Common
Concerns

Runny Nose

Allergies are common in children ? in fact, allergic disorders rank first among children?s chronic diseases. Any child may become allergic, but children from families with a history of allergy are more likely to be allergic. Allergies can show up in different ways in children. Symptoms may be as minor as sneezing and itching or they can be more severe such as skin rashes, asthma or hay fever. The causes of allergies are not well understood. Children get allergies from coming into contact with allergens. Some of the more common allergens are:

• Pollens
• Molds
• House dust mites
• Animal dander and saliva
• Chemicals used in industry
• Some foods and medicines
• Venom from insect stings

Allergies vs Cold Symptoms

Allergies usually appear for longer periods of time and include:

• An itchy, runny nose with thin, clear nasal discharge and/or a stuffy nose
• Itchy, watery eyes
• Repeated attacks of sneezing and itching of nose, eyes, or skin that last for weeks or months
• No fever
• Often seasonal (spring, summer, fall before frost)

On the other hand, cold symptoms usually last for a shorter period of time. Cold symptoms include:

• Stuffy nose
• Nasal discharge that is usually clear initially but can turn colored and thick
• A duration of 3 to 10 days, with or without fever
• Occasional sneezing
• Absence of itching

There are many good medicines to treat allergies and asthma. Some, like antihistamines, are available over-the-counter. They may help relieve many of the symptoms of hay fever and eczema, especially itchy, sneezing, and runny nose. Other kinds of medications must be prescribed.

No matter what treatment you use, you can help your child live a happy, healthy life by working closely with your doctor to prevent problems, avoiding triggers and providing appropriate medications.

Caring For Your Newborn

Your newborn?s first few weeks will be some of the most amazing weeks of your life. This precious life is now in your hands, ready to be cared for, nurtured and loved. On one hand it is simple: love me, feed me, and keep me clean. On the other hand it is complex because newborns can be mysterious. This pamphlet offers the answers to several common questions about newborns. In addition you might consider adding a book or two to your library. The American Academy of Pediatrics has a good one called Caring for Your Baby and Young Child: Birth to Age 5. Please also call our office to talk to our experienced nursing staff if you have concerns.

Sleeping

Sleep patterns can vary quite a bit and still be normal. Some babies like to take frequent short naps and feed often. Others sleep longer and eat less often. Many newborns are born with their days and nights mixed up and seem to sleep all day and stay awake all night. To help them sleep at night you should keep interactions to a minimum and keep the lights dim. In the day you can try to wake the baby if he or she has been sleeping longer than four hours. Almost all infants should sleep on their backs in their own crib or bassinet to reduce the risk of Sudden Infant Death Syndrome. Exceptions to this should be discussed with your baby?s doctor. To help strengthen your baby?s neck you should give him / her ?tummy time? for five minutes, four times a day while awake. With time your baby?s sleep patterns will regulate themselves. To help alleviate your own sleep deprivation you should try to get as much help as possible so that you can sleep when your baby sleeps. We do not expect babies to sleep through the night before four months of age.

Eating

Newborns should be fed when they act hungry. Signs of hunger include crying, rooting, sucking, and fussiness. Usually a newborn fed on demand will eat 8-12 times in 24 hours, about every 2-3 hours. Some newborns will eat hourly for several hours in a row and then sleep for a longer stretch. Research shows that a baby will grow and gain weight better if she / he is fed on demand rather than on a schedule. Putting your baby on a strict feeding schedule this early puts your baby at risk for dehydration or poor weight gain and will not help your baby sleep through the night.

If your newborn seems to be constantly snacking and the falling asleep for a short nap you should make some effort to keep the baby awake for a longer feeding. You could undress the baby, tickle the toes and neck, rub the back, and change the diaper. It is difficult to over feed a newborn. However, some infants have a strong need to suck and may need to try a pacifier if they are feeding to often. If the pacifier does not satisfy them then they are probably truly hungry.

Breastfeeding

Research shows many benefits to breastfeeding your baby. Even if you can do this for only a short period of time it will still be good for your baby. There are many resources available to help you nourish your baby with your breast milk. Many medications (including some antidepressants) that could not be taken during pregnancy are compatible with breastfeeding. If it is possible for you to nurse your baby we encourage you to consider it. We have plenty of personal and professional experience with breastfeeding and we will help you if we can. We also recommend the Bronson Breastfeeding Center. We do understand that breastfeeding is not possible or best for all families. We will support every family in their personal decision.

