The fluid within the blisters presents no threat and will not spread the rash. An over-the-counter cream such as "Ivy Off" may help prevent poison ivy if applied prior to anticipated exposure.

Prevention is the mainstay of our treatment program. You must be able to identify the source of irritation and eliminate exposure. If the reaction is severe, we do have medication that will shorten the course of the reaction. This requires an office visit for the physician to evaluate your child.

GENERAL MEASURES TO CONTROL ITCHING…

• Cool baths or cool compresses especially to blistered areas. Tap water is fine; however, the use of Burrows solution may offer even more relief. This preparation may be obtained without a prescription, and can be used four times a day with cool compresses.
  
  
• Cooling topical lotions that contain a menthol preparation are often effective. Calamine lotion is an example of this, and if applied lightly may offer some benefit for itching.
  
  
• Topical corticosteroids may also offer relief and 1% hydrocortisone cream may be obtained at pharmacies without a prescription. These may be applied four times a day or even more frequently, if required.
  
  
• Antihistamines are medications that are taken by mouth to help relieve itching. Benadryl can be obtained over-the-counter and, at an appropriate dose, may be given as noted:

  6 mos-1 yr . . . . . . . . . ½ tsp . . . . . . . . . 4 x daily
  1-3 years . . . . . . . . . . 1 tsp . . . . . . . . . . 4 x daily
  3-5 years . . . . . . . . . . 1-1/2 tsps . . . . . 4 x daily
  5 yrs and older . . . . . 2 tsps . . . . . . . . . 4 x daily
  

Back to Top

A COUGH is a common symptom of respiratory illness (most often, the common cold). Although coughs sound bad, keep in mind that coughing is the body's way of clearing the airways of the lungs and protecting your child from getting pneumonia. Most coughs are caused by a viral infection. An infection of the trachea (windpipe) is called tracheitis; an example of this kind of viral illness is croup. Most children get such a viral infection as part of a cold. These infections are usually not serious.

HOW LONG WILL THE COUGH LAST …

A viral upper respiratory infection usually causes a dry, tickly cough that can last 2-3 weeks. Sometimes the cough becomes wet for a few days, and your child coughs up a lot of phlegm (mucus). This is usually a sign that the end of the illness is near.

HOME TREATMENTS FOR COUGH …

• HOMEMADE COUGH SYRUP: Children 1 to 4 years old use ½ to 1 tsp of corn syrup. The corn syrup thins secretions and loosens the cough.
  
• COUGH DROPS: Most coughs in children over the age of 4 years can be helped by sucking on cough drops or hard candy. The cough drops coat the irritated throat and help to calm the cough.
  
• WARM LIQUIDS FOR COUGHING SPASMS: Warm liquids usually relax the airway and loosen the mucus. Warm clear juices and teas are best.
  
• COUGH-SUPPRESSANT MEDICAITONS: Cough-suppressant drops reduce the cough reflex. However, keep in mind that the cough reflex helps protect the lungs. Use these medications only for dry coughs that interfere with sleep or school attendance. They may also help children who complain of chest pains from coughing spasms. Do not use them for children less than 1 year old and for wet coughs. Most non-prescription cough suppressants contain dextromethorphan (DM). Some examples what we recommend are Robitussin DM or Delsym products. Any store brand "tussin DM" is fine also.
  
• HUMIDIFIERS: Dry air tends to irritate a cough and make it worse. Use a cool-mist humidifier in the child's room and encourage your child to drink plenty of liquids.

It is important to avoid certain triggers when your child is sick with a cough. Exercise may trigger coughing spasms when a child has an upper respiratory infection. If so, certain physical activity should be avoided temporarily (gym). Smoking around your child or being in an environment with a smoker may also trigger the cough.

*** Antihistamines, decongestants, and antipyretics (fever-reducers) are found in many cough syrups. There is no proof that these extra ingredients will help your child's cough. Stick with the simple remedies as above for the best results and remember that ultimately, only time will heal the cough.

CALL OUR OFFICE IMMEDIATELY IF …

• Breathing becomes difficult AND is not better after you clear the nose.
  
• Breathing becomes fast or labored (when your child is not coughing).
  
• Your child is acting very sick.

CALL DURING REGULAR OFFICE HOURS IF …

• There has been a fever for more than three days.
  
• The cough is lasting more than 2-3 weeks and is not improving
  
• Your child has a history of Asthma or Reactive Airway Disease.
  
• You have any questions or concerns.

Back to Top

CROUP is a viral infection of the upper airway. The viruses that cause croup also cause cold symptoms. The hoarseness is due to the swelling of the vocal cords. STRIDOR occurs as the opening between the vocal cords becomes narrowed.

STRIDOR is a harsh, raspy, vibrating sound heard when your child breathes in. Stridor is usually only present when the child is crying and coughing. As the disease becomes worse, stridor may be heard when the child is sleeping or relaxed.

• Croup usually lasts for 5 or 6 days and generally gets worse at night. The worst symptoms are seen during the 2nd and 3rd nights of the illness.
  
• Primary symptoms of croup include a tight, metallic cough (like a barking seal), and a hoarse voice.
  
• Accompanying symptoms may include a runny nose, sore throat, and fever.

