NEW BORN TOPICS

What is bronchiolitis?

Bronchiolitis is a common viral infection in the airways and lungs of young children.

What are the symptoms of bronchiolitis?

• Faster breathing
• Coughing
• Wheezing
• Difficulty feeding
• Fever

Home care

Clear your baby's nose with bulb suction before feeding and sleeping to improve breathing. Adding a drop of saltwater (Ocean®) to your baby's nose before suctioning may help loosen mucus.

Use of a cool-mist humidifier may decrease congestion and make your child's breathing easier. Do not use a warm water humidifier because if the water is spilled, it can burn your child.

If your child seems to have a mild illness and is not eating or drinking well, try increasing fluid intake by offering small amounts more often.

• For children under one year of age, give 1-2 ounces of formula, breast milk, or rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®) every 30 minutes to an hour.
• Do not give children under 2 large amounts of water.
• Older children who are more severely dehydrated (see warning signs) should be given only rehydration therapy.

Continue to take your child's temperature every 2-4 hours until the fever is controlled.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for fever, pain, and discomfort. Avoid ibuprofen, however, if your child is dehydrated or unable to eat or drink well.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen. Do not give aspirin to children because of the increased risk of Reye's Syndrome with certain infections. Controlling your child's fever may decrease the risk of febrile seizure.

Warnings signs - Call our office for advice if:

Your child is listless or unresponsive, Call Our Office Now.

Your child is having difficulty breathing, Call Our Office Now. We may ask you to put your child on the phone so we can listen to his breathing.

Your child has difficulty breathing to the extent that his skin seems to be sucked in between the ribs or the throat, retractions, Call Our Office Now.

Your child is breathing faster than normal, Call Our Office Now.

Your child refuses to drink, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now.

Your child's skin appears blue around the nose or mouth, Call Our Office Now.

Your child is less than 6 months old and has a temperature greater than 100.4 degrees F, Call Our Office Now.

Your child is older than 6 months and has a temperature greater than 102.5 degrees F, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is a burn?

Burns are damage from exposure to heat, chemicals, electricity, or fumes.

Burns can affect the skin, breathing passages, and digestive tract.

What are the symptoms of a burn?

• Skin typically turns red and hot and is painful.
• Breathing passages and the digestive tract can become swollen, bleed, or scar, making it difficult to breathe or swallow.

Home care

Burns that cause blistering, charring or persistent pain (second and third degree burns) should be evaluated by our office.

Try to see if your child swallowed or inhaled whatever caused the burn.

If your child's burn continues to be painful or develops blisters, Call Our Office Now.

Run cold water over burns to cool the skin and reduce the damage from heat.

Severe face and hand burns should be evaluated in our office.

Do NOT put butter, Vaseline®, or toothpaste on the burns.

If the burn has blistered, do not break the blisters.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for pain and discomfort. Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

Change bandages at home as directed by our office by:

• Taking off the old bandage gently
• Washing your hands
• Washing the burn gently with soap and water
• Checking for signs of infection listed below
• Reappling cream if prescribed by our office
• Re-bandaging the burn with clean gauze pads

Prevention

Keep your child away from electrical cords which can get frayed and cause burns to the lips and mouth.

Cover all electrical outlets with safety caps.

Turn all pot handles toward the back of the stove so that toddlers and young children cannot reach them.

Shield your children from radiators and hearth fires.

Keep matches and lighters out of your child's reach.

Warning signs - Call our office for advice if:

You suspect your child has swallowed or inhaled something that has caused a burn, call the poison control center or Call Our Office Now.

Your child has been burned and there is blistering, charring or persistent pain Call Our Office Now.

Your child has been burned on the hands, face, or buttocks, Call Our Office Now.

You notice any signs of infection after we have evaluated the burn, Call Our Office Now.

• Increased redness or red streaking up the extremity
• Increased swelling around the burn area
• Increased pain
• Fever
• Drainage of cloudy pus

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

Car Seat Safety Tips

The safest place for children twelve years and under is in the back seat.

Every child should be buckled into a child safety seat, a booster seat, or with a fitted lap and shoulder belt.

Infants who weigh less than twenty pounds OR are under one year of age should ride in a rear-facing child seat. The seat must be in the back seat and face the rear of the vehicle.

If facing forward in a crash or sudden stop, a baby's neck can be badly injured.

Babies riding in a car seat should never ride in the front seat. In a crash, the air bag can hit the car seat and injure or kill the baby.

Here are some examples of how NOT to install your baby's care seat:

Never hold a baby in your lap when you are riding in a car. Your child can be badly hurt or killed in a crash or sudden stop.

