…Oh Boy, this topic gives me a bellyache…

There are so many potential causes of belly pain that anything that is severe or prolonged usually deserves a visit to see us in the office. I have decided to approach this as if you are accessing our site to see if you need emergency care or suggestions for relief overnight for acute onset abdominal pain.

Emergency Care:

Call us or seek care if;

• The abdominal pain is severe, located in the right lower part of the abdomen, and your child has refused to eat or drink at all since the onset of the pain. If they are old enough, ask them to jump up and land on their heels. If they refuse or the pain is significantly worse with this pain they may have appendicitis and should be seen immediately.
• Infants or Toddlers with a distended abdomen, (looks like a balloon in their belly) irritability (constantly crying), and bloody diarrhea also need immediate attention. Especially if they are alternating between crying and lethargy.
• They recently had a seemingly minor or moderate trauma to the abdomen and now have pain.
• They have frequent urination, pain with urination
• They have signs of dehydration with vomiting and diarrhea.
• There is any possibility of a poisoning or toxic exposure.
• They have a high fever and significant cough with signs of distress (see cough)
• If they do not meet the above criteria some home treatment may be warranted.

If they are vomiting or have Diarrhea – see this link

For Intermittent gas pain a warm water bottle (hot water bottle) on the abdomen may be soothing. We occasionally will recommend some Tylenol (acetaminophen) for temporary pain relief. In general if there is a risk of dehydration, we avoid the use of ibuprofen.

If the pain is chronic or recurrent, causes are multiple and include:

• Colic, Milk protein intolerance, and reflux in infants
• Reflux, Constipation, and Psychological stress in older children

Obviously, this list is not all–inclusive and determining the cause usually requires an office visit. If you feel it is a chronic problem or due to some stress, let our front desk know so they can give the physicians enough appointment time to take a complete history.

Acetaminophen is generally given every 4 to 6 hours. Do not exceed six doses a day.
It is always best to dose medications based on weight more than age.

Note: READ THE LABELS CAREFULLY.

This table is assuming 1 dropper=80mg, 1 tsp=160 mg, and 1 chewable= 80 mg.

NEVER GIVE ANY MEDICINE TO A BABY LESS THAN 3 MONTHS OF AGE WITHOUT CALLING YOUR PHYSICIAN FIRST.

Definition

Runny or stuffy nose, sometimes with fever, sore throat, cough, hoarse voice or swollen glands in the neck

Other causes of nasal congestion:

Many children and adults have a profusely runny nose in the winter when they are breathing cold air. This usually clears within 15 minutes of coming indoors. This requires no special treatments and is not the result of infection. Children and adults who suffer from allergies will also have nasal congestion. They require appropriate allergy treatment. Newborns may sound stuffy on and off, but there is no nasal discharge. They are having dried mucous developing in the nasal passage which can be cleared with salt water drops and bulb syringing. Chronic nasal congestion lasting greater that 2-3 weeks may be a sign of a sinus infection or a foreign body placed in the nose (causes one-sided foul smelling thick runny nose).

Cause

Colds are caused by viruses, and therefore cannot be treated with antibiotics. Transmission of colds is by hand-to-hand contact, sneezing, and coughing. They are not transmitted by cold air or drafts. People are contagious for a day or two before the onset of symptoms and for an average of 7 to 10 days. As the colds progresses, contagiousness gradually decreases. Incubation time is less than a week. Most children get 6 to 10 colds a year, and the frequency increases if the child is in daycare or has siblings in school.

Expected Course

If a fever accompanies the cold it usually lasts less than 3 days, and the throat and nose symptoms typically last 7 to 10 days. The cough may persist up to 2 to 3 weeks.

Home treatment

For runny nose with lots of discharge- For infants use a bulb syringe to clear the secretions. It is especially helpful before a baby nurses or takes a bottle. Use a humidifier at night. Elevate the head of the crib or bed.- place a pillow underneath the mattress.

For stuffy nose with little discharge-Warm nose drops with a solution of salt water (use 1 teaspoon of salt in a cup of warm water) or purchased saline drops can be placed in each nostril. This helps to break up the mucous and then you can suction the secretions with a bulb syringe. An older child can be told to blow the nose after the drops have been in for a minute. Use a humidifier at night.

Over the counter medications are not recommended in children under 2 years of age. In older children they may or may not be helpful. They do not shorten the course of the cold . These medications may also have some undesirable side effects such as jitteriness or excessive sleepiness. Acetaminophen or ibuprofen may be used for fever recuction.

Call the Doctor immediately if:

• Breathing is difficult and does not improve with nasal suctioning, especially in infants under 4 months.
• The child is becoming dehydrated because of inability to feed or vomiting.

Call during Office hours if:

• Nasal discharge lasts greater than 14 days, especially if the child appears to be getting worse.
• Skin under the nose becomes scabbed/crusted.
• Yellow eye discharge
• Earache or severe sore throat
• Fever for more than 3 days
• Having difficulty eating because of stuffiness in infant under 4 months
• Suspicion of foreign body in the nose

Definition:

Colic means excessive crying in an infant 2 to 12 weeks of age who is otherwise healthy. It is a very common occurrence among infants, and the cause is unknown. Because many physical problems can cause excessive crying in an infant, the diagnosis of colic should be made only by a doctor.

Symptoms of Colic:

Colic usually begins by 2 to 3 weeks of age and may last 3 or 4 months. Colicky infants usually cry at least 3 hours a day. The crying may or may not occur at the same time each day, but usually happens more often in the evening. The baby does not stop crying when usual ways of comforting, such as holding and feeding, are tried.