HOME TREATMENT FOR CROUP

• Mist
  Dry air usually makes the cough worse, so keep the child's room humidified. Cool, moist air is best (cool mist humidifier or hang a wet washcloth). On a cool night it is recommended to crack a window or for increased coughing TAKE CHILD OUTSIDE for at least 20 to 30 minutes. Steam from a hot shower may also calm the cough.
  
• Clear Liquids
  Constant cold, thin drinks will help to decrease the swelling in the throat and help to keep the child hydrated. Some children respond better to room temperature liquids.
  
• Over-the-counter Medications
  Acetaminophen or Ibuprofen: For fevers > 101.5º and general discomfort as needed.
  Benadryl: Not recommended for children < 2 years (Will help with runny nose)
  (The above medications are for comfort only. They will decrease symptoms but will NOT shorten the duration of the illness.)

CHILD SHOULD BE SEEN IMMEDIATELY IF ….

• Stridor at rest
  
• Breathing becomes difficult
  
• Lips turn blue or dusky
  
• Your child develops excessive drooling, spitting, or difficulty swallowing
  
• Any signs of dehydration: no urination in 10 hours, no tears, dry mouth, sunken eyes, and/or lethargy
  
• Fever > 3 days or > 103º for 4 hours
  

Back to Top

Most children begin to develop teeth between six (6) and twelve (12) months of age. Here are some tips on how to keep your child's teeth healthy and strong:

• CLEANING: As soon as teeth start emerging, they should be cleansed with a soft cloth. As your child gets older familiarize them with a toothbrush and its use. Use fluoride free toothpaste until he/she is able to effectively spit during brushing (to avoid excessive fluoride consumption). By age three your child should begin seeing a dentist who is accustomed to working with children.
  
  
• FLOURIDE: Fluoride is necessary to strengthen enamel and prevent cavities. Children need to ingest fluoride for their developing teeth from age six (6) months into adolescents. Wake and Johnston County city water supplies are supplemented with fluoride. Most well water in our area does not contain significant amounts of fluoride, however, we can provide you a water testing kit to check. If your water source does not contain fluoride or if you infant is exclusively breast fed, please inquire about fluoride supplementation at your next visit.
  
  
• Other dental problems may be prevented by discouraging prolonged thumb sucking and pacifier.
• Never give bottles during the night with toddlers as this can cause caries or rotting of the teeth.

Back to Top

A DIAPER RASH is any rash, which occurs in the area covered by a diaper. Almost all children will have a diaper rash at one time or another. Diapers trap in heat, moisture, and waste products. This combined with friction will eventually cause a diaper rash.

CAUSES OF DIAPER RASHES

• Contact with heat + moisture = perfect environment for yeast and fungus (diaper candidiasis)
  
• Bacteria = bowel movements (contact dermatitis)
  
• Ammonia = urine (contact dermatitis)
  
• Allergies to soaps, detergents, diaper brands, wipes (allergic or contact dermatitis)

TYPES OF DIAPER RASHES

• Candidiasis (yeast/fungus): red, inflamed, raw, peeling skin surrounded by red satellite lesions (red dots)
  
• Contact (allergic or non-allergic): red, raised bumps, may appear dry or with some open areas of the skin

HOME TREATMENT

• Anti-fungal creams and ointments for treatment of suspected yeast infection (clotrimazole, miconazole = eg. Lotrimin AF or store brands; Mycostatin = eg. Nystatin)
  
• Protective barrier creams for treatment of contact rashes (Desitin A&D ointment, Vaseline, Triple Paste)
  
• Change diapers immediately and frequently when soiled or wet
  
• Leave diaper off and skin open to air as much as possible
  
• Warm water rinses instead of wipes
  
• Past of cornstarch or baking soda: this will decrease friction and prevent against future rashes
  
• Cornstarch or baking soda baths: soothing to sore skin (add ½ to 1 cup to bath water)
  
• For child with diarrhea: paint rash with Maalox so that when child has a bowel movement, the Maalox will decrease the acidity of the stool and therefore protect the skin
  
• Paint Maalox over barrier cream

CALL IF ….

• The rash appears infected (yellow pus, pimples, blisters, excessive red streaking)
  
• The child is acting very sick
  
• The rash is worsening with home treatment

RECIPE FOR MAGIC BUTT CREAM

(Mix together equal parts and store in an air-tight container)

Lotrimin AF
Desitin (Zinc Oxide)
1% Hydrocortisone Cream

Back to Top

DIARRHEA is the sudden increase in the frequency and looseness of bowel movements. Diarrhea is usually caused by a viral infection of the intestines (viral gastroenteritis). Diarrhea can also be due to excessive fruit juice or to a food allergy. Diarrhea may last from several days to a week, regardless of treatment. The main goal of therapy is to prevent dehydration. (Barton d. Schmitt, MD, 1999)

TREATMENT FOR DIARRHEA

• A lactose free diet is helpful. No dairy (milk) products except yogurt!
  
• For babies, ISOMIL, PROSOBEE, or diluted formula with Pedialyte or water
  
• Lactose free milk or soymilk is fine for children over 1 year
  
• Yogurt is helpful (indicated for children older than 6 months)
  
• White grape juice is the only juice that will definitely not irritate the bowels
  
• Give your child starchy foods to help firm the stools (pasta, rice, cereal, crackers, toast, pretzels, bananas, white potatoes)

CALL IF ….