Children over twenty pounds AND at least one year old should ride in a car seat that faces the front of the vehicle. It is best to keep kids in the forward facing seat, placed in the rear seat of the car, for as long as they will fit comfortably.

Older children over forty pounds AND four years of age should ride in a booster seat until the car's lap and shoulder belt fit correctly. The lap belt should fit low and snug on the child's hips. The shoulder belt must not cross the child's face or neck. Never put the shoulder belt behind the child's back or under her arm.

Know how to properly install your child seat in the vehicle.

For additional information, contact the NHSTA hotline at 1-888-DASH-2-DOT.

What is childproofing?

Childproofing is creating a safer home environment for your curious child who is moving around and discovering a fascinating new world.

Childproofing the kitchen

Place all poisons or cleaning goods in a locked cabinet or out of reach.

Cook on the back burners and turn pot and pan handles towards the back of the stove.

Secure all plastic wrappers and plastic bags out of your child's reach to avoid accidental suffocation. Never let children play with plastic bags.

Turn your hot water temperature down to 120 degrees F so that hot water in the kitchen sink will not scald a curious toddler.

Do not use a microwave to heat up formula because it may heat the formula unevenly - some parts of the liquid may become very hot while other parts remain cold.

Childproofing the bathroom

Place all medicines in a locked cabinet or out of reach. Use childproof caps.

Never leave your child unattended in or near a container of water (baths, toilets, buckets, pools, etc.) to avoid accidental drowning. A child can drown in very shallow water if they are face-down in the water.

Turn your hot water temperature down to 120 degrees F so that hot water in the tub will not scald a curious toddler.

Childproofing the car

Always buckle up your child in the car: car seats, boosters and/or lap belts.

Never leave a child unattended in a car. The inside of a car can become dangerously hot very quickly. Do not allow children to sit inside a closed car without adult supervision.

Childproofing to prevent poisoning

Place all cleaning goods and medicines behind locked cabinets or safely out of reach. Use childproof caps.

Learn how to use Ipecac, a medicine that causes vomiting in order to get rid of poisons. NEVER use Ipecac without first being instructed to do so by our office or the poison control center.

Post the emergency number and poison control numbers next to your phone.

Do not leave medicines, even over the counter medicines, out on a table, bureau or shelf. Make sure pocketbooks (purses) are kept up high, out of reach. Most women keep medicines in their purses.

Avoid keeping poisonous plants, inside and outside your home.

Childproofing to prevent fires

Keep all matches and lighters out of reach.

Keep working fire extinguishers in your house.

Test the battery in your smoke alarms once a month, and change the battery every six months (good times are spring and fall when you adjust your clocks).

Make sure fireplaces, woodstoves and space heaters are surrounded by fire screens or safe guards.

Have a fire drill and go over fire exits with your children. Children will often hide in closets and under the bed in fires. Make sure to designate a meeting place outside in case of a fire.

Do not store gasoline or propane inside your home.

Place flashlights in key places in your home so exit during a fire is easier.

General childproofing

Never leave your infant unstrapped in an infant carrier, car seat, or in a stroller or high chair. DO NOT place an infant in a car seat or infant carrier up on a table or shelf.

Avoid leaving many small objects around that your child may choke on such as peanuts, coins, small toys, hard candies, rubber balloons, etc. This is especially important for small children with older brothers and sisters.

Know what to do if your child is choking. Please refer to the choking page to review instructions on responding to choking at home.

Cover all electrical outlets with safety caps.

Check electrical cords to see they are not frayed. Never let your child play with an electrical cord or put one in his mouth.

Use gates and locks at the top and bottom of stairwells to prevent falls.

Do not use walkers. Children can fall down stairs or run into furniture. Jumpers or swings are safer alternatives.

Never leave your child unattended on a table or bed. Always have one hand on your child when he is on a high surface. Put the crib side up when your child is in the crib.

Never leave your child unattended with pets.

Use window guards. Screens alone are not enough to prevent falls.

What is chicken pox?

Chicken pox or varicella is a viral infection that causes a characteristic itchy rash and fever.

What are the symptoms of chicken pox?

Photo courtesy of Center for Disease Control and Prevention.

The rash usually starts on the stomach or back and may spread all over the body including the mouth, scalp, and diaper area.

The rash usually has three stages:

• Raised red spots that look like pimples
• Raised red spots with small water-filled blisters (dew drop on a rose petal)
• Open blisters that become crusted over

Your child may also have a fever, headache, tiredness, loss of appetite, runny nose, cough, vomiting, and diarrhea.

