CHILDCARE/SCHOOL AGE TOPICS

What is asthma?

Asthma is a chronic or long-standing inflammation of the airways and a tendency or habit of the airways to narrow and produce mucus in response to triggers such as tobacco smoke (even in clothing), dust mites, pollen, animal dander, cold air, exercise, dust, molds, cockroaches, strong odors, and upper respiratory infections.

What are the symptoms of asthma?

• Difficulty breathing
• "Feeling tight" in the lungs or chest
• Wheezing, which can be loud enough to be heard from across a room, but often may be heard only through a stethoscope.
• Other symptoms include cough and rapid breathing. These symptoms may be mild for some people, and very severe for others

Treatment - All treatment plans should be discussed with our office as they are individually tailored for your child.

The first step is to avoid triggers (in increasing order of severity):

• Avoid environmental triggers (smoke, pollen, dust, etc).
• Wash hands after coming into contact with animals.
• Keep stuffed animals away from the bed.
• Launder sheets every week in hot water.
• Use plastic mattress and pillow covers for severe reactions from dust mites.
• Remove carpeting from the bedroom.
• Use HEPA air filtering units.
• Change to non forced-air heating or place filters over heating ducts.

The second step is to take medications prescribed by our office. Medication is geared towards treating two different problems: the sudden narrowing of the airways and the chronic inflammation of the airways.

Bronchodilators treat airway narrowing when an asthma attack happens.

• Albuterol (Ventolin®, Proventil®)
• Ipratropium (Atrovent®)

Anti-inflammatories prevent inflammation and should be taken every day.

• Cromolyn sodium (Intal®)
• Steroids (Beclovent®, Aerobid®, etc.)

Medication delivery

• Inhaler with spacer
• Nebulizer

The third step is to make sure that all caregivers are aware of your child's asthma and know about the warning signs and medications available.

The fourth step is to follow the asthma action plan.

Use a [interlink:Peak Flow Meter Definition:peak flow meter] daily to measure your lung performance.

To determine your green, yellow, and red zones, please refer to the asthma action plan page.

If you are using cromolyn or steroids, be sure to use them EVERY DAY as directed.

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

What is choking?

When someone is choking, they are not able to speak or cough. Coughing is the natural way for people to clear their throats. Do NOT use any of the maneuvers below if your child is still coughing.

If you are concerned about your child's coughing from near-choking, call 911, your emergency number, or Call Our Office Now.

What to do if your child starts choking:

1) Children can choke if:

• Food is breathed into the windpipe.
• Food is lodged in the esophagus, compressing the windpipe from behind.

2) Do NOT stick your finger in your child's mouth because this could cause the object to lodge deeper into her throat.

3) For a child younger than one year, hold your child face and head down with her chest on your upper thigh. You can do this with your hand holding her chest. Strike your child's back between the shoulder blades with the heel of your palm three times.

4) For a child older than one year, try using the Heimlich maneuver:

• Find the bottom of your child's breast bone. It should feel like a point sticking out about 4 inches above the belly button.
• From behind your child, place one fist with the thumb-side inward between the belly button and the bottom of the breast bone. If your fist is too high, you can break ribs and injure her lungs.
• Reach around with your other hand and grip your fist.
• Thrust your fist inward and upward.
• If your child starts to cough or speak, do NOT repeat the thrust.
• If your child is still choking, repeat the thrusting maneuver a total of three times. Then call 911 or your emergency number now.

5) Even if your child stops choking it is still a good idea to have her checked by a physician. Call Our Office Now.

Prevention

Prevent your child from running with anything in her mouth. Your child should never lie down while eating.
You should not leave your baby alone with a propped up bottle.
Small food pieces that are round, hard, or difficult to chew should not be given to children. These items should never be given to children under age 5:

• Nuts
• Hard candies
• Hot dogs
• Raw carrots
• Popcorn
• Grapes
• Raisins
• Small toy parts
• Coins
• Jewelry

We recommend that you never give these items to your child:

• Rubber balloons (mylar balloons are less of a choking risk)
• Buttons
• Button batteries
• Nails
• Small coins
• Screws
• Jewelry batteries
• Safety pins

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.

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 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 eczema?

Eczema is a predisposition of the skin to become itchy and develop a red, scaly rash.

Eczema often runs in families and can be associated with allergies and asthma.

What are the symptoms of eczema?

Your child may have a dry, red rash that is itchy and scaly.