Signs of Colic:

• Crying
• Flailing of arms and legs
• Clenched fists
• Drawing up legs toward abdomen
• Bulging and tense abdomen
• Struggling and angry when held

Possible Causes of Colic:

No one really knows the real cause of colic, but some things that may be related include:

• Gas pains
• Exposure to Tobacco Smoke
• Stomach Spasms
• Immature nervous system
• Hormones out of balance
• Immature digestive system
• Intolerance or allergy to milk/ formula
• Tension or emotional stress in babys environment

Reflux (GERD) and constipation may also cause similar symptoms

Treatment:

There are a wide variety of things that may help, but very few that will work every time. Often, it is trial and error to find the ones that work best for your child. Suggestions that have helped babies with colic include:

• Rocking in a chair or recliner
• Cuddling or Swathing
• White noise such as a vacuum cleaner or hair dryer
• Burping your baby multiple times while feeding to alleviate excessive gas
• Sitting your baby up in a car seat
• Going for a ride in a car or stroller
• Giving your baby a pacifier
• Playing soft and light music

*Never shake your baby!

Important Points:

• Your babys crying is not your fault
• Your baby does not blame you
• Confusion and Anger or normal responses
• Even though your baby is crying, they are still healthy
• There is a light at the end of the tunnel, and most babies symptoms resolve by 3-6 months of life.

When to Call your Doctor:

• Respiratory distress
• Fever >100.5º
• Bile or blood in spitup
• Dehydration
• Hard stools
• Poor weight gain
• Blood in stools
• Or if you have further concerns

General Information

The conjunctiva is a thin clear membrane that lines the eyelids and covers the eyeball. Pink eye is the inflammation or infection of that membrane. It occurs very commonly in all age groups. It can be caused by bacteria, viruses, injury, allergy or foreign body. Infants can have repeated episodes of conjunctivitis secondary to blocked tear ducts. Bacterial conjunctivitis is extremely contagious and is very common in children who attend daycare or preschool.

Symptoms

• Drainage- can be pus-like or watery
• Crusty eyelids
• Swollen eyelids
• Pink color to the white of the eye
• Itch or pain

Treatment

The appropriate treatment depends on the cause of the pink eye. Bacterial conjunctivitis requires antibiotic drops or ointment. The infection usually clears in a few days. After 24 hours of medication it is okay to return to school or daycare. Other comfort measures include washing the affected eye(s) a few times a day with cold water. Apply a washcloth with cold water over the eyes for 5 minutes to soothe the itch or pain. Before putting in any medicines, remove all the pus from the eye with warm water and wet cotton balls. Unless this is done, the medicine will not have a chance to work. Other treatment measures include treatment for allergies or removal of a foreign body if these are determined to be the cause of the pink eye(s).

Call the Doctor Immediately if:

• Eyelids are very swollen with redness of the eyelid
• History of direct or blunt trauma
• Blurry vision, especially after any trauma
• Constant tearing, blinking or pain in the eye
• Possibility of foreign body in the eye

Call during office hours if:

• There is a yellow eye discharge
• Redness for more than three days
• Constant itching, watery discharge
• The child develops an earache

Constipation is a common illness that affects both small infants and older children. It can be a source of pain and embarrassment for the child, and frustration for the parent. In general, we define constipation by pain and effort, instead of duration. For instance, some babies stool every 5th day. This is normal as long as there is no pain associated with the bowel movement (BM). Some babies stool 2 times a day, but have pain associated with it. This is true constipation. Constipation can occur at any time, but usually presents in 2 age groups–shortly after birth and early school years.

Signs of Constipation:

Infants:

• Straining
• Hard, pebble like stools
• Liquid stools (leakage around solid stools)
• Distended or swollen abdomen that improves after a BM
• Blood in stool
• Rectal tear

Children:

• Abdominal pain and cramping
• Very infrequent/ irregular bowel habits
• Soiling or accident in pants
• Distended abdomen

Treatment:

Infants:

• Juices–pear and prune
• If old enough, you may give fruits and vegetables
• Karo syrup
• Switching from rice cereal to oatmeal or barley cereal

Children: Goal of 1 soft BM per day

• Vegetables, fruits, whole grain cereals
• Bran cereal
• Extra water and liquids between meals
• Toilet–sitting to take advantage of the normal reflex to have a BM 15-30 minutes after each meal
• Rewards system–calendar, stickers, favorite tv show, special time

When to call the Doctor

• When your child is irritable and seems to be having abdominal or rectal pain
• If you see blood in the stools
• If symptoms last for longer than 4-5 days
• If the above therapy does not improve symptoms
• If there is fever >100.5º associated

Important points:

Try to stay calm, positive, and understanding. This is not something children decide to do, and therefore punishment is not recommended. Do not give enemas, suppositories, or laxatives unless you are told to do so by your Doctor. Call your Doctor with any further concerns or issues.

Cough is one of the most frustrating symptoms to deal with as a parent, and equally frustrating for the physician. MOST of the time there is very little that can be done about a cough.

Emergency Care
Quick reference guide:

Call us or seek emergency care if:

• Your Baby seems unable to latch to a bottle or breast due to cough and congestion
• Your infant or child is retracting– this means using their ribs, belly or neck muscles to assist in their breathing. You will see the belly and chest going up and down like a see-saw, or each individual rib as the muscles in between the ribs suck in and out .
• You notice your child’s nostrils flaring open with each inward breath.
• You notice a color change, such as a blueish tinge around the mouth, lips or tongue.