Home care

Chicken pox is contagious until all the blisters have crusted over (7-10 days). Furthermore, a child can develop chicken pox up to 21 days after being exposed. A child with chicken pox should stay at home, out of school, until all of the blisters are crusted over. Unfortunately, children with chicken pox are contagious for the two days before the rash occurs, so keep a careful eye on siblings for symptoms of chicken pox.

Your child may need to be evaluated in our office. Please call our office first for an appointment.

Calamine lotion may make your child more comfortable. Do not use Caladryl® lotion with Benadryl® syrup as they both contain diphenhydramine. Using both medications at the same time may cause too much sleepiness.

Bathing with water and baking soda or Aveeno® soap may help reduce the itching.

ain medications such as acetaminophen (Tylenol®, Tempra,® or Panadol®) and ibuprofen (Advil®, Motrin®) should be used cautiously for fever and pain as they may hide the symptoms of necrotizing fasciitis, a bacterial infection that causes dead skin and underlying soft tissues. Watch out for all of the warning signs during the infection.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen. Ibuprofen should be avoided if your child is dehydrated or unable to take anything by mouth.

Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.

• For children under one year of age, give 1-2 ounces of formula, breast milk, or rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®) every 30 minutes to an hour.
• Do not give children under 2 large amounts of water.
• Older children who are more severely dehydrated (see warning signs) should be given only rehydration therapy.

The varicella vaccine is a safe and effective way to prevent the chicken pox. Please refer to the varicella vaccine page.

Adults who have not had chicken pox should contact their doctor to discuss vaccination, especially if exposed to a child with chicken pox.

Warning signs - Call our office for advice if:

You think your child may have chicken pox, but you are not sure, Call Our Office Now.

Your child is less than 6 months old and has the chicken pox, Call Our Office Now.

Your child has any changes in behavior such as unsteady walking, vomiting, severe headache, or stiff neck, Call Our Office Now.

Your child refuses to drink, Call Our Office Now.

Your child has a red or purple rash that does not turn pale briefly after pressing on it, Call Our Office Now.

Your child's skin is painful or swollen 3 to 4 days after the start of the rash, Call Our Office Now.

Your child has a fever for more than 3 days after the start of the rash, Call Our Office Now.

You still need to use pain medications for pain or fever 3 to 4 days after the start of the rash, Call Our Office Now.

Your child has breathing difficulty, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now.

Your child is on steroids for any reason (asthma flare, any autoimmune conditions), Call Our Office Now.

Your child's pox get infected (swollen, hard, hot, or have yellow pus), Call Our Office Now.

Your child's itching is not improved by the treatment suggestions, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is the common cold?

The common cold is a respiratory illness that is caused by a virus. There is no medicine that will make the cold go away, but there are ways to make your child feel better.

What are the symptoms of the common cold?

• Runny or stuffy nose
• Cough
• Feeling tired
• Fever

Home care

Gently clean your child's nose with tissues or a bulb syringe. Use saline drops (Ocean®) to thin mucus before suctioning, especially before feeding or sleeping.

Try a cool-mist humidifier. This may decrease congestion. Do not use a warm water humidifier because your child may be burned if the water is spilled.

If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.

For children under one year of age, give 1-2 ounces of formula, breast milk, or rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®) every 30 minutes to an hour.

Do not give children under 2 large amounts of water.

Older children who are more severely dehydrated (see warning signs) should be given only rehydration therapy.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for fever, pain, and discomfort. Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.

Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Prevention

Frequent handwashing, especially upon returning home and before eating will decrease the frequency of illnesses.

Warning signs - Call our office for advice if:

Your child is not able to keep down fluids, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now.

Your child is less than 6 months old and has a temperature greater than 100.4 degrees F, Call Our Office Now.

Your child is older than 6 months and has a temperature greater than 102.5 degrees F, Call Our Office Now.

Your child is very fussy or sleepy and hard to wake up, Call Our Office Now.

Your child has a red or purple rash that does not turn pale briefly after pressing on it, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is conjunctivitis?

Conjunctivitis is a contagious infection of the eye caused by viruses or bacteria. Eye irritation may also be caused by allergies.

The white of the eye turns pink or red.

What are the symptoms of conjunctivitis?

Children with viral conjunctivitis usually have watery, itchy, and red eyes. This is annoying but harmless and will go away over the course of a week.

Bacterial conjunctivitis often is more painful with a yellow, milky discharge from the eye. The eyelashes may become stuck together because of the milky discharge. This condition requires treatment with antibiotics to avoid a more severe infection.

Children with allergic conjunctivitis usually have watery, itchy, and red eyes associated with a runny nose or other allergy symptoms such as sneezing. This is an annoying but harmless condition.

Home care

Do not share towels or eye droppers with other family members.

Wipe eyes gently from the inside corner to the outside, using a moist cloth or fresh tissue for each eye.