Behavior

Crying is a normal part of newborn behavior. Young infants cry 1-4 hours a day. Crying peaks at about 4-6 weeks, and then averages three hours a day. It may be a way to tell you something, such as the baby is cold, wet, hungry, lonely or uncomfortable. It may be due to being tired or over stimulated, or a way to release energy. Check the diaper, the clothing, the position. Check to see if the baby is too warm or too cold. Try feeding, holding, bundling or rocking the baby. Try a bath, music, a walk outdoors or a car ride. If the baby seems sick, then contact our office. Find someone to help you if you need a break from a fussy baby. If you find yourself becoming too stressed then put the baby down in a safe place and take a break. It won?t hurt your baby to occasionally cry for five or ten minutes while safely supervised in his or her crib.

Sneezing is very common. It does not mean that there are allergies or a cold. Sneezing is a normal newborn behavior that helps your baby clear out his or her nose. It will probably continue for several weeks.

Hiccups occur frequently. You may have even noticed them before birth. Because of an immature nervous system your baby?s vagus nerve is irritated easily by a full stomach. This nerve controls the diaphragm and causes hiccups. Usually hiccups do not disturb the baby much. If they seem annoying you can offer a few sucks at the breast or bottle, hold the baby in an upright position, or burp the baby.

Stuffy noses are universal. The nasal passages are small, and tiny amounts of dried secretions can cause stuffiness. If the stuffiness is not bothering your baby then you do not need to do anything to correct this condition. Your baby will outgrow it as the nose gets bigger. If the stuffiness is clearly causing problems with nursing or sleeping, then you should use saline nose drops, one drop per nostril, as needed to help keep the passages clear. The drops are available without prescription at the pharmacy. They should contain no other active ingredients. You simply tilt the baby?s head back slightly and drop them into the nostrils. Your baby will act mad and snort and possibly sneeze. This will help clear the nose. The bulb syringe should only be used in the very front of the nose if you can see mucous that needs to be removed. Aggressive use of the bulb syringe will cause more swelling and more stuffiness.

Irregular breathing patterns are called periodic breathing. These are normal in newborns. The baby will seem to be panting for 5-15 seconds, then take a few sighs, then pause briefly, then go back to normal. The variability is what identifies these irregular breathing patterns as normal. It would not be normal to have panting respirations for minutes at a time.

Spitting up occurs in almost all babies - some more than others. If spitting up does not cause discomfort or poor weight gain we usually consider it to be mostly a nuisance and something that will be outgrown.

Diaper Contents

Bowel movements will initially be black and sticky, like molasses. These are called meconium stools. As milk enters the baby?s system the stools will change to a dark green, then light green, and then orange or yellow. It is normal for stools to seem mucousy, runny, or ?seedy?. Stool frequency should increase from one or two a day in the first 2-3 days to almost a stool with each feeding by a week of age. Formula fed babies usually develop fewer (2-2/day) and thicker stools. A consistency up to the thickness of peanut butter is normal.

Breastfed babies often have stools that are more runny and frequent (sometimes with every feeding) initially. They can sometimes slow to one stool per week by 4-6 weeks of age, which is also normal.
After 3-4 days your baby should be urinating at least four times a day. Initially the urine will appear dark yellow. There may be a little red or pinkish staining on the surface of the diaper at times. This is simply urate crystals that form from concentrated urine. It should disappear once the urine is more dilute.

Little girls almost always have a cloudy mucousy discharge from the vagina in the first 2-3 weeks. The baby is exposed to estrogen through the placenta in the last few weeks of the pregnancy. This estrogen causes temporary swelling of the breast (in girls and boys) and discharge from the vagina. Sometimes the discharge can be bloody. This is temporary and will resolve as the estrogen effects disappear. When cleaning a female newborn?s genitalia it is easiest to focus on simply removing any meconium or stool that has gotten into the vaginal area. The whitish material in the folds of the labia will gradually come off with baths.

Cord Care

The stump of the baby?s umbilical cord usually dries up and becomes hard and yellow before you leave the hospital. The most important part of caring for the cord is that you keep it dry. Only give sponge baths (do not immerse your baby in water) until the cord falls off. If it is oozing or seems too moist, you can wipe the base of the cord with water and then dry it off, or use rubbing alcohol to clean it. Once the cord falls off (usually 1-3 weeks) you may need to continue cleaning the base for a few more days. If there is bleeding that persists more than a day or two after the cord falls off then we should see your baby in the office.

Skin

At first your newborn may have dry, flaking, or peeling skin. This will take 3-4 weeks to improve. It is not really helped by lotion. If you would like to try cream or lotion then use an unscented one that is for sensitive skin. If there is cracking of the skin (especially the ankles) then use Vaseline on those spots. Red spots may be apparent on the eyelids and back of the head. These marks, caused by dilated blood vessels, are so common that they are known as Angel kisses and Stork bites. The ones on the face generally fade within a month or two. The ones on the head often do not completely fade, but will be covered up by hair eventually. Faint dark grayish spots may be located on the lower back or buttocks of babies with more pigment in their skin. These are called Mongolian spots and will resolve over several years. It is a good idea to note their location and remember that they are not bruises.

