Jeffers, Mann and Artman - Helpful Information about Common Childrens Illnesses

	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
	ABDOMINAL PAIN 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
	ACCIDENT PREVENTION AND CHILDPROOFING YOUR HOME 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
	ALLERGIC RHINITIS (Hay Fever) 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 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
	BITE, ANIMAL OR HUMAN 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: Cleanse with ½ strength Peroxide and water. Antibiotic ointment three (3) times a day. Monitor for signs and symptoms of secondary infection. 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 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. CAUTION: Call a rescue squad (911) if your child has a different kind of attack during which he stops breathing for more than one minute or turns white (not blue). Back to Top
	BRONCHIOLITIS 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 (VARICELLA) 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
	CHOKING 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 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 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 (Poison Ivy, Oak, Sumac, and Certain Chemicals or Metals) 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
	COUGH 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 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
	DENTAL CARE AND FLOURIDE 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
	DIAPER RASHES 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 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
	EAR INFECTIONS (Otitis Media) 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
	FEVER 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 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
	FROSTBITE 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 wat