Placing a cool, moist facecloth to your child's eyes several times a day may make the eyes feel better.

If our office has prescribed an antibiotic ointment, use as directed.

• Wash your hands before and after giving the medicine.
• Pull the lower lid down gently with one finger and hold the tube close to the lower lid.
• Put the drops or ointment in a thin strip in the lower lid making sure that the tube does not touch the eye.
• Ask your child to blink gently.
• Put the medication in the other eye as well, even if it doesn't appear to be affected.
• Do not share this eye medication with other family members.

Prevention

Keep your child from rubbing her eyes. Bacterial and viral conjunctivitis are contagious.

Make sure that your child washes her hands frequently, especially upon returning home or before eating.

Warning signs - Call our office for advice if:

Your child has a yellow, green, or milky discharge from her eyes, Call Our Office Now.

Your child's eyes are painful or swollen, Call Our Office Now.

Your child complains of pain with eye movement or has difficulty moving her eyes, Call Our Office Now.

Your child has not improved in 2-3 days, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is constipation?

Constipation is the condition of having difficult or absent bowel movements caused by hardened, dry stools or feces. The stools may become dry when too much water is absorbed in the colon or large intestine. This may occur when stool material is unusually dry to begin with, or if it moves too slowly through the colon.

Constipation should not be confused with the normal variability in infant stooling habits. Breast fed babies often may go a few days without passing stool.

What are the symptoms of constipation?

Your child may find it difficult or uncomfortable to pass stools. Straining, however, without hard stools can be normal in infants as the child learns to coordinate abdominal muscles and the anal sphincter.

Hard stools usually look like dark brown balls.

Older children may exhibit stool-holding behavior such as leg-crossing, buttock-tightening and pressing his bottom against a wall.

Passing hard stools occasionally will cause anal fissures, small tears in the skin, leading to small streaks of blood on the stools.

Home care

Are there identifiable causes for the constipation?

For infants, a reduced stool frequency can occur after weaning from the breast, adding cereal to the diet or advancing the diet to more complex foods (e.g., meats, vegetables, other cereals).

For toddlers, constipation can occur at or around the time of toilet-training.

For older children, constipation can occur when they go off to school, travel, or camp-out. Children do not like to visit "foreign bathrooms" and will withhold stool to avoid having a bowel movement at a place other than home.

New medications such as codeine (found in prescription cough syrups) can be constipating.

• Do not stop prescribed medications without first speaking with someone in our office.

Increase fluids

• Children under 6 months of age should have only breast milk or formula prepared at full strength unless someone in our office recommends rehydration therapy (e.g Pedialyte®, Rehydrate®, Infalyte®).
• Children 6 months or older may be given additional formula or juice. Children under age 2 should NOT be given large amounts of water.
• Prune juice is an excellent source of fiber.

Increase fruits and fiber for children eating solid foods.

• Beans
• Fruits such as prunes and bananas
• Vegetables such as spinach and broccoli
• It is important that children receive plenty of fluids in addition to the fiber. Fiber without fluids can make the constipation worse.
• Bran cereals

For infants, try adding some corn syrup to the formula.

• If increased fluids are not effective, corn syrup (Karo®) may be added to the diet temporarily as one teaspoon twice a day mixed in 4 ounces of formula.
• If the constipation is long-standing or does not respond to home therapies after two weeks, call our office for a regular appointment.

Warning signs - Call our office for advice if:

Your child has red, jelly-like stools, Call Our Office Now.

Your child has black tarry stools, Call Our Office Now.

Your child is vomiting, please refer to the vomiting in infants.

Your child has predominantly right-sided abdominal pain, Call Our Office Now.

Your child is unable to pass stools for more than five days, Call Our Office Now.

Your child has a fever, please refer to the fever page.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is croup?

Croup is a swelling of the breathing tube in the region of the throat and usually is caused by a virus.

Croup affects younger children because their breathing tubes are smaller, making them more susceptible to the swelling associated with the infection.

Croup is usually worse at night and lasts 2-4 nights.

The second night is usually associated with the worst symptoms.

What are the symptoms of croup?

• Fever
• Barky cough
• Noisy, difficult breathing, especially when he breathes in

Home care

Do whatever you can to help your child remain calm. The following may make his breathing easier:

• Try using a cool-mist vaporizer. This may decrease congestion. Do not use a warm water vaporizer because your child may be burned if the water is spilled.
• If your child has a fever, dress him in light clothing and bring him in a cool room or by a fan.
• Take your child in the bathroom with a running hot shower. The steam may also help make breathing easier. Supervise your child to avoid hot water burns.

If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.