There are several common newborn rashes. Milia are little white bumps that are usually on the nose. They will go away on their own. Erythema toxicum is a normal and harmless rash that looks like little welts or bites. It can come and go for several weeks. Infant acne usually appears on the face at about one month of age. It is best treated only with a mild baby soap and water. It will resolve within a few months. Cradle cap is a yellowish thick scaly rash on the scalp and sometimes the forehead and eyebrows. It is treated with baby or mineral oil once or twice a week. The oil is massaged into the scalp and then a fine comb is used to loosen the scales.

Diaper rashes can occur due to frequent stools. A cream with a higher level of zinc oxide (such as Desitin, Triple Paste, or A&D ointment) will help. In addition, washing your baby?s bottom gently with soap and water as well as exposing it to fresh air several times a day helps to resolve diaper rashes.

Fingernails

Fingernails are often long and sharp in newborns. However, it is difficult to tell where the nail stops and skin begins. There are several options for managing this problem. You can initially cover your baby?s hands to keep him or her from scratching. If the nails are long enough, a very good method is to peel the tips away manually. A nail clipper can be used carefully to remove just the part of the nail that is clearly not connected to the skin. A nail file or emery board can be used to smooth any leftover sharp edges. It is sometimes easier to do one or two nails at a time while the baby is asleep.

Eyes

Initially a newborn?s eyes will be puffy. It may seem as if he or she opens one eye better than the other. This will go away in a few days after the swelling goes down. You may notice red spots next to the iris or on the white part of the eye. These are spots of blood caused by pressure on the face and eye during delivery. They are not painful and do not affect the baby?s vision. They will resolve completely within 2-3 weeks. Sometimes a newborn seems to have one eye that is watery or has a little mucousy discharge. The most common cause of this would be a partially blocked nasolacrimal duct. This duct is supposed to drain tears into the nose. Babies almost always outgrow this condition by a year of age. If there is thick yellow or green discharge from the eye, you should contact our office during regular business hours. If there is an associated fever (rectal temperature > 100.5 F) then you should call right away.

Circumcision

Circumcision is a procedure that removes the part of a male infant?s foreskin that covers the head of the penis. After circumcision the head of the penis is exposed. The procedure does have limited medical benefits; however it is mostly considered an elective and even cosmetic procedure. The decision to have your baby circumcised is personal. We are happy to discuss it with you, but we do not generally make recommendations one way or the other. The technique we use to circumcise a baby is called the Gomco. We use a local anesthetic as a nerve block during the procedure. Caring for the penis involve putting Vaseline or petroleum jelly liberally on the head of the penis after each diaper change. If the remaining foreskin tends to creep up onto the head of the penis you can gently ease it back before applying the Vaseline. The head of the penis will initially appear red and swollen. Then a sticky yellow coating will appear in splotches on the head. After about a week, the coating will be gone and you can stop using the Vaseline.

Jaundice

Jaundice is a yellow color tat can appear on a newborn?s skin a few days after birth. It is caused by bilirubin, which is part of the hemoglobin molecule within our blood cells. Newborns have more bilirubin than older children and adults, and their immature lives have difficulty breaking it down. At extremely high levels, bilirubin has sometimes been known to affect a baby?s nervous system. A screening test is done before discharge to help determine if your baby is at risk for severe jaundice. There are several effective treatments for jaundice.

Illness

A rectal temperature of 100.5 F is a fever in a newborn. We recommend taking temperatures only if your baby is acting ill (lethargic, poor feeding, vomiting, feels hot to touch, etc.). A simple digital thermometer identified as ok for rectal use is the best thermometer for a newborn. Ear thermometers do not work at this age. If your baby has a fever you should call us right away. Other signs of illness might include persistent coughing, excessive spitting up that looks like vomiting, poor color, or anything that seems abnormal to you. Call us if you are concerned. Do not use any medication for your newborn without talking to a nurse or doctor from our office.

Conclusion

We hope this guide will answer many of the common questions that come up during the first weeks of your baby?s life. We realize we cannot address every situation in a simple hand-out. If you have other questions or concerns, please contact our office during regular business hours (269-381-0118). If you believe your baby is ill, please call at any time (after hours: 269-998-0554). Congratulations! We wish you all the best.

Immediate Relief for Constipation

Constipation is the passage of infrequent, hard stools. It can cause stomachaches, abdominal cramps, irritability, poor appetite, decreased activity level, pain, and sometimes bleeding with passage of stool. Children who have recurrent problems with constipation often learn to hold the stool in because they fear the pain of having a bowel movement. The following information is targeted at infants and children who are at least four months old.