Most of you reading this will not be dealing with a child with the above level of distress and you are accessing our web site to learn if there is some way to get through the night. First, a bit about why we cough:

As it is with most “symptoms”, our bodies produce the cough as a means of protection. Coughing increases mucous clearance and speeds up the tiny hair cells in our airways that help protect our lower recpiratory tract from infection. So, think of a Cough as a good thing. This is why we don’t necessarily recommend suppressing it. A good example of how helpful our cough is comes from the experience in caring for children with cystic fibrosis. These children have much thicker mucous and have damage to their Cilia (the tiny Hair cells mentioned above) consequently, their cough is less effective. They suffer from recurrent bouts of pneumonia and need external assistance to bring up mucous. So, hopefully after reading this as you hear your child cough you may have less anxiety about it and actually welcome a bit of coughing.

Most coughs then, are a product of an upper respiratory infection (a cold or flu) that causes increased secretions. Mucous that an adult or older child would spit out or blow into a tissue is swallowed by the young ones. This post nasal drip is what accounts for the more severe sounding cough in our children. Cough without the post nasal drip can also be caused by irritation or mild inflammation to the upper respiratory tract, such as croup. Croup causes a dry dog or seal like barking cough that is worse at night. Most of these viral coughs last about 2 weeks, but some cause a prolonged (>3 week) cough. If your childs cough has lasted more than 2 weeks and is not improving or worsening we should see them in the office the next day. Prolonged cough without the above emergency symptoms does not need emergency care.

WHAT DO I DO???

If you think you are dealing with one of the viral coughs this is where the frustration comes in. First, calm yourself by re-reading how protective coughs are, then get a humidifier or vaporizer going in your childs room (unless they have a known allergy to dust mites or molds). This adds moisture to the air and may make the cough less disruptive to sleep–it DOES NOT stop the cough. Some menthol and camphor based products, like Vicks can either be put in the humidifier or rubbed on the chest if they are old enough not to touch it and might put it in their eyes.

There are now menthol products that can be plugged indo an outlet, but I am unsure of their safety with small children at this time. The menthol conctricts the blood vessels in the nasal passage and may indirectly reduce cough by reducing the amount of congestion.

Cough syrups are rarely helpful. Dextrometorphan is the DM added to the end of the brand name and it is foul tasting and not very effective. It is hard to justify the fight it takes to get this medication into your child when it may reduce the frequency of cough by 5 – 0%. Expectorants don’t help as children don’t expectorate, so skip this one in total. If sleep is disturbed (the childs, not just yours) a single dose of diphenhydramine, (Benadryl) may help your child cross over from drowsy to actually asleep .

Of course, one should not forget the tried and true concentration on pushing fluids during a cold, it helps clear the secretions, and provides some calories for the little ones who reduce their solid food intake during the illness.

If your child has a hictory of wheezing or asthma and has a significant cough it is never wrong to try the Albeterol or Xopenex and monitor for decreased cough as a result. Remember that for a few minutes after the treatment the Cough may worsen as the treatment opens up previously closed airways and secretions are mobilized.

Perhaps one of the most frightening of the common childhood illnesses that we deal with as parents is croup. Your child may wake up in the middle of the night with a barky cough, or even gasping for breath, and leave you feeling panicked. This is what croup is all about:

Croup actually describes a group of illnesses that cause inflammation (swelling) of the larynx (vocal cords) and trachea. That’s why children tend to get a dry, barky cough or hoarse voice when they get croup. Croup is almost always caused by a virus – most commonly parainfluenza – although influenza, RSV, rhinovirus, and others may also cause croup. Unfortunately, this means that antibiotics will not help cure croup. These illnesses are most common in the spring and fall/early winter, though they can occur year round. A typical infection tends to last about five days and may be accompanied by fevers (sometimes quite high), decreased appetite, and sore throat. Some children have recurrent episodes of croup, or spasmodic croup, which tends to be triggered by a mild cold or allergy. Most children with spasmodic croup do not have a fever.

There are a few important therapies that you can provide for croup. The first is humidification. Run a humidifier (warm or cool – it doesn’t matter) in your child’s room. The second is hydration. It is very important to keep your child well hydrated when he/she is sick! If your child awakens in the middle of the night coughing or gasping, first try to calm him/her down. You may notice that croup “attacks” worsen when children are upset. Sit your child directly in front of a humidifier, or sit in bathroom with a steam shower running, or take your child outside if the night air is cool. Spasmodic croup may respond to asthma medicines. Give him/her something cool to drink. If he/she is running a fever, you may give an appropriate dose of acetaminophen or ibuprofen. The humidifier/steam treatments almost always work. Try this for about 15-20 minutes if your child wakes up at night, but if you’re having trouble, call us!

You should call a doctor if:

• after trying to calm your child down, you think he/she is having significant difficulty breathing
• is blue around the mouth
• is drooling, having difficulty swallowing
• has noisy, musical breathing (stridor) at rest

Croup can be very scary, both for children and their parents, but most of the time, kids end up doing just fine and fighting off the infections on their own. Occasionally we will put kids on oral steroids to help decrease the inflammation around the larynx, if there’s stridor. Call us if you have any questions!

When can my child return?  Is it contagious?

Should I cancel the

a) play date

b) birthday party or

c) family visit?

Exclusion criteria have been practiced for decades and there is a great deal of practical evidence that they are ineffective. (We docs are still in business). Before blaming your best friend for bringing their child into contact with your own, remember – The period of highest infectivity (most contagious) is usually BEFORE THE CHILD HAS ANY SYMPTOMS!  Therefore, you must be clairvoyant to stop the spread of disease.

That said, there are some good medical tenants to REDUCE, not eliminate spread of disease.

* unless caused by allergies – itchy with clear discharge

These are guidelines only and individual schools and institutions may have different restrictions. Consult your school handbooks for guidance.