• Bloody stools
  
• Severe abdominal pain
  
• Fever is present for longer than 3 days
  
• Any signs of dehydration which include: lethargy, no urination for 12 hours, no tears, dry mouth, and sunken eyes
  
• The diarrhea does not slow down after 5 to 7 days
  

Back to Top

OTITIS MEDIA is an infection of the area behind the eardrum or "middle ear". When a child is well, the middle ear is filled with air. However, when a child has a cold this space becomes filled with fluid if the eustachian tube becomes blocked by mucus or congestion. (The eustachian tube runs from the middle ear to the back of the throat, and should allow drainage of this fluid when not blocked.) Once the space behind the eardrum is filled with fluid, bacteria may grow and cause an ear infection. Ear infections are very common during childhood and most children (75%) will have at least one ear infection.

SYMPTOMS OF AN EAR INFECTION

• Older children will be able to tell you that they have an ear infection or that their ears feel stopped up and that they can not hear well
  
• Younger children may pull at their ears, not sleep well, not want to suck a bottle or they may cry with pain
  
• They may have fever
  
• These signs are not specific for ear infections, and it may be difficult to tell if young children have another infection or just a cold
  
• If you feel your child has symptoms worse than a typical cold, we recommend you call our office

RUPTURED EARDRUM

• About 5% of ear infections cause enough pressure in the middle ear to cause the eardrum to rupture.
  
• A small hole develops in the eardrum to let out the infected fluid.
  
• You will see this as yellow or cloudy fluid coming out of the ear
  
• When the ear infection is treated, the hole usually heals on its own over the next week.

TREATMENT OF EAR INFECTIONS

• Antibiotics are a type of medicine that kill the bacteria that causes the ear infection. It is important to give all the doses of antibiotic to ensure that the ear infection heals completely
  
• Your child will need to be seen for follow-up 2 to 3 weeks after the treatment is started to ensure that the infection is resolved and that further antibiotics are not needed
  
• Acetaminophen (Tylenol) or Ibuprofen (Advil or Motrin) can be given for a few days for the earache or fever
  
• To help soothe the pain you can use ice wrapped in a wet washcloth or a heating pad held to the outside of the ear for about 20 minutes at a time.
  
• Call the office, if your child is still needing pain medicine after 48 hours after starting the antibiotic

AIR TRAVEL AND SWIMMING

• Swimming is not restricted as long as there is no tear in the eardrum (rupture) or drainage from the ear.
  
• Air travel is safe - your child may be more comfortable during descent if he/she swallows fluids, sucks on a pacifier, or chews gum during this part of the flight

PREVENTION OF EAR INFECTIONS

• Protect your child from second hand tobacco smoke as this has been shown to increase the frequency and severity of ear infections
  
• Reduce your child's exposure to colds during the first year of life
  
• Breast-feeding during the first 6-12 months of life - Antibodies in the breast milk reduce the likelihood that a child will get ear infections
  
• Never prop up a bottle when feeding an infant by bottle
  

Back to Top

A FEVER means the body temperature is above normal. Your child has a fever is his/her:

• Rectal temperature is over 100.4° f
  
• Oral temperature is over 99.5° f
  
• Axillary (armpit) temperature over 99.0° f

FEVER is a symptom not a disease. It is the body's normal response to infections. In fact, fever is a positive sign that the body is fighting infection. The body's temperature normally fluctuates during the day and mildly increases oral temperature. (100.4° f to 101.3° f, can be caused by exercise, excessive clothing, a hot bath, or hot weather.

Most fevers are caused by viral illness and temperatures can range from 101° f to 104° f and last for 2 to 3 days. In general, the height of the fever does not relate to the severity of the illness. The child's appearance and level of activity are more important than the height of the fever. A fever only needs to be treated if the child is uncomfortable (treat the child not the fever).

TREATMENT OF FEVER

• Encourage rest and increase fluid intake
  
• Be sure not to bundle or overdress a child with fever
  
• If the fever is causing the child to be uncomfortable you can consider the use of acetaminophen, ibuprofen, and sponging.
  
• Do not use medication if your child is less than 2 months without speaking to your doctor first

ACETAMINOPHEN (Tylenol/Tempra)

• Give 80mg (0.8ml dropper, ½ tsp, or 1 chewable tablet) per year of age every 4-6 hours

IBUPROFEN (Advil/Motrin)

• 6 months -1 year ½ tsp (50mg) every 6-8 hours
  
• 1-3 years 1 tsp (100mg) every 6-8 hours
  
• 3+ years 2 tsp (200mg) every 6-8 hours

SPONGING WITH WATER (never use alcohol)

• Sponging is usually not necessary to reduce fever
  
• Never sponge your child without trying acetaminophen or ibuprofen first
  
• Should the temperature be greater than 104° f (40° c), in spite of medications, sponging might be helpful.
  
• Place the child in the bathtub in about 2 inches of tepid water (85º to 95º f, or 29º to 32º c, neither hot nor cold water) and keep watering the skin surface by rubbing vigorously with a washcloth for 20 to 30 minutes.
  
• NEVER use rubbing alcohol

CALL IMMEDIATELY IF ….