Anyone can become constipated. There may be a tendency for the colon to move more slowly than is desirable. Dietary factors are common. Illness, change in activity level, and change in daily routine can lead to constipation.

Immediate relief for constipation can be accomplished with rectal medications such as suppositories or enemas. Oral laxatives can also provide relief within 12 to 24 hours. The best medication is determined by the child?s age and symptoms. All of the medications described here are available in a pharmacy without a prescription. Medications such as suppositories, enemas, and laxatives are designed for short-term relief. They should be used infrequently. Chronic constipation is managed in a different way.

Rectal medications

A glycerin suppository is appropriate for the infant, toddler, and young child. Dip one end of the suppository into an ointment such as petroleum jelly. Then insert the suppository fully into the child?s rectum. Usually a bowel movement is produced within a few minutes. The suppository can be repeated if necessary. Suppositories should be used only occasionally to stimulate a bowel movement.

For a school age child use ? or 1 bisacodyl suppository, following the instructions above. A sodium-phosphate enema is another option. Use an adult-sized enema for children 12 and older, and a pediatric-sized enema for younger children. Instructions for use come with the enema. Suppositories and enemas are not intended for regular use.

Oral medications

Senna or sennoside tablets can be used for children who can swallow pills. Give 1?3 tablets by mouth each night for up to three nights, until the bowel is emptied. ? to 1 small square of ?chocolated laxative? is another option for school age children. The oral medications may take several days to produce results, and can sometimes cause temporary diarrhea. If your child needs more immediate relief you should consider using a rectal medication described above. The stimulant laxatives described here are meant for short-term use only.

Once the episode is resolved you should do everything you can to keep your child?s bowel movements soft and regular. Ideally your child should have 1 or 2 soft stools daily. Increasing fluids, cutting back on dairy products, and increasing fiber should help. Encourage corn, peas, dried fruits, grapes, sweet potato, baked beans, higher fiber cereal, oatmeal, and high fiber cereal bars. Fiber powder can be added to your child?s food. The number of grams of fiber per day should equal your child?s age plus five. Occasionally add fruit juice (apple, pear, prune) up to 8 oz per day. Encourage your potty-trained child to sit on the toilet after meals. Infants who are not eating solid foods may benefit from 1 teaspoon of dark corn syrup mixed with breast milk or formula once or twice a day.

If your child continues to have problems with constipation despite your efforts, please make an appointment or bring it to our attention during regular business hours.

Coughs & Colds

How to recognize the common cold (or viral upper respiratory infection)

Children with colds have runny and/or stuffy noses. They also may have a cough, a sore throat (especially when coughing, or first thing in the morning), and a fever (especially in the first 2?3 days). The nasal drainage may range in color from clear, to yellow or green.The symptoms will last 10?21 days, and usually are improving by the last 3?4 days. Children under five years commonly have 10?12 colds per calendar year. Most of these occur between October and April.

How to treat cough and cold symptoms

A virus is the germ that causes the common cold. For this reason antibiotics (which are designed to treat bacteria) will not help. Instead we recommend treating the most bothersome symptoms, providing plenty of fluids, and allowing adequate rest for the body to fight off the infection.

Cough/cold medications

We do not recommend using these medications in children under six years of age. While they are probably not extremely harmful, there is no scientific evidence that these work better than placebo (a sugar pill). In addition, they may cause side effects such as irritability and wakefulness. For these younger children and infants, we recommend nasal saline drops (available at pharmacies without a prescription, or made at home by mixing 1/4 tsp salt in 8 ounces of warm water), elevating the head for sleep, and possibly using a vaporizer in the bedroom if the nose is just stuffy and not runny. A cool mist vaporizer is safest. Taking a shower with you before bed may also help to clear out the nose. A bulb syringe should be used infrequently and cautiously so the stuffiness doesn't get worse from too vigorous cleaning.

For children over six years of age, cough and cold medications should be used conservatively in order to help the child sleep, or to deal with symptoms that are very bothersome to the child (such as a nonstop runny nose, or a constant cough). Symptoms that bother you, but don?t bother your child do not need to be treated. For example, sometimes children sound stuffy, but are sleeping and eating normally. They do not need medicine. Many children will have side effects from these medications, such as irritability, wakefulness, hyperactivity, or sleepiness.

In general, the medicine used should fit the symptom. If the nose is stuffy, use a plain decongestant (such as Sudafed). If the nose is stuffy and runny, use a decongestant plus antihistamine (such as Dimetapp, or Triaminic cold & allergy). The decongestant will help the nasal stuffiness and the antihistamine will help dry up the drainage. A dry cough might be helped by a plain cough suppressant, such as Robitussin DM or Delsym. A wet cough will respond better to a cough suppressant plus an antihistamine, such pastrami Nighttime, or Delsym plus Benadryl Allergy (an antihistamine). A croupy (barky, seal-like) cough will respond best to a vaporizer, steam from the shower, or going outdoors for 10?15 minutes to breathe cool air.