Diaper rash is one of the most common pediatric health issues. Nearly all children develop a rash or inflammation in their diaper area at some time, often during the first year of life. Most of these rashes are caused by contact with moisture and irritants found in urine and stool.

The steps outlined below should help an existing rash to heal. They are also good techniques for preventing rashes when your child has diarrhea, whether from a viral infection or as a side effect of antibiotic therapy.

• Change diapers frequently and be sure the skin is completely dry before closing the new diaper. Wet skin is more easily penetrated by the irritating substances in stool and urine. It is also more easily damaged by chaffing of the diaper against the skin.
• Clean the skin gently with water. Avoiding the chemicals in store-bought wipes can help rashes to heal more quickly. Instead, use soft paper towels or washcloths moistened with water (these can be stored in air-tight bags for travel). Clean the skin with a light patting motion. Brief soaks in the sink or tub provide another way to cleanse without rubbing the irritated skin. You might also try using a squirt bottle filled with water.
• Leave the area open to air. During naps and any other time that is practical, expose the skin to air by placing your child on a towel without a diaper. While this may be the most challenging suggestion to implement, it may also be the most helpful.
• Use a diaper cream. The main purpose of these creams is to provide a barrier between the baby’s skin and urine/stool. Zinc oxide creams are the best (brand names include Desitin and Balmex) but creams made from petroleum jelly are also acceptable (brand names include Vaseline and A&D Ointment). Do NOT use powders or cornstarch as these have been shown to cause breathing problems when inhaled by some infants.

If you have followed these steps for 3-4 days and the rash is not improving, your child should be seen by a doctor. It is possible that the skin has become infected with yeast or bacteria and that a prescription will be required to clear the rash.

Ear pain is one of the biggest causes of distress and sleepless nights for children and their parents.  For those of us who have experienced one of those sleepless nights with our children we understand how difficult they can be! However, it rarely is a true emergency that necessitates a middle of the night ER visit.

SYMPTOMS:

Most ear infections are otitis media or an infection of the inner ear. Typically, an ear infection is preceded by a cold or upper respiratory infection, although not always. Most children with ear infections have fever and complain of a painful ear. Typical symptoms in an infant are fever, sudden difficulty sleeping or lying flat, and crying when sucking/decreased appetite.  Parents often bring infants in because the baby is “pulling” on the ear. Sometimes this is associated with an infection, but it is unlikely to be in the absence of any other symptoms. Sometimes you can see pus-like drainage coming from the ear. This usually means the eardrum has perforated. If your child has ear tubes, follow the directions of your ENT if you see drainage from the ear. If your child does not have ear tubes, we should see them in the office the next day.

TREATMENT:

Ear infections can be caused by a viral infection or a bacterial infection. We used to almost always treat ear infections with an antibiotic. However, we have learned that this is probably not necessary as in many cases the ear infection will resolve on its own. We follow the most up to date recommendations by the American Academy of Pediatrics when considering how to treat an ear infection. In children under 2 years old, we usually treat the ear infection with antibiotics. In children over 2 years old, we can treat the pain of the ear infection but wait to see if it resolves on its own in 48 hours. If the infection has not gone away in 48 hours, we would then consider treating with antibiotics. We do not call in antibiotics on the phone. In order to give your child the best care possible, we will need to see them in the office to examine their ear.

WHAT YOU CAN DO:

Most of the time if your child has symptoms that you suspect are related to an ear infection, it is ok for the child to wait to be seen the next day in our office. It will not cause damage to the ear if the infection is not treated right away. At home, you can treat the ear pain by using acetaminophen (Tylenol) or ibuprofen (Motrin/Advil).

WHEN TO CALL YOUR DOCTOR:

• A high fever that is not relived by medication (see FEVER)
• Severe ear pain that is not relived by medication
• A severe headache or neck pain.
• The ear seems to be swollen, red, or very tender on the skin around the ear.
• Any trauma to the ear.
• Your child is very irritable, looks very ill, or is very drowsy.
• Your child is not able to drink or is not urinating appropriately.
• Your child is under 3 months old.
• ***You have any concerns or feel that your child is very sick.

***If your child has ear tubes you should follow the instructions of your ENT. Sometimes your ENT will give you special drops that can be used at home if you suspect an ear infection.

SWIMMER’S EAR:

Swimmer’s ear orotitis externa is an infection of the ear canal. It is usually caused by swimming in a lake/ocean/river or by very frequent swimming. Typical symptoms are a very painful ear. It is painful to touch the outside of the ear with swimmer’s ear but there is no redness or swelling of the ear or the skin around the ear. It should not be painful on the skin around the ear. There is no fever with swimmer’s ear. We treat swimmer’s ear with antibiotic drops that are applied to the ear canal. Swimmer’s ear can also be treated at home with pain medication and then be seen in our office the next day.

Fever is the number one concern for which parents call us and the number one symptom for which we see patients in the office. Fever can be frightening and concerning for parents, but it doesn’t have to be.

What is a fever?

Fever is a body temperature that is higher than normal. Most pediatricians consider any temperature over 100.3 F (38 C) to be a fever. Fever is usually a sign that your child is fighting an infection. In children, viral infections (like the common cold) are the most common cause of a fever. Fever is a sign that your child’s immune system is working and doing what it is supposed to do.

How do you measure a fever?

We recommend using a digital thermometer (not mercury) for measuring your child’s temperature. The temperature can be measured rectally, orally, or underarm (axillary). Under 3 years of age the best method for taking the temperature is rectally. This is easy to do and does not hurt the child. You can ask one of our nurses or doctors to show you how to take the temperature rectally if you would like. Over 3 years old, most children can cooperate enough to have their temperature taken orally. An underarm temperature is an alternative in children over 3 months of age; however this method is not as accurate as an oral or rectal temperature. We do not recommend using tympanic (ear) thermometers, pacifier thermometers or other methods as they are much more likely to be inaccurate. Regardless of the method you use to take the temperature, it is important to tell us what method you used if you are reporting the fever to us.