• For children under one year of age, give 1-2 ounces of formula, breast milk, or rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®) every 30 minutes to an hour.
• Do not give children under 2 large amounts of water.
• Older children who are more severely dehydrated (see warning signs) should be given only rehydration therapy.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for pain and discomfort. Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

Warning signs - Call our office for advice if:

Your child is having retractions, or difficulty breathing to the extent that his skin is sucked in between the ribs or around the throat, Call Our Office Now.

Your child cannot remain calm, Call Our Office Now.

Your child's skin appears blue around the nose or mouth, Call Our Office Now

Your child inhaled or swallowed any small toy or object, Call Our Office Now.

Your child is less than 6 months old and has a temperature greater than 100.4 degrees F, Call Our Office Now.

Your child is older than 6 months and has a temperature greater than 102.5 degrees F, Call Our Office Now.

Your child refuses to drink, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now .

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now

What is dehydration?

Dehydration is when your child's body loses too much fluid.

Fever, vomiting, and diarrhea are the most common causes of dehydration.

What are the symptoms of dehydration?

• Dry mouth
• Cracked lips
• Fewer wet diapers than usual (6 wet diapers per day is about normal)
• No tears with crying
• Irritability or less energy
• Sunken eyes, sunken soft spot in infants

Home care

If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.

• For children under one year of age, give 1-2 ounces of formula, breast milk, or rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®) every 30 minutes to an hour.
• Do not give children under 2 large amounts of water.
• Older children who are more severely dehydrated (see Symptoms) should be given only rehydration therapy.

Avoid ibuprofen (Advil®, Motrin®) when your child is dehydrated or unable to take anything by mouth.

Warning signs - Call our office for advice if:

Your child has any signs of dehydration listed above, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is diarrhea?

Diarrhea is a frequent, watery bowel movement often caused by a viral infection but sometimes is caused by bacteria or certain foods.

What are the symptoms of diarrhea?

• More bowel movements per day than usual
• Soft and watery stools
• Belly aches or abdominal pain

Home care

• If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.
• Older children who are more severely dehydrated (see warning signs) should be given only rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®).
• Give your child foods that are easy to digest such as bananas, toast, rice, noodles, crackers, and applesauce.
• Do NOT give your child heavy foods until he feels better.
• Do NOT give your child any anti-diarrhea medication.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

• Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.
• Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

Warning signs - Call our office for advice if:

• Your child becomes listless or unresponsive, Call Our Office Now.
• You notice blood in your child's stool, Call Our Office Now.
• Your child refuses to drink, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal) or urination, or sunken eyes, Call Our Office Now.

Your child continues to have diarrhea after 4 days, Call Our Office Now.

Your child develops a fever, please refer to the fever page.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is diaper rash?

Diaper rash is a red, raw rash on the skin of the buttocks and upper thighs. It is caused either by long contact with moisture, stool and urine or an infection by yeast or bacteria.

A diaper rash can become infected with a bacteria or yeast such as candida.

Healthy, pudgy babies often have folds where the skin is pressed against itself. Diaper rash from contact with stool or urine usually does not extend into the skin folds.

In contrast, a candida rash usually extends into the skin folds and consists of a red area with red dots just outside the main border of the rash.

What are the symptoms of diaper rash?

• Red, raw rash in the diaper area
• Peeling skin, especially at the edges of the rash
• Your child may be quite irritable when you change the diaper or wipe her bottom.

Home care

Change your child's diapers more often when she has a diaper rash to keep her clean and dry.

Expose your child's bottom to air as much as possible.

Make sure your child's bottom is completely dry before closing the new diaper.

Fasten diapers loosely so air can get in between the legs and skin folds.

Clean your child's skin with water and a soft cloth.

Avoid chemical diaper wipes because they may sting.

Change your child's diaper at least once at night.

Try applying an ointment such as Balmex®, A&D Ointment®, or plain zinc oxide to your child's skin after bathing or cleaning.

Do not use talc powder since breathing it in is unhealthy for your child.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for fever, pain, and discomfort. Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

Warning signs - Call our office for advice if:

Your child's skin develops any large blisters or open sores, Call Our Office Now.

Your child's rash spreads beyond the diaper area, Call Our Office Now.

Your child's rash does not turn pale briefly after you press on it, Call Our Office Now.

Your child's rash extends all the way into the skin folds and appears to have small red dots surrounding the larger rash, call our office for an appointment.

Your child develops fever, please refer to the fever page.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is a fever?

Fever is a body temperature higher than 100.4 degrees F or 38 degrees C as measured by a rectal thermometer for infants and young children or oral thermometer for older children.

Fever is a natural response to an infection.