When should a child with a cold or cough be seen at the pediatrician?s office?

If your child seems to have persistent pain (in infants this may show up as extreme fussiness or poor sleep) they should come in to the office. They may have an ear infection. If the cough is associated with wheezing (a high-pitched sound made upon exhalation) or labored breathing (breathing too fast, having difficulty talking, or using the chest and abdominal muscles to breathe) we also want to see your child. You may also consider having your child evaluated if the cold symptoms are persisting beyond three weeks and either worsening or showing no sign of improvement. The color of your child?s nasal drainage should not influence your decision to bring your child to the office. It is very common for simple viruses to cause yellow or green nasal drainage. Colored drainage does not automatically mean your child has a sinus infection. A sore throat causes some to worry about ?strep throat.? Most sore throats associated with a cold are just caused by drainage or ?post-nasal drip.? These sore throats are worse in the morning and tend to improve throughout the day. They are associated with a runny, stuffy nose and a cough and have been present for most of the duration of the cold. Usually there is not much of a fever. If the sore throat is like this then your child probably does not need to be evaluated for strep throat.

Diarrhea

Diarrhea is usually part of a vomiting illness, described above. It often lingers on, sometimes for days to weeks after the vomiting is over. Diarrhea caused by a virus can be watery, runny, loose, brown, yellow, green, or orange. It often smells terrible. There is no treatment for viral diarrhea other than to let it run its course. We do not usually run tests on diarrhea that appears to be caused by a virus. This is because by the time we get the test results back, the diarrhea is mostly gone, and we don?t have a treatment for viral diarrhea anyway. We do not recommend using antidiarrheal medicines such as Kaopectate or Immodium. These tend to cause increased gas, abdominal distension, and discomfort for the child. Additionally these medicines hold the virus in the body and may end up prolonging the illness.

If there is a significant amount of blood mixed into the stool, a bacteria instead of a virus may cause this, and then we will usually run tests to detect it. If the diarrhea is not associated with ?stomach flu? then we have to look at other possible causes. Children commonly get diarrhea from an antibiotic. This is treated by diet, as described below. Toddlers often have diarrhea, and this is related to their diet. If they have too much juice or fruit they will have loose stools, the next day the diet is starchier and the stools are thicker. This type of diarrhea will resolve on its own as the child gets older.

How to handle diarrhea at home

Assuming the vomiting that often accompanies diarrhea has mostly stopped, the way to handle diarrhea is with clear fluids and bland foods. When the diarrhea is frequent, you should give your child a drink of a clear liquid after every stool (Pedialyte, dilute juice?white grape juice is good, water). If you are breastfeeding, breast milk is also ok. If your child won?t take anything but his/her bottle of formula or milk, then try it. If it makes the diarrhea worse you could dilute the bottle with water or Pedialyte for a maximum of 24 hours.

The classic diet for diarrhea is the ?BRAT? diet. This stands for bananas, rice, applesauce, and toast. Other good foods are yogurt, dry cereal, crackers, pasta, and bread. There is a food additive called ?acidophilus? that can be purchased in capsules at the pharmacy or in powder form at the health food store. This can be given three times a day to try to replenish the normal bacterial flora in the intestine. There is no strict dosing for acidophilus. You could try a teaspoon of the powder, or the contents of one capsule three times a day, either mixed in food or drink.

When to call or come in to the office because of diarrhea

If your child is dehydrated (see the vomiting section, above), or has bloody stools you should bring him/her into the office.

New Dietary Guidelines for Children

In September 2005, the American Heart Association (AHA) updated the dietary guidelines for children. The update is the result of the increasing incidence of childhood obesity over the past 20 years. The risk factors associated with obesity include heart disease, diabetes, arthritis and a number of cancers. Establishing good eating habits in children at a very young age and including healthy lifestyle practices such as regular exercise and avoiding junk food can work to lower the risks of obesity.

The AHA recommends starting healthy eating habits in infancy, with an emphasis on breastfeeding and starting adult foods with healthy vegetables.

Dietary recommendations from the AHA for youngsters over 2 years old include the following:

• 2 servings of fish weekly are recommended.
• Discretionary and essential calories are clearly distinct to account for different levels of physical activity. The discretionary caloric intake increase recommended for physical activity ranges from 100 to 150 calories to 200 to 500 calories.
• Pediatric studies confirm adult studies? conclusions that restricting saturated fat intake from 10 to 7 percent may reduce low-density lipoprotein cholesterol by as much as 16 percent.
• Total fat intake in children may be restricted to less than 30 percent daily with no adverse effects on growth, neurological development, metabolic function, and nutrient adequacy observed.
• Caloric estimates with serving sizes provided in a table are based on age group (1 year, 2-3 years, 4-8 years, 9-13 years and 14-18 years), consistent with the Dietary Guidelines for Americans 2005.
• Guidelines for 1-year-old children include 2 percent-fat milk instead of fat-free milk.