What do you do for a fever?

Fever does not have to be treated. Treating a fever gets rid of the fever but not the underlying cause of the fever. However, treating a fever usually will make your child feel better. Medications commonly given to treat fever are acetaminophen (Tylenol) and ibuprofen (Motrin or Advil). It is important to know the correct dose of these medications for your child. CHILDREN UNDER THE AGE OF 3 MONTHS SHOULD NOT RECEIVE ANY MEDICATIONS FOR FEVER, UNLESS YOU HAVE FIRST TALKED TO YOUR PEDIATRICIAN. Children under the age of 6 months or children who have been vomiting or are dehydrated should not receive ibuprofen. Aspirin should never be used in children for fever.

When should I call my doctor?

Call us right away if;

• Your child is younger than 3 months and has a rectal temperature higher than 100.3
• Your child looks very ill, is very drowsy, or is very irritable.
• Your child has been in an extremely hot place, like an overheated car (fevers from external sources are more dangerous than fevers from an infection).
• Your child has a condition that suppresses immune response, such as sickle-cell disease, diabetes, cancer or is taking steroids.
• Your child has a seizure.
• Your child has other symptoms such as a stiff neck, severe headache, severe sore throat, severe ear pain, severe abdominal pain, unexplained rash, repeated vomiting and diarrhea, or pain with urination.
• Your child has not had the scheduled vaccinations for his/her age.
• Your child has a fever for more than 3 days.
• You have any concerns or feel that your child is very sick.

How high can fever go?

The height of the temperature does not necessarily mean that your child is sicker or is in more danger. Fevers of 102-103 are very common in children. Your child’s fever will not “keep going up and up” unless your child has been exposed to an external source of heat, like an overheated car.

There is no specific temperature at which we get worried. THE MOST IMPORTANT THING IN EVALUATING FEVER IS EVALUATING THE CHILD. If a child has a temperature of 104 and is happy, smiling and eating well, it is very unlikely that the child has a serious underlying cause of the fever. Alternatively, if a child has a fever of 100 but is irritable and inconsolable, we should be called right away. However, most children and adults feel worse with high temperatures. That is why we recommend treating fever.

Isn’t fever dangerous?

NO! Fever is not dangerous. Fever is good. It is a sign that your child’s body is working well. Fevers of up to 105 do not cause brain damage. It is true that some children have seizures with fever. However, this is more related to the child’s genetic make-up than the level of the fever. Some parents believe that all children will have a seizure if the fever gets high enough. This is not true. Let us know if you have a family history of febrile seizures or other seizure disorders.

What is it?

Hand-foot-mouth disease (HFM) is a common illness that we see in children. The disease is most common in toddlers and school age children but can be seen rarely in adolescents. It is caused by a VIRUS known as the coxsackie virus, so antibiotics will NOT treat this illness.

What are the signs and symptoms of HFM?

HFM disease may start with the child simply feeling a bit under the weather for a few days after they were exposed to the disease. They will often begin to refuse to eat solid foods and sometimes liquids because their throat hurts a lot. These children may develop high fevers.

The distinguishing part of this disease is that they will develop red spots on the throat that may become blisters or ulcers. The kids also get small red spots which may blister on their hands, feet and even the buttocks. The rash is often found on the soles and palms which is usually for other viral rashes. It may also be painful but it usually does not itch.

How do we diagnose/treat HFM?

Diagnosis is made by history and exam of the body that shows us the rash.

Treatment is only supportive. This is a virus so antibiotics do not help. It is important to control the child’s pain with Tylenol and/or Motrin. It is also important to keep the child well hydrated by pushing fluids such as water, formula or pedialyte. You can also use jello or Popsicles as alternatives to fluid. Drinks such as orange juice should be avoided as the acidic nature may hurt the throat.

When do I call the doctor?

• If your child has no urine in 24 hours, dry mouth or a sunken soft spot (all signs of dehydration) the doctor should be called.
• If the fever lasts for more than 5 days or if the child has other signs of illness such as an ear infection.

How can I prevent HFM?

The virus is spread via particles in the stool and your respiratory secretions (AKA snot). You can also get this from objects such as changing tables and toys. You should wash hands frequently.   Children should also not attend daycare for several days.

If you have accessed this page of our web site you may still be in a panicked mode because your child’s head recently made a loud hollow sound after a fall or collision. Take a deep breath and jump to the list below:

• Did your child cry right away? YES, then start relaxing
• Did they recognize you as their parent? YES, continue to feel calm
• Have they vomited since the accident? NO, great
• Do you see bleeding form the ears or nose? NO
• Are they able to walk or talk normally now? YES
• Is there rapid and continued swelling ABOVE THE EAR? NO
• Did your child have a seizure or loss of consciousness? NO

If your answers are DIFFERENT than those listed, call us to discuss care immediately.

If your answers are the same then you can relax and count this as another moment of parenthood that contributes to the graying or total loss of hair.  

The amount of swelling of the forehead is not correlated with severity or internal bleeding; this area of the scalp has a great blood supply and as a result swells up rapidly.

Also, be warned the swelling and blood may, via gravity, appear under the eyes the next morning, making your child appear to be a defeated boxer.  

Waking children up after a head injury is rarely necessary if they match the answers above, but if it was a severe blow or they just seem “not right” to your parental instincts, then wake them up every hour for the next 2–3 hours. Once they are noted to awaken, you can let them go right back to sleep.