• Your child is less than 3 months old
  
• Your child's fever is over 105º f (40.6º c)
  
• Your child looks and acts very sick

CALL WITHIN 24 HOURS IF ….

• Your child is 3 to 6 months old
  
• Your child has had a fever more than 24 hours without an obvious cause or location of infection
  
• You have other concerns or questions

Back to Top

FIFTH DISEASE (true medical name - Erythema Infectiosum) is a bright red or rosy rash on both cheeks. ("slapped cheek" appearance) followed by a pink "lace-like" rash on the extremities.

Origin of name - Many years ago, when it was unclear to pediatricians what caused childhood rashes, these rashes were labeled as to when they first appeared. Fifth Disease was so named because it was the fifth pink-red rash to be described by physicians. These 5 rashes are (1) Scarlet Fever, (2) Measles, (3) Rubella, (4) Roseola, and (5) Erythema Infectiosum.

• Caused by the human parvovirus B19.
• Associated symptoms may include: low-grade fever, slight runny nose, and/or sore throat.
• The lace-like rash may come and go for up to five weeks, especially after warm baths, exercise, and sun exposure.
• This distinct rash is harmless and causes no symptoms, which require treatment.
• Over 50% of exposed children will develop the rash within 10 to 14 days.
• The child is no longer contagious after the rash appears so he/she may attend daycare/school.

*** Studies have shown that 10% of fetuses who are infected with Fifth disease before birth develop severe anemia or may even die. If a pregnant woman is exposed to a child with Fifth Disease before the rash appears, she should consult her obstetrician!

Back to Top

What is Frostbite?
Frostbite is injury to the skin that occurs with prolonged exposure to cold temperature. It is essentially freezing of the skin and/or the body tissues like blood vessels and nerves under the skin. The most common areas to get frostbite are fingers, toes, feet, nose, ears, and other parts of the face. In extreme cold conditions or when there is a high wind-chill factor, brief exposure of uncovered body parts can result in frostbite in just a few minutes.

What are the Signs and Symptoms of Frostbite?
Mild frostbite affects only the surface of the skin and makes the skin appear white. Usually these symptoms disappear as warming occurs, but the skin may appear red for several hours. If frostbite is more severe, the skin will appear waxy-looking with white, grayish-yellow or blue coloration. Numbness of the skin or blisters may be present. The skin may feel frozen or "wooden". When severe frostbite is rewarmed, there may be swelling, itching, burning, or deep pain.

What do I do if I am concerned my child may have Frostbite?

• Your child needs to be seen immediately if color and sensation do not return to normal after one (1) hour of warming. Also your child should be seen immediately if the skin is white, hard, and numb before rewarming, if blisters develop or if the area is red and looks infected. Please call the office, if you are concerned.
• If the frostbite is mild, this will respond to warming at home. Place the frostbitten part in very warm water (104F-108F) in bathtub. If the affected area is on the face apply warm, wet washcloths. Continue immersion in warm water until the skin appears pink and flushed which indicates return of good circulation to the area. This usually takes about 30 minutes. There should be no numbness at this point. Sometimes the last 10 minutes of warming can be painful to your child.
• Use blankets to keep the rest of the child's body warm if not in the tube.
• Have your child drink warm liquids.
• DO NOT apply snow to the frostbitten area or massage it in. This can cause further injury to the skin.
• DO NOT use dry heat such as from electric hearter or heat lamp to rewarm because frostbitten skin may not sense burning.

How can I prevent Frostbite in my Child?

• Dress your child in layers if he or she is going outside in cold weather. The outer layer should be waterproof and should not be tight-fitting.
• Mittens are warmer than gloves. Avoid tight gloves as they can cut off circulation in the fingers.
• Have your child wear a hat while outside.
• Change wet clothing immediately.
• Tell your child that tingling or numbness are reminders to go inside.

GENERAL COLD EXPOSURE:
Serious cold exposure can cause shivering and sleepiness. Hypothermia occurs when the body temperature drops below 95 degrees F rectally. If your child is exposed to extreme cold temperatures and is unconscious, has confused thinking, or slurred speech or has temperature below 95 degrees F, CALL 911. If your child has shivering that lasts for more than 10 minutes after rewarming and getting dry, then your child needs to be seen right away in the office or emergency room.

Back to Top

What is a headache?
When your child complains that his head hurts, he probably has a headache. A headache is a symptom that can be caused by:

• A cold or other viral illness.
• A high fever.
• Hunger (many children get a headache in the late afternoon when they are hungry).
• Tension.

What are recurrent headaches?
Recurrent headaches are headaches that keep coming back. In children and adults the most common cause of recurrent headaches is tension. Tension headaches give a sensation of tightness that completely encircles the head. The neck muscles also become sore and tight. Tension headaches can be caused by prolonged use of video games, computers, or typewriters. Many children get tension headaches as a reaction to stresses (such as pressure for better grades or unresolved disagreements with their parents). There can be many other causes for recurrent headaches. Your child should see a doctor if he or she keeps getting headaches.

How long does it last?
Many headaches caused by illness go away when the fever comes down. Other come and go during the illness. Tension headaches usually last from a few hours to a day and tend to return.

How can I take care of my child?