Ear Pain

Ear pain is a common complaint in children, and a common concern of parents. Toddlers and school age children will be able to describe ear pain, while infants may simply be more fussy, sleep poorly, or refuse to feed well in response to ear pain. Causes of ear pain include middle ear infection, external ear infection, trauma to the ear drum, ear canal, or external ear. Children have also been known to put small objects in their ears, which may lead to pain or rupture of the ear drum.

What to do about ear pain?

Treatment of ear pain depends on its cause. When a child complains of ear pain, initially a dose of ibuprofen or acetaminophen may help relieve their discomfort. In older children, a warm compress on the external ear may also help. Younger children and infants may get some relief from keeping them in a sitting or upright position. We do not recommend putting anything into a child?s ear canal (including Q-tips, ear drops) without our advice, especially if there is drainage coming from the ear. Most causes of ear pain can be eased temporarily by following these tips. Any child with persistent ear pain should be evaluated in our office.

What about ear infections?

Many parents worry that their child may have an ear infection when they complain of ear pain. A middle ear infection (otitis media) is an infection that is caused by a bacteria or virus in the middle ear, behind the ear drum. Frequently, this occurs following a blockage of the Eustachian tube due to a cold, sore throat or allergy, which leads to accumulation of fluid behind the ear drum. Infection of this fluid causes pressure on the ear drum, leading to ear pain. In most infants and younger children, ear infections are treated with an antibiotic. When the antibiotic begins to work on the infection, the pressure will lessen, and the pain will decrease. Because this may take some time, we recommend also using ibuprofen or acetaminophen to alleviate the pain. Current research has shown that in older children and adolescents, many ear infections will resolve without the use of an antibiotic. We will discuss whether an antibiotic is needed and which one to use after evaluating your child.

Another common cause of ear pain is an external ear infection, or ?swimmer?s ear.? This is due to a growth of bacteria in the external ear canal which leads to redness, drainage, and discomfort. It typically follows repeated episodes of swimming, thus the name- swimmer?s ear. We will usually treat this with an antibiotic drop placed directly into the ear canal.

Treat Your Body Right!

A person who weighs 150 pounds has to run for 30 minutes at 5 miles per hour to burn the calories in a small order of fast-food french fries. But a cup of strawberries provides fiber, calcium, and potassium, and supplies the energy for 5 minutes of jogging. The right foods will fuel your body for energy and supply needed nutrients. Foods high in calories and low in nutrients contribute more calories than you can use effectively.

Running and walking are great, but they should be about getting where you want to go or making your favorite dog happy, not burning off high-fat foods. Next time, think about packing a healthy lunch or order a salad with diet dressing. Invest in some good food energy to fuel an afternoon of rollerblading or beach volleyball.

Find out why so many people make time to work out

Fitness is important, but most people exercise because it?s fun. Whether you play organized sports, get together with friends for a video dance game, or join a martial arts class, when you get up and move, your mood shoots up, too.

On the other hand, high-calorie snacks are more likely to be on hand when the TV and computer are on. That?s another good reason to think about cutting your screen time and heading outdoors?maybe shooting some hoops or swimming some laps.

Do right by your body and it will do right by you!

Vitamin A (carrots, cantaloupe, and sweet potatoes) and vitamin C (bell peppers, broccoli, strawberries and oranges) will keep your skin healthy.

B vitamins (nuts, oatmeal, bananas, eggs, and soy) help convert food to energy. They also speed healing and boost your nervous system?

Vitamin D and calcium (milk, yogurt, and cottage cheese) will build strong bones for life.

Little changes go a long way; small steps add up fast. Cut out one soda a day and add one minute a day to your walk. In a month, your heart and lungs will be getting a 30-minute daily workout and you?ll have cut 4500 liquid calories. You?ll feel better, look better, and have more energy for the things you enjoy and the people you care about.

?Get it? together?partner with a few friends?

Experiment cooking or trying healthy foods, then invite 5 or 6 friends for a tasting. If dining out, choose grilled foods with a big salad. Split meals but add a fruit or vegetable. Skip the sugared drinks and grab a water.

Next time you?re thinking about settling in front of the TV with a big bag of chips, call a friend instead. Or call a few more friends and set up a dance party. There are many ways to make sure that you look and feel your best?and a lot of them, like pick-up hoops or dance parties, can take on a life of their own. Why not be the one who gets the first one started? Before you know it, you?ll have a dance party every Friday night!