Your child's rash will usually be in bending areas of the body such as on elbows, knees, wrists, and ankles. Eczema can occur anywhere, including on the face.

Home care

The key to treating eczema is avoiding the triggers that cause your child's skin to itch.

Keep your child's skin moist.

• Dry air, especially in the winter, dries the skin.
• Use a cool-mist humidifier to keep the air moist in your child's room. Do not use a warm water humidifier because your child may be burned if the water is spilled.
• Use a moisturizer for your child's skin.
• Bathe your child with a moisturizing soap (e.g. Basis for Dry Skin®, Dove®).
• Do not use plain soap as it may dry the skin.
• After bathing, pat your child's skin with a towel. While your child's skin is still moist, cover the dry or itchy areas with cream such as hydrated petrolatum (Eucerin®). Apply large amounts and rub it in well.
• Wash your child's clothes in a perfume-free liquid detergent instead of powdered detergents (so less detergent stays on clothes) and rinse well after washing.

Have your child wear loose cotton clothes and avoid wool clothes.

Avoid extremely warm showers and baths.

Keep your child's fingernails clean and short.

Try to prevent your child from scratching (gloves or socks can be placed on her hands).

1% Hydrocortisone cream:

• Rub the cream on dry, scaly areas of skin.
• Apply immediately to any area of itchy skin.
• Use twice a day for no more than one week at a time.
• Stop using the medication, especially on the face, if the skin gets thin or develops small, streaky, red blood vessels.
• Do not use any other type of steroid cream on the face.

Diphenhydramine (Benadryl®):

• This over-the-counter medicine when taken by mouth will help stop itching.
• 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.
• It may make your child sleepy, although a few children will get hyperactive.
• Take the medication according to package instructions.

Warning signs - Call our office for advice if:

Your child's skin becomes swollen or bleeds, Call Our Office Now.

Your child has a red or purple rash that does not turn pale briefly when you press on it, 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 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 are nosebleeds?

Nosebleeds are common throughout childhood and usually happen when a child rubs or picks her nose.

Nosebleeds particularly are common when the lining inside a child's nose is dry and irritated, often as a result of allergies or trauma.

What are the symptoms of nosebleeds?

Blood dripping from the nose

Vomiting of swallowed blood

Home care

Have your child spit out any blood. Swallowed blood is very irritating to the stomach and may cause vomiting.

Clear your child's nose by gently blowing it, and squeeze the soft part of the nose for 10 minutes, measured by the clock.

Holding the hard part of the nose will not help.

Prevention

Encourage your child not to pick her nose. Distract her from picking if necessary.

Apply a small amount of Vaseline® twice a day to the middle wall just inside the nose with a cotton swab.

Try a salt water nasal spray (Ocean® mist) or warm water drops to keep the nasal lining moist.

Try a cool-mist humidifier in your child's room. Do not use a warm water humidifier as your child may be burned if the water is spilled.

Put 2-3 drops of warm water in each nostril before blowing a stuffy nose.

Do not give your child aspirin or ibuprofen because it can cause heavier bleeding.

Warning signs - Call our office for advice if:

Your child's nosebleed does not stop after 20 minutes of direct pressure, Call Our Office Now.

Your child faints or feels dizzy when standing up, Call Our Office Now.

Your child has nosebleeds daily despite preventive measures, Call Our Office Now.

Your child has easy bruising that is new along with the nosebleeds, 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 otitis media?

What is pneumonia?

Pneumonia is an infection in the lungs.

What are the symptoms of pneumonia?

• Fever
• Cough
• Difficulty breathing (respiratory distress)
• Your child may have extra mucus in the lungs and sound "junky" when breathing

Home care

Your child should be evaluated in our office. Please call our office today for an appointment, sooner if your child has any of the warning signs.

Medicine:

• Fill the prescription right away.
• If we prescribe an antibiotic, make sure your child takes it for the number of days prescribed. Give the medicine even if your child feels better.
• Not giving all the medicine may cause the infection to come back and be harder to treat.
• Sometimes antibiotics can cause diarrhea. Do not stop the antibiotic before consulting our office.

Activity:

• Rest helps to fight the infection.
• Let your child rest and have quiet times.

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.

Extra fluids will help to thin the mucus in the lungs.

Encourage your child to cough. Coughing will help open the breathing tubes.

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.