Touching your child's skin or forehead may not tell you whether your child has a fever because the skin can be cool to the touch even though the inside of the body is very warm.

Taking your child's temperature with a thermometer is the best way to determine whether your child has a fever.

Accurately determining your child's temperature is an important part in managing your child's fever.

When you are anxious it can be easy to misread a thermometer, for example, reading 100.5 degrees F as 105.0 degrees F. Please refer to how to read a thermometer for a refresher.

What are the symptoms of fever?

• Warm and sweaty or cool and clammy skin
• Complaints of being very hot or cold
• Shivering

Home care

You may be able to treat your child's fever at home if none of the warning signs below apply. The following are common situations in which home therapy is generally effective:

• Your child appears well, seems comfortable and is responding to treatment.
• Your child has minor symptoms in addition to a fever, such as cough or diarrhea.
• Your child has had contacts with people with similar mild symptoms.

Remember - if you have any questions, or if you are not sure whether home therapy is advisable, please Call Our Office Now.

If your child has ear pain and does not have any of the warning signs, you may treat the fever at home and schedule an appointment with us today or tomorrow.

Dress your child in light clothing. Overbundling a child can cause your child to become too warm.

Continue to take your child's temperature every 2-4 hours until the fever is controlled.

Monitor your child for any of the warning signs below or other worrisome symptoms as you treat your child at home.

If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.

• For children under one year of age, give 1-2 ounces of formula, breast milk, or rehydration therapy (e.g. Pedialyte®, Rehydrate®, Infalyte®) every 30 minutes to an hour.
• Do not give children under 2 large amounts of water.
• Older children who are more severely dehydrated (see warning signs) should be given only rehydration therapy.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for pain and discomfort.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.

Do not use aspirin because of the increased risk of Reye's syndrome with certain infections.

Never add alcohol to bath water. It could trigger a hypoglycemic seizure.

For fevers above 104.0 degrees F that do not respond to treatment with acetaminophen and ibuprofen, you may try giving your child a lukewarm or tepid bath. Do not give your child a bath in cold water because this may cause him to shiver which increases his body temperature.

Warning signs - Call our office for advice if:

Your child has a stiff neck, or complains of an excessive headache, or eye pain, Call Our Office Now.

Your child is crying inconsolably, Call Our Office Now.

Your child is having difficulty breathing or swallowing, Call Our Office Now.

Your child has a petechial rash, a red or purple rash that doesn't turn pale briefly after pressing on it, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal) or urination, or sunken eyes, Call Our Office Now.

Your child is less than 6 months old and has a temperature greater than 100.4 degrees F, Call Our Office Now.

Your child is older than 6 months and has a temperature greater than 102.5 degrees F, Call Our Office Now.

Your child appears very ill, irritable, or lethargic, Call Our Office Now.

You have any questions or concerns, or are unsure whether your child's symptoms are worrisome, Call Our Office Now.

What is head injury?

Head injury is caused by trauma to the head, most often from falls, sports-related accidents, motor vehicle accidents, and shaking.

What are the symptoms of head injury?

Pain and crying are common. Crying should stop approximately 10 minutes after the injury.

Vomiting after a head injury is also common.

Home care

Head injury may safely be treated at home only if all of the following are true:

• Your child has none of the warning signs listed below.
• Your child fell less than four feet.
• The surface the child struck is relatively soft (not concrete or ceramic, for example).
• Your child behaves normally, crying at first but is consolable within a few minutes.

Continue to observe your child carefully for any of the warning signs for two days after the injury. You may have to wake your child periodically at night after an injury.

Apply a cold compress to reduce swelling to any bruised area.

Prevention

Always keep one hand on your child when she is on a high surface. Children begin to roll over around the age of 4 months.

Always make sure your children are wearing adequate head protection - bike helmets or the appropriate head gear for sports.

Always buckle up your child when in the car. Please refer to the car seats page for the lastest recommendations.

NEVER shake your child! If you feel yourself becoming angry or frustrated with your child, put her in a safe place such as a crib, with your partner, etc. and take a breather.

Warning signs - Call our office for advice if:

Your child becomes drowsy or cannot be woken from sleep, Call Our Office Now.

Your child vomits more than 2 times following a head injury, Call Our Office Now.

Your child develops blurry vision, Call Our Office Now.

Your child changes in behavior or personality, such as appearing confused or irritable, Call Our Office Now.

Your child has clear fluid draining from her ears or nose, Call Our Office Now.

Your child develops severe headaches, Call Our Office Now.

Your child has difficulty using her arms or legs, Call Our Office Now.

Your child develops slurred speech or difficulty talking, Call Our Office Now.

Your child develops seizures, Call Our Office Now.