• Take a walk
• Walk a dog
• Play an active video game
• Play basketball, soccer, or wall ball
• Go dancing
• Go bowling
• Go rollerblading
• Join an exercise class
• Snowboard
• Turn up the radio and dance
• Play cards
• Dig out that board game
• Take a woodworking class
• Learn to make jewelry
• Sometimes you just have to get up and go!

Fever

Fever is one of the most common reasons parents call the pediatrician. Parents want to know when they should ?panic? and often fear that the fever will cause brain damage. Be reassured that a fever is only a symptom of an illness, and it won?t harm your child. Only in unusual situations such as heat stroke or allergic reactions to general anesthesia can a fever do harm.

If you call us to report a fever you may be surprised that we are more interested in your child?s behavior and other symptoms than we are in the fever. We will tell you that there is no temperature at which you should ?panic? and that you should look at your child?s behavior after being given a fever-reducing medicine to decide if your child is seriously ill. The exception to this is the very young infant, as noted below.

Sometimes parents ask us about febrile seizures. These are generally harmless brief seizures (a period of unconsciousness usually associated with rhythmic jerking of the arms and legs) that occur in only a small percentage of children when the child begins to get a fever. These can occur with any degree of fever, not necessarily a high fever. It is impossible to predict which child will have a febrile seizure. While we will not be alarmed, we would expect most parents to contact us if they think their child had a febrile seizure.

How and when to take your child?s temperature

If your child is ill and feels hot to your touch you may want to take their temperature once or twice a day until their symptoms improve. It is not necessary to take the temperature multiple times per day, or to keep detailed records. All you are trying to do is to confirm that they have a fever (temperature is > 100.5 F) and whether it is high enough to warrant using anti-fever medications and keep them away from other children. If your infant is under two months of age and has a fever you should notify us right away. In older babies and children the fever is considered to be just a symptom of the illness, part of a bigger picture. This is discussed further in the next section.

The simplest and most reliable thermometer is an inexpensive digital thermometer. For children who cannot cooperate to hold a thermometer under their tongues (difficult before age five or six) you should take the temperature under their arm. You will need to hold the thermometer there longer than for an oral temperature (four minutes for many digital thermometers). To get a more accurate temperature for an infant or toddler you can take it rectally using a disposable probe cover over the tip of the digital thermometer. Lubricate the tip with petroleum jelly, insert it approximately ? inch into the rectum and wait for it to signal that it is done. Ear thermometers are quick and easy, but not very accurate. However, with practice they are good enough to alert you to the presence of a fever, and whether or not it is high. This may be all the information you need. They will not work for infants under six months of age because of the shape of the ear canal. Glass mercury thermometers should no longer be used because of the potential danger of mercury poisoning if the thermometer is broken.

Anti-fever medications and other treatments for fever

Aspirin is never used for fever in children because it has been linked with Reye's syndrome. Reye's syndrome is a very serious illness than can cause liver failure and death. Acetaminophen (Tylenol) may be used starting at age two months. If desired, ibuprofen (Motrin, Advil) may be used instead of acetaminophen for infants and children older than six to nine months. Ibuprofen can be a little hard on the stomach, so it should be given to children who are at least eating a little and drinking adequate amounts of fluids.

The purpose of using anti-fever medications is to make your child more comfortable. If the temperature is under 101-102 F and your child does not feel uncomfortable, let the fever run its course. It may help your child fight off a mild infection. If your child is very uncomfortable and has a high fever (103 F or higher) you may want to bathe your child in lukewarm water in addition to giving anti-fever medication to help bring the temperature down. High fevers will probably not come back down to normal even with medication and bathing. Your child will feel better even if you only bring the temperature down by one or two degrees. The fever itself won?t hurt your child.

You should not sponge bathe your child with anything other than water. Long ago, rubbing alcohol was used to sponge down feverish children. We know now that this can poison a child.

Sometimes we recommend alternating acetaminophen with ibuprofen. We will only recommend this for a maximum of 24 hours, for uncomfortable children who have fevers of 103 F or higher. The alternate medication is given in its usual dose every three to four hours. For example: Acetaminophen at 6am, ibuprofen at 9am, acetaminophen at noon, ibuprofen at 3pm, acetaminophen at 6pm, and so on.

When to call or bring your child to our office

Before two months of age an infant with a rectal temperature greater than or equal to 100.5 F needs urgent evaluation. Medications should not be used to treat fever in these young infants. Two to four month olds may need evaluation urgently, or within a day or two, depending upon other symptoms. For example, you should call us or make an appointment that day if the baby looks very ill, is vomiting repeatedly, or has a persistent cough because we will want to see the baby sooner.