Fever:

• The antibiotic takes 2-3 days to begin taking effect. Your child may still have a fever during this time.
• Follow the package instructions to determine the appropriate dose by your child's WEIGHT or age for acetaminophen or ibuprofen.
• Call our office if the fever lasts more than 3 days after starting the medicine.

Cough suppressants and decongestants have not been shown to be effective in children under 1 year of age.

For young children who have a lot of nasal drainage, try nasal saline drops and bulb syringe suction to clear the passageway, especially before feedings and sleep.

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.

Warning signs - Call our office for advice if:

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 cannot lie flat, Call Our Office Now.

Your child cannot speak full sentences, Call Our Office Now.

Your child vomits the medicine, Call Our Office Now.

Your child has a fever after 3 days of medicine, 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 is breathing hard, Call Our Office Now.

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

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

Your child grunts at the end of each breath, 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.

All parts are toxic.

Symptoms

• Itchy rash with redness, swelling, and blisters.
• Burning the poison ivy leaves will cause the poisonous oils to go into the air which can settle on skin and be breathed in. Eating fruits causes abdominal pain and diarrhea.

Warning signs - Call our office or the poison control center if:

You think your child has eaten or been exposed to any poisonous plant, bring a piece of the plant to the phone and call the poison control center 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 ringworm?

Ringworm is a fungal infection of the skin and scalp. Although the rash is ring shaped, there are no worms in the infected skin. Ringworm occurs most commonly in children between age 2 and 10 and usually appears on their scalp or skin. Younger children and adults may also get ringworm.

Ringworm is spread by sharing combs, brushes, hats, pillows, and bath towels that have been used by infected people.

Your child also can be exposed to ringworm from close contact with an infected person, dog, or cat (usually at home or in a child care center).

What are the symptoms of ringworm?

• Circular rash that has red, raised, scaly borders
• The rash usually is clear in the center.
• The rash may be itchy.
• Your child may lose hair in the area of the rash.

Home care

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

Treatment for skin infections:

• Fill the cream prescription today or buy the appropriate over the counter antifungal cream.
• Use the cream 3 times a day on and around the rash.
• Itching should go away within one week.
• The rash is slow to heal. It may take 2-3 weeks to show signs of healing.
• Use the medication for the full length of time recommended by our office, even if the rash looks better or has gone away.
• Not using the medication for the full length of time may result in the infection returning and becoming harder to treat.

Treatment for scalp infections:

• Infection of the scalp involves the hair roots and requires a medicine by mouth (usually griseofulvin) to treat the infection.
• Give griseofulvin by mouth as directed by the pharmacist.
• Give griseofulvin with milk, ice cream, or other fatty foods to aid absorption.
• Griseofulvin is usually taken for at least 6 weeks. Sometimes it takes several months to clear the infection so it is important to continue taking the medication for the full amount of time even if the rash looks better.
• Not taking all of the medication could lead to the infection returning and becoming harder to treat.
• Topical creams do not heal ringworm of the scalp. If directed, use a special shampoo to decrease the spread of the ringworm
• Undo braids so the shampoo can reach the scalp.
• You do not have to shave your child's hair off.
• Do not expose your child's head to the sun.

Your child can return to school once he has begun using the medication.

If your child is taking griseofulvin, be sure to make a two week follow-up appointment at the office.

Some pharmacies sell creams that help with itching. Please make sure that any cream you buy does not contain steroids (hydrocortisone) as they can make the infection worse.

Prevention

Infected people and animals spread ringworm. Avoid sharing combs, towels, hats or other hair devices used by infected people.

Teach your child not to share these items.

Wash towels, combs, etc. used by the infected person in hot soapy water on a daily basis.

Treat your infected pets.

Warning signs - Call our office for advice if:

Your child develops nausea or abdominal pain while on the medication, Call Our Office Now.

Your child's scalp infection becomes redder, drains pus, or has a yellow crust, Call Our Office Now.

Your child develops a new rash after starting treatment, Call Our Office Now.

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

Your child's scalp is swollen or feels as if there is a collection of water under the skin, call our office for an appointment.

Your child's rash is not better after 3 weeks of treatment, call our office for an appointment.

Other family members get a similar rash, 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 scabies?

• Scabies is an infection of the skin caused by a small insect called a mite.
• Scabies is contagious. As a result, family members often get the infection at the same time. Your child can get scabies by coming into close personal contact with someone who is infected.

What are the symptoms of scabies?