• General headache care
  • Your child should lie down and rest until he is feeling better.
  • If your child is hungry, offer fruit juice or some food.
  • Give Ibuprofen (Advil) or acetaminophen (Tylenol) as soon as the headache begins.
  • Put a cool washcloth on your child's forehead.
• Tension headaches
  If your child has been checked by your health care provider and has tension headaches, try the following to help ease the pain:
  • When a headache occurs, your youngster should lie down and relax. Give Acetaminophen or Ibuprofen as soon as the headache begins. The medication is more effective if it is started early.
  • If something is bothering your child, help him talk about it and get if off his mind.
  • Teach your child not to skip meals, if doing so bring on headaches.
  • Stretch and massage any tight neck muscles.
  • To prevent tension headaches, teach your child to take breaks from activities that require sustained concentration. Encourage your child to do relaxation exercises during the breaks.
  • If overachievement causes headaches, help your child get out of the fast track.

When should I call my child's doctor?

Call Immediately if….

• The pain is severe AND persists more than two hours after your child takes pain medications.
• Your child has difficulty with vision, thinking, speech, or walking.
• The neck is stiff.
• Your child is acting very sick.
• There are more than 2-3 episodes of vomiting associated with the headache.
• The headaches are following a recent head injury.

Call during office hours if….

IMPETIGO is an infection of the skin caused by staphylococcus or streptococcus bacteria. These bacteria normally live on our skin and in the environment. They can start infections when there is a scratch, insect bite or other wound that causes a break in the skin. The most common places to see impetigo are on the face, especially around the nose, and on the legs. Sores associated with impetigo begin as small red bumps, but then often develop soft, yellow, crusty scabs. Sometimes the patches will drain pus. Scratching or picking at the scabs can spread these sores to other areas.

TREATMENTS:

• Small, single patches of impetigo can be treated with soaking the scabs in order to remove the crust, and then applying antibiotic ointment (like Polysporin or Bacitracin) applied four times daily.
  
  
• If there are multiple patches, or the patches are spreading, antibiotics taken by mouth will probably be needed. In this case, your child will need to be seen in the office within 24 hours.

CALL THE OFFICE IMMEDIATELY IF …

• A fever occurs.
  
• There are sores or large blisters that are more than one (1) inch in diameter.
  
• If the skin around the sore is red and tender.

Back to Top

IDENTIFYING AN INSECT BITE OR STING…

Mosquito bites, chiggers (Harvest mites), fleas, and bedbugs usually cause itchy red bumps. Swelling of the bites does not mean your child is allergic to the insect bite. It is simply a local swelling reaction. Mosquito bites usually occur on areas of the body that are not protected by clothing. Fleas and bedbugs don't fly so they may crawl under and into clothing. Flea bites may turn into blister in young children.

Bites from Horseflies, deerflies, gnats, fire ants, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within hours, the fire ant bites change to blisters or pimples.

Insect stings (yellow-jackets, wasps) usually cause a small bump that may itch and cause pain. This should usually subside in a few hours. Although allergic reactions are rare, bee stings are the most likely to cause an allergic reaction. Some stinging insects are scavengers and may transmit germs when they sting. Contact the office if pus, new swelling or tenderness appear at the site of the sing. Multiple stings (usually > 4) may cause a toxic reaction (this is not an allergy) characterized as fever, diarrhea, vomiting, headache, and swelling. Call our office if your child has multiple stings and begins to show any of these symptoms.

HOME CARE FOR INSECT BITES OR STINGS…

For itching - Apply calamine lotion or a baking soda paste to the area of the bite. If the itching is severe (as with chiggers) apply an over-the-counter 1% Hydrocortisone cream four (4) times a day. Another way to reduce the itching is to apply a firm, sharp, direct, steady pressure to the bite for ten (10) seconds. A fingernail, pen cap, or other object may be used. For severe itching, an oral antihistamine such as Benadryl is recommended (for children > 1 yr old). Encourage your child not to pick at the bites or they may leave a mark.

For painful insect bites or stings - Rub the area of the bite with a cotton ball soaked in a meat tenderizer solution for twenty (20) minutes. Avoid the area around the eyes. Baking soda or an ice cube is a fair substitute if there is no meat tenderizer. Ibuprofen (Advil or Motrin) or Acetaminophen (Tylenol) may also be given for pain relief. If the child has been stung and the stinger is visible, remove the stringer with a sharp edge of a credit card, needle, or blade. Do not try to pull it out with tweezers since this may cause more venom to be injected.

LOCAL REACTIONS TO BUG BITES AND STINGS…

• Redness, swelling, and itching
  
• Variable severities - usually worse on the hands and face
  
• NOT an allergy (unless it spreads beyond the site of the bite)
  
• May last several days

CALL IF …

• Bite appears to be infected
  
• Red streaks
  
• Increased tenderness
  
• For hives alone and no trouble breathing, call our office immediately

These symptoms usually occur 3-4 days after bite.

TRUE ALLERGIC REACTIONS …

• Hives all over
  
• Feels dizzy or light headed (drop in blood pressure)
  
• Respiratory distress (swelling of tongue/mouth, face, shortness of breath, wheezing

For shortness of breath or swelling in the mouth, CALL 911

Back to Top

• Do not be alarmed.
• Sit your child upright in a chair or in your lap and have him tilt his head slightly forward. Do not have your child lean back - this may initiate gagging, coughing, or vomiting.
• Gently pinch his nose shut just below the bony ridge with a tissue or washcloth. Keep pressure on the nose for about ten (10) minutes - if you stop too soon bleeding may start again.
• After the nosebleed, discourage blowing, picking, rubbing or any rough play for several hours.

