**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.

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

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.

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.

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.

• 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.

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

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.

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.

• 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 ]]> http://www.farrellpediatrics.com/recommended-reading-for-parents/feed/ 0