• An itchy, red rash that may look like dry skin, bumps or blisters.
• The rash usually is between fingers and toes, in the private areas (especially at the underwear line), and under the arms.
• Sometimes the rash looks like there are curly lines under the skin.

Home care

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

We may prescribe a medicated lotion like Elimite®, Nix® or Eurax®.

Permethrin (Elimite® or Nix®) cream

• As with any medication, please follow the instructions provided by the pharmacist or our office carefully.
• Do not apply to the face.
• Apply a thin layer to cover all other skin areas from the jawline down.
• Keep medicine on for 8 hours. After 8 hours wash the areas with warm soapy water.
• Consult the information included with the medicine for more details.

Crotamiton (Eurax®) lotion

• As with any medication, please follow the instructions provided by the pharmacist or our office carefully. Do not apply to face.
• Apply a thin layer to cover all other skin areas from the jawbone down.
• Keep lotion on skin for 24 hours
• Without washing the skin, reapply lotion 24 hours after the first treatment.
• Wash off the skin 2 days after the second treatment.
• Repeat in one week.
• Consult the information included with the medicine for more details.

Itching and the rash may continue for 2-3 weeks after treatment due to the allergic nature of the rash.

• Give your child frequent cool baths.
• Apply over-the-counter hydrocortisone cream to itchy areas.

Your child can return to school after one treatment with the scabies medicine.

Wash all of your child's underwear and recently worn clothes in hot water.

We recommend treating all people in close contact with the infected person with one application of the scabies medicine since scabies is very contagious.

Wash all recently worn clothing and linens in hot water.

Put away any bedding that cannot be washed for 3 days.

Inform your child's school or childcare provider.

Warning signs - Call our office for advice if:

Your child's rash is red or purple and does not turn pale briefly after pressing on it, Call Our Office Now.

Your child's rash gets worse with the medicine, Call Our Office Now.

Your child develops a rash on the face, Call Our Office Now.

Your child has been exposed to another person with scabies, you may want to 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 sinus infection?

A sinus infection is a bacterial infection of one or more of the air spaces in the head that are a part of the nasal passages.

What are the symptoms of a sinus infection?

• Pain surrounding the eye, eyebrow, and cheekbone that lasts longer than ten days
• Green mucus discharge (snot) that lasts for more than ten days
• Runny nose
• Cough and/or bad breath that lasts longer than ten days
• Mild fever

Home care

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

e may prescribe antibiotics (prescription medicines to fight off bacteria):

• Fill the prescription right away.
• It is important to give all the medicine that we have prescribed, even if your child feels better.
• If you do not give all of the medicine, your child's illness may return and become harder to treat.

We may prescribe decongestant nasal drops or spray for children older than 1 year.

• To drain the sinuses you can use nose drops or sprays (Afrin®, Neo-Synephrine®).
• Use the drops or spray as directed for 3 days.
• Stop the drops or spray for 3 days in between treatments to prevent your child's nose from getting used to the medicine. If this happens, the medicine will no longer work and the symptoms will get worse after you stop the medication.

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 develops swelling of the face around the eyes, Call Our Office Now.

Your child's fever and pain do not go away after 2 days of medicine, call our office for an appointment.

Your child's other symptoms do not go away in 4-5 days, call our office for an appointment.

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 a sore throat?

A sore throat is an irritation of the throat that includes the back of the mouth and down the neck.

Sore throats are usually caused by a virus, bacteria, sinus drainage, or allergies.

Most sore throats are caused by a virus, but some are caused by the "strep" bacteria.

What are the symptoms of a sore throat?

• Throat pain or scratchiness
• Difficulty swallowing
• Fever
• Irritability

Home care

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

Your child may need to be treated with a prescription medicine if he or she has an infection in the throat with the "strep" bacteria.

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.

Try a salt water gargle for your child's sore throat.

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.

If your child gets a prescription:

• Fill it right away and give the medicine as directed.
• Continue giving the medicine for the prescribed number of days even if your child feels better.
• Not taking the full course of medication can cause the infection to return and become harder to treat.

Warning signs - Call our office for advice if:

Your child cannot talk, Call Our Office Now.

Your child has trouble breathing, increasing difficulty swallowing, or begins to drool, Call Our Office Now.

Your child develops a rash, Call Our Office Now.

Your child's sore throat lasts longer than a week, 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 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 a sore throat?

A sore throat is an irritation of the throat that includes the back of the mouth and down the neck.