• Keep your child's nails cut short to prevent picking.
• Keep the inside of your child's nose moist with saline nasal spray or Vaseline (dabbed gently around the opening of nostrils)
• Use a humidifier to prevent dry air.

• The nosebleed is the result of a blow to the head or fall.
• If the nosebleed lasts longer than 15 minutes.
• If your child has difficulty breathing.
• If the nosebleed is associated with bleeding from other sights (such as their gums).
• If your child has just started taking a new medication.
• If you see a foreign body in your child's nose.
  

Back to Top

What is ringworm? Ringworm is a fungus infection of the skin. Often your child gets ringworm from a puppy or kitten. If your child has ringworm, your child will have a ring-shaped pink patch on the skin. The patch will:

• Usually be ½ to 1 inch in size with a scaly, raised border and clear center.
• Get slowly bigger.
• Be mildly itchy.

How can I take care of my child?

• Use antifungal cream -
  Buy Tinactin, Micatin, or Lotrimin cream at your drugstore. You won't need a prescription. Apply the cream twice a day to the rash and 1 inch beyond the edge of the rash. Continue this treatment for one week after the ringworm patch is smooth and seems to be gone.
• Keep your child in school or daycare -
  Ringworm of the skin does not spread from one person to another easily enough to worry about. After 48 hours of treatment, it is not contagious at all. Your child does not have to miss any school or daycare.
• Get treatment for pets -
  Kittens and puppies with ringworm usually do not itch and may not have any rash. Pets with a skin rash or sores should be examined by a veterinarian. Also have your child avoid close contact with the animal until he is treated. Natural immunity also develops in animals after four months even without treatment. Call your veterinarian for other questions.

Call your doctor during office hours if….

• The ringworm continues to spread after one week of treatment.
• The rash has not cleared up in four weeks.
• You have other concerns or questions.
  

Back to Top

Infants and children are more susceptible to the injury of sunburn than adults. This most frequent summertime problem is easily prevented. Short-term over-exposure to the ultraviolet rays of the sun may cause injury that ranges from slight redness to blistering, nausea, vomiting, and even heat stroke. Long term repeated exposure to the sun results in wrinkling, increased and decreased pigmentation of the skin, and skin cancers.

Preventive measures include keeping the children shielded from the ultraviolet rays with a commercial sunscreen. These products now come with a sun protection factor number after them. The following table describes your child's skin type and recommends the correct sunscreen protection factor.

SKIN TYPES AND RECOMMENDED SUNSCREEN PROTECTION FACTORS (SPF)

Skin Type - I
· Pigmentation - Very fair skin, freckling, blonde, red, brown hair
· Ethnic Origin - Celtic, Irish, Scottish
· Sunburn & Tanning History - Always burns easily, never tans
· Recommended SPF - 15 or more

Skin Type - II
· Pigmentation - Fair skin, blonde, red, or brown hair
· Ethnic Origin - Caucasian
· Sunburn & Tanning History - Always burns easily, tans minimally
· Recommended SPF - 15

Skin Type - III
· Pigmentation - Brown hair and eyes
· Ethnic Origin - Darker Caucasians
· Sunburn & Tanning History - Burns moderately, tans gradually & uniformly (light brown)
· Recommended SPF - 8 to 10

Skin Type - IV
· Pigmentation - Light brown skin, dark hair and eyes
· Ethnic Origin - Mediterranean, Orientals, Hispanics
· Sunburn & Tanning History - Burns minimally, always tans well (moderate brown)
· Recommended SPF - 6 to 8

Skin Type - V
· Pigmentation - Brown skin, dark eyes and hair
· Ethnic Origin - American, American Indian, Hispanic, Latin Middle Eastern.
· Sunburn & Tanning History - Rarely burns, tans profusely (dark brown)
· Recommended SPF - 4

Skin Type - VI
· Pigmentation - Brown-black skin, dark eyes and hair
· Ethnic Origin - African and American Blacks
· Sunburn & Tanning History - Never burns, deeply pigmented (black)
· Recommended SPF - None necessary

Sunscreen is not recommended for infants under six months of age . Instead their exposure to direct intense sun should be minimized. We do not recommend sunscreen/bug repellant combinations. In addition to a sunscreen, children should wear protective clothing such as a light long sleeved shirt and a broad brimmed hat; dark fabrics offer a better screening than light fabrics. Parents should also be aware that the most hazardous time of the day is between 10:00 am and 2:00 pm and that sand, water, snow, and wet clothing all increase harmful effects of the sun. Beware of cloudy days, as the ultraviolet rays may still cause burns.

Treatment of affected areas depends on the severity of the burn. With or without blistering, apply cool Burrows Solution compresses or bathe in cool water. An additional pain reliever such as Ibuprofen or Acetaminophen may be given. Blister should be allowed to burst on their own because their fluid will sometimes reabsorb. If you are concerned about the severity of the sunburn, please call our office.

Back to Top

SWIMMERS EAR is caused when water repeatedly gets trapped in the ear canal; the lining becomes set and swollen. This makes it prone to superficial infection (swimmer's ear). Ear canals were meant to be dry.