Note: If your child is under 6 months and had a significant head injury, some of these questions do not apply. Call us for guidance.

Note: Chewable ibuprofen tablets come in different strengths.

You must read the box to know the appropriate dosing schedule.

Weight is the most important factor in determining dosing of ibuprofen. Ibuprofen is generally given every 8 hours. Do not give more often than every 6 hours and do not exceed more than 4 doses a day.

DO NOT GIVE IBUPROFEN TO CHILDREN LESS THAN 6 MONTHS OLD.

Over–the–Counter (OTC) medications can be very confusing and potentially dangerous for parents and their children.  Even doctors and nurses can feel overwhelmed and confused when walking into the cold/flu aisle of your local pharmacy. There are hundreds of products each supposedly providing relief for different symptoms. We are going to try and help take away the myth of all these medications and to help you safely use these medications for your children. First lets figure out the basic types of medication.

**Aspirin should NEVER be giving to children unless directed by a physician secondary to Reye syndrome.

Rules of Over the Counter Medications

• Children less than 12 months old should NOT receive any over the counter medications except fever reducers (ex. Acetaminophen/Ibuprofen)
• Children under age 6 months should>NOT get Ibuprofen.
• READ LABELS VERY CAREFULLY—Many medications are multi-symptom medicines. It can be very tricky because you can give your child to much of a medication. For example, your “cold medicine” may have a fever reducer in it such as acetaminophen and you could double dose your child easily.
• Medications with one ingredient are easier to monitor than the multi-symptom medications.
• Cough medications should only be given at night if your child is unable to sleep so that he/she may get some rest.
• Antihistamines will do little to relieve cold symptoms and may cause increased sleepiness.
• Decongestants may cause irritability, sleeplessness, increased activity and elevated heart rates.
• Nasal sprays that contain a decongestant such as phenylenphrine (Afrin) may relieve congestion quickly but will actually make symptoms worse upon stopping medication. This is known as a rebound effect. Therefore, the medications should only be used with doctors supervision.

Remember these medications will NOT cure your child’s illness and they are not a miracle fix.  Many time cool mist humidiers, bulb suction and nasal saline drops in the nose, warm showers and plenty of fluids will work just was well.

WHAT IS IT?

This is a contact allergy that is caused by urushiol oil. Urushiol oil is found on poison ivy, oak and sumac. The oil can be irritating for up to 5 years after the plants are dead. You can inhale the oil when the plants are burned, and as little as one nanogram (one billionth of a gram) can cause a reaction.

WHAT DOES THE RASH LOOK LIKE?

The rash is usually red and may look like scratch marks. It is usually extremely itchy. It may be swollen and have weeping blisters.

HOW DID I GET THIS?

You can inhale it. You can touch it directly. You can touch clothes that had contact with the oil, or you can touch a pet that touched the oil (brushed its fur on the plant).

IT’S SPREADING – WHAT DO I DO?

The rash does NOT spread. Once someone comes in contact with the oil, it may take 3-7 days for the rash to fully develop, but can appear as early as a few hours to days after first contact. Once the rash has fully developed it may take another 1 to 3 weeks to heal, depending on severity. The areas that had the greatest and longest contact with the oil will be the first to develop.

IS IT CONTAGIOUS?

No, the rash is NOT at all contagious. The only way to get the rash is to come into contact with the oil. One you have washed with soap and water and washed your clothes, you cannot spread the oil.

(Remember – wash your hands BEFORE and AFTER you go to the bathroom to avoid this rash on the genitals.)

CAN I GO TO SCHOOL OR DAYCARE?

Yes, this rash is not contagious.

WHAT CAN I DO TO MAKE IT FEEL BETTER?

Benadryl, by mouth, or Claritin my control some of the itchiness. You may also apply 1% Hydrocortisone to the area 3-4 times per day. You may also apply Calamine lotion and/or take an Aveeno oatmeal bath. Avoid any lotions that contain Benadryl (i.e. Caladryl) as they may make the rash worse. Benadryl by mouth is fine.

WHAT DOES AN INFECTED RASH LOOK LIKE?

It can be tender, red (or dark pink), and/or warm to the touch beyond the rash itself. It may have red, tender streaks going from the rash. There may be honey-crusted scabs around the blisters. The blisters may grow or ooze pus.

WHEN SHOULD I CALL THE DOCTOR?

You should call the doctor immediately, or go to the emergency room if after hours, if you are having difficulty breathing. You should call the doctor during office hours if the rash is over one quarter of your body or more, it is on your genitals, you think an infection may be starting, there are any large blisters, the rash is open and oozing, the rash is on the eyes, lips or mouth. Call the doctor immediately if you think there may be an infection with a fever, there is severe swelling, or you are uncertain if infection is spreading.

By spending a few minutes learning about how infections are spread, you may be able to significantly reduce the number of times you and your children become ill this winter.

Despite many people’s beliefs, colds are not caused by being cold; they actually spread from one person to another. The germs that cause colds and flu are found in the secretions from our noses, mouths and eyes. The germs spread when people sneeze, cough or blow their nose, allowing the particles to travel up to 6 feet into the surrounding environment. They can then infect people directly or may come to rest on nearby objects. Viruses and bacteria can live for several hours on surfaces such as toys, tables and doorknobs. When someone touches the contaminated object, then touches their nose, mouth or eyes, the cycle of infection continues.

To help break this cycle and prevent infection, follow these suggestions:

Wash hands frequently! This is the single most important step you can take to prevent illness.