Sore throats are usually caused by a virus, bacteria, sinus drainage, or allergies.

Most sore throats are caused by a virus, but some are caused by the "strep" bacteria.

What are the symptoms of a sore throat?

• Throat pain or scratchiness
• Difficulty swallowing
• Fever
• Irritability

Home care

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

Your child may need to be treated with a prescription medicine if he or she has an infection in the throat with the "strep" bacteria.

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.

Try a salt water gargle for your child's sore throat.

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.

If your child gets a prescription:

• Fill it right away and give the medicine as directed.
• Continue giving the medicine for the prescribed number of days even if your child feels better.
• Not taking the full course of medication can cause the infection to return and become harder to treat.

Warning signs - Call our office for advice if:

Your child cannot talk, Call Our Office Now.

Your child has trouble breathing, increasing difficulty swallowing, or begins to drool, Call Our Office Now.

Your child develops a rash, Call Our Office Now.

Your child's sore throat lasts longer than a week, 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 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 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 toilet training?

Toilet training is the process of teaching a young child control over her bladder and bowel movements, resulting in the child's ability to use the toilet.

How do I know if my child is ready for toilet training?

Most children are ready for toilet training by about two years of age, but some are ready by 18 months and some are ready at two-and-a-half years.

By age three, all children should be able to control their bladder functions. Nighttime control may take longer; up to six years old is not uncommon.

Signs that your child is ready to be toilet trained include:

• Your child should understand when she has gone and show awareness of a wet or soiled diaper.
• She should recognize your favorite terms for bodily functions. Children who are ready for potty training usually have the vocabulary to express the need for a bowel movement or urination.
• Your child may go off by herself for privacy when filling her diaper.
• Your child may show independence by feeding herself and undressing.
• Your child can sit still for five minutes without help.

Tips on toilet training

DO's:

• Encourage your child to watch parents or siblings use the bathroom.
• Assist your child in undressing and sitting.
• Start having your child sit on the toilet when she starts giving signs that she might need to go.
• Another good time to have your child sit on the toilet is fifteen or twenty minutes after a meal.
• When your child begins to use the adult toilet, it is unlikely that his feet will touch the ground. It is difficult for the child to initiate a bowel movement with the feet dangling in the air. Therefore, place a step-stool in front of the toilet to allow your child to push down on the stool during a bowel movement.
• Put a potty chair right next to the toilet in the bathroom. It is less threatening than a regular toilet for young children. Limit your child to five minutes on the toilet, even if she is just sitting there.
• Give your child lots of verbal praise and rewards. Stickers and 'big girl' or 'big boy' underpants are good rewards for using the potty chair.
• Take your child into the bathroom for diaper changes. With a soiled diaper, place the stool in the toilet to demonstrate the appropriate outcome.
• Children should be taught to wipe properly, flush, and wash their hands as part of the toilet training routine.

DON'Ts:

• After your child has been training for a while, she may be sad and distressed if she goes in her training pants. Do not criticize your child. Try to lift her spirits with encouragement.
• A common cause of resistance to potty training is too much scolding and lecturing. It is best to avoid a power struggle because your child will always win; she ultimately has control over when she empties her bowels and bladder. If your child resists training, stop your efforts and try again in a month or two.

Buying the potty chair.

• Take your child with you to the store when you buy it and let her pick it out.
• Your child should feel that this is her own special chair; let her customize it with stickers and designs.
• Leave the chair out in the area where you child usually plays so she can get used to it. This usually takes about two weeks. After your child is used to the chair move it into the bathroom, next to the toilet.

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.

What is an asthma action plan?

An asthma action plan is a set of guidelines for children who are old enough to use a peak flow meter to help you manage your asthma and keep you as healthy as possible.

An asthma action plan can prevent attacks by helping recognize the early signs of an asthma attack and to use your medications properly.

Asthma attacks occur when the lungs become inflamed, causing plugging and narrowing of your breathing tubes.

This narrowing is what makes it hard to breathe during an attack.

If you don't have a peak flow meter or are unable to use one, it is important to recognize the symptoms of an early asthma attack.

Pay attention to the symptoms that come before severe difficulty breathing such as an annoying cough, allergy symptoms, cold symptoms etc.

It is important to remember that no two people with asthma are alike; the plan below is only a general guideline. If you have questions about the best way to control your asthma, please call our office for an appointment.

How do I begin using an asthma action plan?