Your child fell on a hard surface such as concrete or ceramic tile, Call Our Office Now.

Your child's eye was injured in the head injury, Call Our Office Now.

You think your child might require stitches for a cut on the skin, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What are head lice?

Head lice are sesame seed-sized insects that live in human hair.

Lice are relatively common and can be spread when children are in close contact or share combs, hats, etc.

Having lice is no indication of a child's personal cleanliness.

What are the symptoms of head lice?

Your child may have nits (eggs the louse lays) firmly attached to the base of her hair. Developing nits are similar in color to the color of your child's hair. Hatched eggs dry, turn white and are easier to see.

You may want to try looking for nits on hairs at the nape of the neck. Nits on hairs draped over skin are easier to spot.

Nits cannot be shaken off or easily brushed away.

Lice move quickly and are difficult to see.

Home care

Your child may need to be evaluated in our office. Please call our office today for an appointment.

We may prescribe anti-lice shampoo:

• Pour approximately 1/2 ounce of the shampoo into your child's hair, add water, and work up a lather all the way down to the scalp.
• Scrub for 10 minutes and rinse your child's hair well to remove all of the shampoo.
• Depending on the shampoo, you may have to repeat the treatment in 7 days.

Vacuum the floors, especially in your child's room.

Soak all combs and brushes in diluted anti-lice shampoo

Wash all sheets, blankets, and pillowcases in hot water.

Store all items that cannot be washed in plastic bags for three weeks to kill all of the nits.

Check all other household members for lice by inspecting their scalps. Look for lice, nits, rashes, sores, or itching. If family members have any of these symptoms, they should be evaluated.

It is usually necessary to use a fine-tooth comb to remove eggs and lice manually, especially since some schools will not allow a child to return until all of the nits are gone, even if they are killed by the anti-lice product.

Notify your child's school or child care provider.

Prevent future episodes of lice by encouraging your child not to share combs, brushes, and hats with other children.

Warning signs - Call our office for advice if:

Your child's sores start to spread or turn red and get swollen, Call Our Office Now.

Your child's rash has not cleared up one week after treatment, call our office for an appointment.

Your child gets new eggs in her hair, call our office for an appointment.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is otitis media?

In young children, the tube that connects the middle ear to the back of the throat is small, and often becomes clogged with fluid from the nose and throat. If some of the fluid gets trapped behind the eardrum, it can become infected.

What are the symptoms of otitis media?

• Fever, runny nose, coughing and sneezing
• Your child may pull, rub or scratch his ear.
• Irritability
• Decreased appetite
• Difficulty hearing
• Drainage from the infected ear
• This usually indicates the eardrum has developed a hole.
• The hole should heal quickly once the infection is treated.

Home care

Your child should be evaluated in our office. Please call our office today for an appointment.

We may prescribe antibiotics. It is important to give the medicine on time and in the correct amount until all the medicine is gone, even if your child is feeling better.

If your child does not take all of the medicine the infection may return and be harder to treat.

Antibiotics occasionally can cause diarrhea. Do not stop the antibiotic before calling our office.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for pain and discomfort. Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Do not use aspirin because of the increased risk of Reye's Syndrome with certain infections.

It may take five to six days of treatment for your child to show improvement.

Your child should have his ear rechecked after 2-3 weeks because persistent fluid behind the eardrum can reduce hearing.

Plane travel can be painful during or after a bout of otitis media. Teach your child how to swallow during landings or try feeding formula or peanut butter for children older than one year, who are not allergic to peanut butter, during landings.

Do not prop up a bottle or send your child to bed with a bottle because this can lead to more frequent ear infections, too much weight gain, and cavities.

Warning signs - Call our office for advice if:

Your child vomits after taking the medicine, Call Our Office Now.

Your child still has a fever after three days of taking the medicine, Call Our Office Now.

Your child does not improve after three days of medication, call our office for an appointment.

Your child develops a drainage from the ear, call our office for an appointment.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is a temperature?

Temperature is a measurement of how hot the inside of the body is. Normal body temperature is 98.6 degrees F or 37 degrees C. Your child's temperature may be higher when she is sick.

Accurately determining your child's temperature is important in managing her illness.

The best way to tell whether your child has a fever is to take her temperature with a thermometer.

Touching your child's skin or forehead may not tell you whether she has a fever because her skin can be cool to the touch even though the inside of her body is very warm.

How should I take my child's temperature?

By rectum (age 4 and under)

The most reliable way to get an accurate reading on your baby's temperature is to take it rectally with a digital thermometer.