SYMPTOMS …

• An infection of the skin that lines the ear canal.
  
• Itchy and somewhat painful ear canal.
  
• Currently engaged in swimming.
  
• Discomfort when the ear is moved up and down.
  
• The ear feels plugged.
  
• Discharge is slight in amount and clear.
• Pain at the TMJ (temperomandibular joint)with chewing.

CALL IMMEDIATELY IF …

• Your child looks or acts very sick.
  
• Severe pain.
  
• Fever.
  
• Redness and swelling of outer ear.

CALL WITHIN 24 HOURS IF …

• You think your child needs to be seen.
  
• Constant ear pain.
  
• Yellow discharge from ear canal.
  
• Blocked ear canal.
  
• Swollen lymph node near ear.
  
• Cause is uncertain.

PARENT CARE AT HOME …

• White Vinegar Rinses: Rinse the ear canals twice a day with white vinegar. Fill the ear canal. After five (5) minutes, remove it by turning the head to the side and moving the ear. (Exception: ear tubes or hole in eardrum) This restores the normal acid pH of the ear canal and reduces swelling.
  
• Pain Medicine: Give acetaminophen or ibuprofen for pain relief.
  
• Local Heat: If pain is moderate to severe, apply a heating pad (set on low) or hot water bottle to outer ear for twenty (20) minutes (Caution: Avoid burns.) This will increase drainage.
  
• Reduce Swimming Times: Try to avoid swimming until symptoms are gone. If on a swim team, it is OK to continue. Swimming may slow recovery, but causes no serious harm.
  
• Contagiousness: Swimmers ear is not contagious.
  
• Expected Course: with treatment, symptoms should be better in three days.

PREVENTION AND RECURRENCES …

• Try to keep the ear canals dry.
  
• After showers, hair washing, and swimming help the water run out by turning the head.
  
• Avoid cotton swabs (reason: packs in ear wax).
  
• If swimmers ear is a repeated problem, rinse the ear canals after swimming with a white vinegar-rubbing alcohol solution (equal parts of each).
  
• If symptoms last for more than three (3) days after treatment, call your doctor.

Back to Top

What is teething?

Teething is the normal process of new teeth working their way through the gums. Your baby's first tooth may appear any time between the time he is three months to one year old. Most children have completely painless teething. The only symptoms are increased saliva, drooling, and a desire to chew on things. Teething occasionally causes some mild gum pain, but it does not interfere with sleep. The degree of discomfort varies from child to child. Your child won't be miserable. When the back teeth (molars) come through , the overlying gum may become bruised and swollen. This is harmless and temporary.

Because teeth erupt almost continuously from six months to two years of age, many unrelated illnesses are blamed on teething. Fevers are also common during this time because after the age of six months, infants lose the natural protection provided by their mothers' antibiotics.

Which baby teeth come in first?

Your baby's teeth will usually erupt in the following order:

1. 2 lower incisors
2. 4 upper incisors
3. 2 lower incisors and all 4 first molars
4. 4 canines
5. 4 second molars

How can I take care of my child?

• Gum Massage -
  Find the irritated or swollen gum. Massage it with your finger for two minutes. Do this as often as necessary. You may also massage the gum with a piece of ice.
• Teething rings -
  Your baby's way of massaging his gums is to chew on a smooth, hard object. Solid teething rings and ones with liquid in the center (as long as it is purified water) are fine. Most children like them cold. A wet washcloth or banana chilled in the freezer for ten minutes will please many infants. Avoid ice, popsicles, or other frozen objects that could cause frostbite of the gums. Also avoid hard foods that he might choke on (like raw carrots). Teething biscuits are fine.
• Diet -
  Avoid salty or acid foods. Your baby probably will enjoy sucking on a nipple, but if he complains, use a cup for fluids temporarily.
• Acetaminophen or Motrin (if over six months of age)-
  If the pain increases, give acetaminophen, (Tylenol or Motrin) orally for one day. Special teething gels are unnecessary. Many teething gels contain benzocaine, which can cause an allergic reaction. If you want to use a gel, do not apply it more than four times a day.
• Common myths about teething:
  • Teething probably does not cause fever, diarrhea, diaper rash, or lowered resistance to any infection. If your baby develops fever while teething, this fever is caused by something else.
  • Don't tie a teething ring around your baby's neck. It could catch on something and strangle your child. Attach it to your baby's clothing with a "catch-it-clip".

When should I call my child's health care provider?

• Call during office hours if….
  • Your child develops a fever over 101° F.
  • Your child develops crying that does not have a cause.
  • You have other questions or concerns.

Back to Top

THRUSH is an overgrowth of the yeast germ, Candida albicans, producing white patches inside the mouth. It is most commonly seen in babies but may occur in anyone who has been on antibiotics for a long time. Each of us has the yeast germ in our mouths, as they live there in harmony with normal mouth bacteria.

Babies usually obtain both yeast and bacteria from their mother's birth canal. Occasionally the yeast growth overtakes bacterial growth before the body develops a balance between the two, and thrush develops. Thrush is not dangerous and it looks worse than it really is, although a baby with thrush might east less than normal. Mild thrush usually goes away by itself. When treatment is necessary, physicians often prescribe an antifungal medication that can be painted on the thrush four times each day (your pediatrician will describe in detail how to apply the medication). Breast-feeding mom might want to apply the same medication to their nipples as well. In addition, carefully wash pacifiers and anything else that goes into the baby's mouth. It is a good idea to store bottles, nipples, and pacifiers in the refrigerator - the yeast does not like a cold environment.