• Hands should be washed before eating and after sneezing, coughing, blowing your nose, using the bathroom, changing diapers, playing with animals or playing outside. According to the CDC, a study of 305 school children found that youngsters who washed their hands 4 times a day had 24% fewer sick days due to respiratory illness and 51% fewer days with upset stomach.
• Hands should be washed with warm, soapy water (not necessarily with antibacterial soap) for 15 to 20 seconds. This is about the time it takes to sing the “Happy Birthday” song twice.
• If you don’t have access to soap and water, use alcohol-based hand sanitizer gels or hand wipes.
• If you have an infant, don’t allow people to touch him or her without washing their hands first.

Cover your mouth and nose when you sneeze or cough.

• If you don’t have a tissue available, then use your upper sleeve so that germs won’t be spread to your hands.
• Always wash your hands after sneezing, coughing or blowing your nose.

Try not to touch your mouth, nose or eyes.

• This will help prevent spreading infection when you are ill and will also protect you from germs you might pick up in the environment.

Don’t smoke around your children.

• Exposure to smoke increases the frequency and severity of colds and other respiratory infections.

For more information, see http://www.cdc.gov/germstopper/index.htm.

The doctors of Farrell and South Riding Pediatrics have composed this list of books for parents. This list is a collection of books we as doctors and/or parents have found useful to assist parents with raising their children. There are thousands of books available to parents and this list is just a small sampling. We hope that you will find these books helpful but we know that every child is unique and what we have included may not work for your family. Please contact our offices if you are in need of further assistance.

• The Doctors of Farrell and South Riding Pediatrics •

Book List

General Pediatrics

Your Baby and Child, Birth to Age 5, Penelope Leach—General book on raising children with a behavioral focus.

Happiest Baby on the Block, Harvey Karp—A book that provides guidance to parents with fussy/colicky babies.

Touchpoints, T. Berry Brazelton

Your Child’s Health, Barton Schmidtt—This book is a guide for common childhood illnesses, emergencies and behavior problems.

AAP: Caring for Your Baby and Young Child, Birth to Age 5, Steven Shelov, Robert Hannemann—General guide for basic child care including infancy.

AAP: Caring for Your School Age Child: Ages 5-12, Edward Schor—Comprehensive guide to your “middle aged” children and the unique challenges facing this age group.

AAP: Your Baby’s First Year, Steven Shelov—Comprehensive guide for newborns includes topics such as safety, well child care and month-to-month guides to development.

Baby 411, Ari Brown, MD and Denise Fields—Written by a doctor and a mom, this is a helpful guide for you and your new baby.

Discipline/Behavior

The Discipline Book, William Sears, MD and Martha Sears

Parent Power, John Rosemond—Traditional views of parenting kids of all ages.

The Challenging Child, Stanley Greenspan, MD, Jacrueline Salmon

1, 2, 3 Magic, Thomas Phelan—Teaches parents some simple, precise and effective ways to manage your children age 2-12 years.

Raising Your Spirited Child, Mary Sheedy Kurcinka

The Book of Virtues, William Bennett

Sleep

Solve your Child’s Sleep Problems, Richard Ferber—Recommends techniques for working through different childhood sleep problems.

The No-Cry Sleep Solution, Elizabeth Pantley—This book may be helpful for parents who seek and alternative to “the crying it out” method of sleep.

Healthy Sleep Habits, Happy Child, Marc Weissbluth

Nutrition & Diet

Child of Mine, Ellyn Satter

AAP: Guide to Your Child’s Nutrition, William Deitz, Loraine Stern—Reference guide to childhood nutrition.  Provides an easy guide to help parents manage dietary requirements for newborns thru adolescent.

Puberty

The Care and Keeping of you: The body book for Girls (American Girl Series) Valorie Lee Schaefer—Book provides an age appropriate look at puberty and body change in our adolescent girls.

Who Moved the Goal Posts

ADHD

Taking Charge of ADHD, Russell Barkley

Sensory Integration Dysfunction

The Out of Synch Child, Carol Stock Kranowitz

Quirky Kids, Perri Klass & Eileen Costello

Autism

The Boy Who Loved Windows, Patricia Stacey

Miscellaneous

Baby Bargains, Denise and Alan Fields—Helps to navigate the world of baby stuff and recommends what a new parent needs.

Siblings without Rivalry, Adale Faber, Elaine Mazlish—Provides a positive approach to help parents teach their children to get along.

Mommy Guilt, Devra Renner—Provides a helpful approach to make parenting enjoyable and less stressful

Babyhood, Paul Reiser—Laugh out loud about being a new parent

In general, a child should not return to school or daycare until they have had no fever for 24 hours. Please keep in mind that individual illnesses have different times of contagion. There is no set rule for all viruses or bacterial illnesses. Some rashes are not contagious, but others are. Please check with your own school or daycare for specific guidelines.

For additional information, please see our article on Exclusion Criteria.

Sore throats are one of the most common illnesses that affect children. There are many different causes of sore throat, the overwhelming majority of these being viruses. Common viral infections that may cause a sore throat include: influenza, parainfluenza, RSV, rhino virus, Coxsackie virus, adenovirus, herpes, EBV, CMV, and countless others. Typical symptoms that may be associated include fever, malaise, runny nose, cough, lymph node swelling, decreased appetite, and mild irritability. Unfortunately, nobody has found the cure for the common cold and scratchy throat.

Treatment options usually involve symptomatic care with ibuprofen, acetominophen, and other over–the–counter medications (please see specific OTC section). Luckily, severe symptoms tend to last less than 3–7 days, with residual complaints of cough and runny nose for up to 2 weeks.