• Shake the thermometer so that the mercury (silver line) is below the numbers.
• Lubricate the silver tip of the thermometer with Vaseline®.
• Lay your child on her stomach and spread the buttocks so that the rectum is visible. Alternatively, you can lay your child on her back and lift up her legs by the ankles so the rectum is visible.
• Insert the thermometer into the rectum about 1/2 - 1 inches with a slight downward direction.
• Hold the thermometer in place for 2 minutes.
• Remove the thermometer and wipe off the lubricant. Read the degree of the temperature exactly where the mercury (silver line) stops.
• Temperature above 100.4 degrees F or 38 degrees C is a fever.
• It is easy to confuse 100.4 degrees and 104.0 degrees. Visit our refresher on how to read a thermometer.

By mouth (age 4 and over)

• Make sure your child has not eaten or drunk anything for several minutes before you take her temperature.
• Shake the thermometer so that the mercury (silver line) is below the numbers.
• Place the silver tip of the thermometer under your child's tongue.
• Have your child close her lips around the thermometer. Be careful that she does not bite down on the thermometer.
• Keep the thermometer under your child's tongue for 2-3 minutes.
• Remove the thermometer and read the degree of temperature exactly where the mercury (silver line) stops.
• A temperature of 100.4 degrees F or 38 degrees C is considered a fever.
• It is easy to confuse 100.4 degrees and 104.0 degrees. Please refer to the how to read a thermometer page.

If your child has a fever, use a fever-reducing medication. Take your child's temperature every 2-4 hours until the fever is controlled.

Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for fever, pain, and discomfort. Avoid ibuprofen, however, if your child is dehydrated or is not eating or drinking well.

Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.

Warning signs - Call our office for advice if:

Your child is less than 6 months old and has a temperature above 100.4 degrees F, Call Our Office Now.

Your child is older than 6 months and has a temperature above 102.5 degrees F, Call Our Office Now.

The thermometer breaks while taking your child's temperature, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is a urinary tract infection?

A urinary tract infection is a bacterial infection in the bladder (where the body holds urine) or kidneys.

What are the symptoms of a urinary tract infection?

• Your child may feel the need to urinate often even though only a little urine comes out.
• Your child may feel a burning sensation when she urinates.
• Blood in the urine
• Foul-smelling urine
• Abdominal pain or vomiting

Home care

Your child should be evaluated in our office. Please call our office today for an appointment.

Medications:

• If we prescribe medication, have the prescription filled right away and give the medication as directed.
• Give your child all of the medication we prescribe even if she feels better.
• Not giving all of the medicine may result in return of an infection that is harder to treat.

Pain:

• Soaking in a warm tub several times a day for 10 minutes can soothe the discomfort.
• Pour water over the private parts when urinating to soothe the burning.
• Use acetaminophen (Tylenol®, Tempra®, or Panadol®) or ibuprofen (Advil®, Motrin®) for pain and discomfort. Avoid ibuprofen if your child is dehydrated or unable to take anything by mouth.
• Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen. Do not use aspirin because of the increased risk of Reyes Syndrome] with certain infections.

Fluids:

• Give plenty of liquids.
• Fluids will help make the urine less concentrated and it will hurt less when urinating.

Prevention:

• Girls should wipe carefully from front to back after using the toilet.
• Make sure your child drinks lots of fluids.

Warning signs - Call our office for advice if:

Your child develops pain or blood in the urine after 2-3 days of taking medication, Call Our Office Now.

Your child develops a fever, please refer to the fever page.

Your child vomits the medicine, Call Our Office Now.

Your child does not urinate in a 12 hour period, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now.

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.

What is vomiting?

Vomit is a sudden and uncomfortable return of stomach contents to the mouth.

What are the causes of vomiting?

There are many causes of vomiting, some of which include viral infections, poisoning from food or chemicals, fever, irritation, and other more serious but less likely things.

Home care

If your child seems to have a mild illness and is not taking in as much by mouth, try increasing fluid intake by offering small amounts more often.

Give older children who are more severely dehydrated (see warning signs) only rehydration therapy.

Monitor your child for the warning signs below, and check your child's temperature.

Warning signs - Call our office for advice if:

You notice blood in the vomit, Call Our Office Now.

You notice a dark yellow or green color to the vomit, Call Our Office Now.

Your child refuses to drink, Call Our Office Now.

Your child has any signs of dehydration such as no tears while crying, dry lips and mouth, fewer wet diapers (around 6 per day is normal), or sunken eyes, Call Our Office Now.

Your child continues to vomit even on clear fluids or rehydration therapy, Call Our Office Now.

Your child has no energy, Call Our Office Now.

Your child has abdominal pain, Call Our Office Now.

Your child develops a fever, please refer to the fever page

You have any questions or concerns, or if you have any doubts about the severity of your child's symptoms, Call Our Office Now.