How can I take care of my child?

• Nystatin oral medical -
  The drug for clearing this up is nystatin oral suspension. It requires a prescription. Give 1 ml of nystatin four times a day after meals or at least 30 minutes before you feed your baby. Place the nystatin in the front of the mouth on each side (it does not do any good once it is swallowed). If the patches of thrush in the mouth do not start improving in two (2) days, rub the Nystatin directly on the patches. Use a cotton swab or a gauze wrapped on your finger. Keep this up for at least seven (7) days, or until all the thrush has been gone for three days.
• Decrease sucking time during feeding -
  If sucking on a nipple is painful for your child, temporarily use a cup or spoon. In any case, while your child has thrush, reduce sucking time to 20 minutes or less per feeding. If the thrush comes back after treatment and your child is bottle-fed, switch to a nipple with a different shape and made from silicone.
• Restrict pacifier use to bedtime -
  While your child has thrush do not given him a pacifier, except when it is really needed for going to sleep. If your infant is using an orthodontic-type pacifier, switch to a smaller, regular one. Soak all nipples in water at 130° F (60° C), which is the temperature of most hot tap water, for 15 minutes.
• Diaper rash associated with thrush -
  If your child has a diaper rash as well as thrush, assume the rash is caused by yeast. Ask for a prescription for Nystatin cream and put on your baby's bottom four times a day. Lotrimin-AF is an over-the-counter anti-fungal cream (apply three (3) times per day until cleared for three days) that works well for diaper rash caused by yeast.

When should I call my child's health care provider?

Call during the office if ….

• Your child refuses to drink.
• The thrush gets worse during treatment.
• The thrush lasts beyond 14 days.
• You have other concerns or questions.
  

Back to Top

A cold or UPPER RESPIRATORY INFECTION is a VIRAL infection of the nose and throat. The cold viruses are spread from one person to another by hand contact, coughing, and sneezing - NOT by cold air or drafts. Since there are up to 200 different cold viruses, most healthy children get at least 6 colds per year. Children in daycare could get up to 12 a year. The fever part of a cold usually lasts 3 days and all nose and throat symptoms should be gone by 10 to 14 days. A cough may last 2 to 3 weeks.

HELPFUL HINTS

• Antihistamines are unnecessary unless the child has allergies
  
• Over-the-counter cold (decongestants) might relieve the symptoms. We do not recommend decongestants or cough suppresants for children under two years of age.
  
• Yellow to green nasal drainage is NORMAL during the second half of a cold
  
• For sore throats: cold drinks, popsicles, ice chips, and pain medications (Acetaminophen and Ibuprofen) are helpful
  
• For babies and toddlers, nasal saline drops or gel with a nasal aspirator, cool-moist air, and elevating the head of the child's bed may relieve discomfort
  
• Since the typical cold can last 10 to 14 days, it is not considered a SINUS INFECITON unless it has been at least 10 days and is now accompanied by headaches and/or all day thick nasal drainage, and/or a cough (a cough is usually the hallmark sign of SINUSITIS). For children with recurrent infections, this time frame may be shorter than 10 days.

SPECIAL NOTE
Antibiotics will not help the typical cold. Some heath care providers in an effort to please patients do use antibiotics prematurely. This is unnecessary and contributes to the overuse of antibiotics and can cause antibiotic resistance in future illnesses.

CALL IF ….

• The child complains of ear pain
  
• For babies and toddlers: waking up at night crying with difficulty returns to sleep and no feed well
  
• There has been a fever for longer than 3 days
  
• Symptoms are present for more than 10 days with an increasing cough
  
• For any wheezing, shortness of breath, or frequent coughing
  

Back to Top

VOMITING is the forceful ejection of a large portion of the stomach's contents through the mouth. Most vomiting is caused by a viral infection (viral gastritis) or eating something that disagrees with your child. The vomiting usually stops in 6 to 24 hours. Dietary changes usually speed recovery. If diarrhea is present, it usually persists for several days. (Barton D. Schmitt, MD, 1999)

TREATMENT FOR VOMITING
(Remember to be slow and easy on the belly!)

• Begin with NOTHING by mouth for 1 to 2 hours after the vomiting episode
  
• Later, begin with only SIPS of clear liquids. Offer cledar fluids like Pedialyte or Liquidlytes to infants under 12 months of age. For toddlers and older children, you can begin with Gatorade, water, white grape juice, chicken broth, and decaffeinated tea.
  
• Advance the diet slowly if the child is tolerating the fluids to a bland diet of starchy foods (pasta, rice, cereal without milk, crackers, toast, bananas, baked white potato, etc.)
  
• If the child vomits again, START OVER

CALL IF ….

• Severe abdominal pain.
  
• Fever is present for longer than 3 days
  
• Any signs of dehydration, which include: lethargy, no urination for 12 hours, no tears, dry mouth, and sunken eyes.
  
• Any vomiting associated with head trauma or poison/medication ingestion.
  

Back to Top