Strep pharyngitis or “strep throat” is a different cause of sore throat that is important to be diagnosed. It is caused by a particular type of bacterium (Group A beta hemolytic streptococcus or Streptococcus pyogenes). This infection is most common in school aged children and adolescents, but it occasionally can be seen in the toddler age group. It is rarely seen below two years of age. Symptoms include a high fever, severe sore throat, difficulty swallowing, headaches, stomach aches, vomiting, and sometimes a rash. If your child suffers from any or all of these, in the setting of a sore throat, they should be checked for strep. Strep needs to be treated with antibiotics to prevent Rheumatic Fever. Before the age of penicillin, people developed severe skin, heart, and kidney problems as a result of untreated strep pharyngitis. We have two different tests that check for the strep bacteria. There is a rapid test that will discover the strep 85-95% of the time and a 24 hour culture that is 100% accurate. The advantage of a rapid strip test is quick identification and earlier treatment. Occasionally, however, the rapid strep test may be negative and the 48 hour throat culture may be positive. Strep throat is one of the only bacteria which is not becoming more resistant to our current antibiotics!! For that reason, most antibiotics, including penicillin and amoxicillin, are still very effective. Ibuprofen and acetaminophen are also indicated for fever and pain control.

Important Differentiating Points:

• Cold viruses: lower fever, runny nose, cough
• Strep throat: pain with drinking or swallowing, high fever, headache, rash, abdominal pain

As always, please call the clinic with any further concerns.

During the summer months, we start seeing a lot of “swimmer’s ear”, but if your child or adolescent is on a swim team year round, you may be dealing with this problem regardless of the month.

Basically, otitis externa is an infection of the skin that lines the ear canal. When water repeatedly gets trapped in the ear canal, the lining becomes wet and swollen. This makes it prone to superficial infections. It causes an itchy, painful ear, sometimes with drainage. There may be a sensation that the ear is plugged. Generally there is pain when the outer ear is moved up and down.

If it’s a mild case, you can try a home remedy:

• Rinse the ear canals twice a day with ½-strength white vinegar (mixed with equal parts water).
• Fill the ear canal.
• After 5 minutes, remove it by turning the head to the side.

More significant cases usually require prescription ear drops, so you’ll need to make an appointment to see one of us. Give acetaminophen or ibuprofen for pain relief. You can also use a heating pad or hot water bottle to the outer ear for up to 20 minutes for pain relief. With treatment, symptoms should be better in about 3 days.

Try to avoid swimming until all the symptoms have resolved. If your child is on swim team, it’s OK to continue. Swimming may slow recovery, but causes no significant harm.

The key to prevention is keeping the ear canals dry. After swimming, hair washing, showers, etc, turn the head to let the water run out of the canals. If your child is on swim team, you can make a home remedy of ½ rubbing alcohol and ½ white vinegar to rinse your child’s ear canals with after practices to restore to normal acid balance to and dry the canals.

You should call a doctor if:

• your child is experiencing severe ear pain
• your child’s ear pain is accompanied by fever
• there is redness and swelling of the outer ear

“The ill child” can be a term that means different things to doctors and parents. The main goal is to determine if the child might be seriously ill.

One key factor is to remember that the height of the fever is NOT as important as how a child is acting. For example, a child with a fever of 101º can be sicker than the child with a temperature of 103º. Many kids look quite ill when they have a fever so it is important to give an adequate dose of Tylenol/Motrin. You should give the medicine and then observe the child in about 1–2 hours to see how sick they are acting.

The following are signs that a child might be seriously ill:

• Babies—they are refusing to eat or unable to eat because they are breathing to fast, they are crying constantly and cannot be consoled by anything you attempt, the baby cannot be aroused for feedings
• Toddlers—refusing to play and won’t interact with you, they may appear weak or not moving, if they are crying and cannot be comforted, they are difficult to awaken from sleep
• Older kids—they my refuse to talk or interact, again they are difficult to arouse from sleep, they do not have period of activity between times of sleep, they are not making sense when the talk to you

It is important to remember that all children will sleep an increased amount when they are sick.   However, the children should have periods of quiet play in between such as coloring or just playing with a toy quietly.

Vomiting and diarrhea are common in children. Both are almost always caused by viruses, and no medicines are used to stop either. Both usually resolve without any medical intervention.

If your child is vomiting, stop all food and drink for at least one hour. After an hour, give one teaspoon ONLY of clear liquid (Pedialyte preferred, but Gatorade may be used if the child is over a year of age). Try this every five minutes. If there is no vomiting after thirty minutes, you may give one ounce of clear liquid. Continue to give small amounts of fluids very slowly until the child has been without vomiting for at least four hours. Do not give solids or more than three ounces of fluids at a time until the child has not vomited for eight hours. Then resume bland foods (toast, applesauce, bread) slowly. The vomiting should stop within twenty-four hours. Call the office if it does not, if there is any blood in the vomit, or if your child cannot tolerate small amounts of fluids.

Diarrhea is also common. If your child has diarrhea without vomiting, there are no diet restrictions, although fruit juice may make the diarrhea worse. Feed your child a regular diet. Diarrhea can last for up to ten days. Call the office if there is blood in the diarrhea, your child refuses to drink, or if the diarrhea lasts more than ten days.

Because vomiting and diarrhea are generally caused by viruses, your child should be considered contagious until the symptoms resolve. Be sure to wash your hands thoroughly when cleaning either vomit or diarrhea, and sanitize any soiled areas. Your child should not attend daycare or school while vomiting. Many child care centers will not allow your child to attend if there is diarrhea, either.

We do not recommend the use of medications such as Phenergen or Immodium.

Dehydration

Signs of Dehydration that require evaluation

• Lack of tears
• Lack of any urine output in 24 hours
• Dry mouth and lips
• Listlessness—Acting Weak