To begin using an asthma action plan, you must first establish a personal best, or measurement of how your lungs perform when you are healthy.

When you experience symptoms, you will be able to determine their severity compared to your baseline.

To establish your personal best, follow the instructions below on using a peak flow meter:

• The peak flow meter measures how much air you can blow out of your lungs as fast as you can.
• Take peak flow readings once or twice a day for a week when you are feeling healthy.
• You may want to print out a table to help you record the peak flow readings.
• Please refer to the asthma table page.

It is a good idea to use the peak flow meter each morning to see how your lungs are doing.

Always check a peak flow reading at the earliest sign of difficulty breathing such as an annoying cough as this is the easiest time to head off an asthma attack.

What role do my medications play in managing my asthma?

Some asthma medications must be taken EVERY DAY to be effective, even when you are feeling well.

These medications act by toning down the inflammation in your lungs and include steroids (Aerobid®, Azmacort®, Beclovent®, Flovent® etc.) and cromolyn (Intal®).

Other medications should be used when you have difficulty breathing or before exercise if exercise is a trigger.

• A common medication of this type is albuterol (Ventolin® or Proventil®).

Once you know your baseline lung performance, you can use your peak flow meter to determine the degree of your symptoms.

• Then you can use this information to decide how often you should use your nebulizer or inhaler.
• Once you know your baseline, a peak flow reading can tell you that your airways are narrowing even before you experience difficulty breathing.

How do I use a peak flow meter?

A peak flow meter measures how much air you can blow out of your lungs as fast as possible. Use these steps to take a peak flow reading:

• Step 1. Move the arrow to the bottom of the meter (at zero).
• Step 2. Stand up straight and take a deep breath.
• Step 3. Put the meter in your mouth, closing your lips tightly around the opening. Make sure that your tongue is not blocking the opening.
• Step 4. Blow out as much air as you can, as quickly as you can. Don't try to keep blowing for a long time - try to get it all out as fast as possible.
• Step 5. When you are done, write down the number you get from the meter.
• Step 6. Repeat Steps 1-5 twice to get two more peak flow readings. Use the highest number as your reading.

What does my peak flow reading mean?

Compare your peak flow reading to your baseline (normal) reading. Follow the management instructions below under the appropriate zone for your reading.

To calculate your zone, follow these steps:

• 1. Using a calculator, enter your baseline peak flow reading (for example, 560).
• 2. To find 80% of your baseline, multiply your peak number by 0.80 (for example, 560 x 0.80 = 448). If your reading is between this number and your baseline, you are in the GREEN ZONE (for example, a reading of 500).
• 3. To find 60% of your baseline, multiply your peak number by 0.60 (for example, 560 x 0.60 = 336). If your reading is between this number and your 80% value, you are in the YELLOW ZONE (for example, a reading of 350).
• 4. If your number is less than the 60% value, you are in the RED ZONE (for example, a reading of 220).

We suggest calculating and recording these ranges when you determine your baseline, so that you will not have to calculate them when you are having an attack.

You can adjust the colored arrows on your peak flow meter to show you where the zones are.

The next time you come to our office for an appointment, please bring your ranges with you so we can see how you are doing.

If you are confused or are having difficulty calculating your zones, call our office to speak with a nurse.

GREEN ZONE (between 80-100% of your baseline)

Great! Your lungs are doing fine. Use your daily medications normally as directed by our office. If you continue to have any difficulty breathing, check your peak flow again. If you have any questions or concerns, or if you have any doubts about the severity of your symptoms, Call Our Office Now.

YELLOW ZONE (between 60-80% of your baseline)

Caution--You are probably experiencing some symptoms such as coughing or mild wheezing. If you are having difficulty breathing or feel like you need to use your albuterol nebulizer or inhaler, try the following:

• 1. Take two puffs of your albuterol (Ventolin®, Proventil®) inhaler as often as every 15 minutes during the first hour, and then every four hours after that.
• 2. Recheck your peak flow before each dose of albuterol.
• 3. If your peak flow returns to the green zone, great! Recheck your peak flow reading at the first sign of trouble.
• 4. If your peak flow has not improved or has gotten worse after the first hour, Call Our Office Now.
• 5. If you are taking a daily medicine such as inhaled steroids take twice as many puffs as usual (for example, four puffs instead of two) for the next two days.
• 6. If you need to use your inhaler more often than every four hours after the first hour, or if you have any questions or concerns, or if you have any doubts about the severity of your symptoms, Call Our Office Now.

RED ZONE (below 60% of your baseline)

Danger! Your peak flow is very low, indicating a severe asthma attack. Try the following:

• 1. Take two or three puffs of your albuterol inhaler.
• 2. After 5 minutes, recheck your peak flow.
• 3. If you are still in the red zone, take two more puffs and Call Our Office Now.
• 4. If you are in the yellow zone, take two puffs and follow the yellow zone instructions.

IF YOU CANNOT REACH US AT THE OFFICE, GO DIRECTLY TO THE EMERGENCY ROOM AT THE NEAREST HOSPITAL!

Rehydration Therapy Definition

There are three phases of rehydration therapy. The first phase, called the rehydration phase, is used to replace the salt and water loss the child has sustained from the beginning of the illness until the diagnosis of dehydration. This phase usually lasts one to six hours. The second phase, called the maintenance phase, lasts 12 to 18 hours with the goal to replace the ongoing loss of salt and water from the child's body as a consequence of diarrhea with or without vomiting. The final phase, called the reintroduction of food phase, continues until the child is fully recovered. The fluids used for rehydration therapy are made specifically to replace salt and water loss as a consequence of dehydration. They are made from sugar, salt and water mixed in the proper proportions to allow the body to absorb. Rehydration therapy fluids (e.g. Pedialyte®, Rehydrate®, Infalyte®) are usually readily available in grocery stores and pharmacies. You should not attempt to mix up a salt solution at home or give your child under 2 years of age large amounts of plain water.

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

• 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.

If you have any questions about your child's fever, please consult our fever page.

If your child is under 6 months of age with a temperature greater than 100.4 degrees and you have not consulted someone in our office, call our office now.

The best way to determine the proper dose of acetaminophen is by weight, especially if your child is under two years of age.

Be aware when you give your child acetaminophen (Tylenol®, Tempra®, Panadol®) because different formulations have different strengths. For example, the infant drops formulation is roughly three times stronger than the children's elixir. Read the box carefully and dose the medication by milligrams (mg).

You may give your child acetaminophen as often as every 4 hours, but no more than 5 times in one 24 hour period.

To use the following chart:

• First, find your child's weight in the far left corner.
• Then, find the column containing the formulation of acetaminophen you are using - infant drops, children's elixir, children's tablets, adult tablets
• The appropriate dose is the cross point of the row and column you are using.
• For example, a child weighing 27 pounds would need a dose of 1.6 ml of the infant drops or 2 children's tablets.
• If you do not know your child's weight and he is not unusually heavy or light for his age, you may use age instead of weight.
• If you are confused, or are not sure how to convert milligrams to the proper dosage in milliliters, teaspoons, or tablets, call our office now.

If you have any questions about your child's fever, please consult our fever page.

If your child is under 6 months of age with a temperature greater than 100.4 degrees F and you have not consulted someone in our office, Call Our Office Now.

Ibuprofen should not be given to any child under 6 months of age, any child who is dehydrated, or any child who is unable to take anything by mouth.

You may prefer giving acetaminophen (Tylenol®, Tempra®, Panadol®) first because it has been used for a long time and has been shown to be safe for both infants and children.

Ibuprofen is a relatively new medication for children and has been shown to be safe for children in clinical trials.

Check the product dosing carefully when you give your child ibuprofen (Advil®, Motrin®) because different formulations have different strengths. Drops, Liquids, and the Junior Strength Chewables contain different concentrations (milligrams or mg) of medication.

Read the manufacturer instructions carefully and know the concentration of the of the ibuprofen brand you are using.

If you are confused about how much ibuprofen to give your child, try using acetaminophen instead or Call Our Office Now for advice.

You may give your child ibuprofen as often as every 6 hours, and no more than 4 times in one 24 hour period.

What is candida?

Candida is a type of yeast that causes skin infections, usually in the diaper area or the mouth, see Thrush

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.

What are the symptoms of candida diaper rash?

Red, raw rash in the diaper area that starts in the skin folds.

Small, red, pencil-point dots outside the main area of rash.

Your child may be quite irritable when you change the diaper or wipe her bottom.

Home care

To treat a candida rash effectively, you will need an anti-fungal cream. Many of these are now over-the-counter. Call our office for advice. Your child may need an appointment.

Apply the prescription medicine to the diaper area three times a day for ten days.

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. Diaper rash itself should not be a cause of fever.

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 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.