If your child is four months or older you should try to look at the whole picture in deciding when to contact us. For example, if your child has a fever but still interacts with you normally, is drinking and sleeping pretty well, and feels better after a dose of acetaminophen or ibuprofen, it is probably ok to just observe and care for your child at home for a day or two. In this case you should call or come in if your child develops persistent or worrisome symptoms in addition to the fever (ear pain, sore throat, persistent cough, to name a few). If your four months or older child develops a high fever (103 F or more) you should not panic. We will still be reassured by the presence of fairly normal behavior, sleeping and drinking patterns. If your child has a fever and is very irritable, in pain, or seems very ill despite using anti-fever medicines, you should contact us. If you are still very worried about your child even after following this advice, then you should contact us.

Acetaminophen (Tylenol) dosages

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Flu Facts

About Flu

Influenza (commonly called the flu) is a contagious respiratory illness caused by influenza viruses. An estimated 10% to 20% of U.S. residents get the flu each year.

Symptoms of Flu

Symptoms of flu include fever (usually high), headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Although nausea, vomiting, and diarrhea can sometimes accompany the flu, the term ?stomach flu? is a misnomer and is sometimes used to describe gastrointestinal illnesses caused by organisms other than the flu virus.

Most people recover fully after one to two weeks, but some develop serious complications, such as pneumonia. The very old and very young are most at risk for complications as are people with chronic health problems such as asthma, diabetes, respiratory conditions, and immunologic disorders.

Contagiousness and incubation period

Virus-infected droplets coughed or sneezed into the air spread influenza. Symptoms usually appear one to four days after a person is exposed to the flu virus. People are contagious for about 24 hours before they exhibit symptoms until about seven days after that. Compared with adults, children have high infection rates and prolonged viral shedding with large amounts of infectious virus. They also come into close contact with many other children thereby increasing their risk of exposure to the influenza virus.

Prevention

The single best way to prevent the flu is to get vaccinated each fall. Because the vaccine is not foolproof, however, there are other ways to protect against the flu.

• Avoid close contact with people who are sick;
• Stay home from work, school, and errands when you are sick to avoid spreading your illness, and keep kids home from daycare when they are ill;
• Cover your mouth and nose with a tissue when coughing or sneezing;
• Wash your hands often to help protect you against germs;
• Avoid touching your eyes, nose or mouth.

The American Academy of Pediatrics recommends flu vaccine for all children 6 months of age and older, their household contacts, and out of home caregivers. Certain other children with chronic medical conditions should receive the vaccine including those with asthma, diabetes, or significant heart disease. Children less than nine years old who have not received the vaccine before require two doses, at least 1 month apart. The optimum time to be immunized against the flu is October through January for the initial dose.

Certain persons should not receive the vaccine including those who are allergic to eggs or chickens because the vaccine is produced in egg embryos. Speak with our office about the appropriateness of the flu vaccine for your child, and to receive complete vaccination information.

Treatment

Children with the flu should rest in bed to help their bodies fight the infection. Fluids are helpful to prevent dehydration and mobilize secretions in the airway. A non-aspirin medication such as acetaminophen can be taken to relieve aches and pains and to reduce fever. Do not give your child aspirin because of the risk of Reye syndrome (a neurological disorder) associated with aspirin use and influenza.

A few drugs have been approved in children for the treatment of influenza. They have side effects, however, and must be used within two days of onset of illness to be effective. In addition, they are only effective in reducing flu symptoms by about one day. Talk with your doctor about whether these drugs are indicated in your child.

Call us if your child is less than six months old and shows signs of the flu, if your child seems particularly ill, or any time you have a question about your child?s condition.

For further information on the flu, check out the following web sites:

• cdc.gov/ncidod/diseases/flu/fluinfo.htm
• kidshealth.org

Taken in part from Department of Health and Human ServicesCenters for Disease Control and Prevention Fact Sheet

Conjunctivitis (pink eye)

The conjunctiva is the thin clear membrane that covers the eyelids and eyeball. The conjunctiva is easily irritated by allergies, foreign bodies, viruses and bacteria. Allergic conjunctivitis is usually seasonal (spring and fall) and produces bilateral redness and itching. A child with a foreign body in his eye will complain of a gritty sensation and pain when he blinks. Viral conjunctivitis is usually associated with an upper respiratory infection and produces irritation and a mostly clear discharge. Bacterial conjunctivitis is a secondary infection that produces thick, pus-like drainage from one or both eyes. Unless there is severe pain or abnormal vision, pink eye is not an emergency and can be handled during regular business hours. Pink eye in the newborn is not discussed below.

Allergic and viral conjunctivitis associated with redness of the white part of the eye and clear discharge can be treated at home. Use a warm, moist cotton ball to clean the child?s eye from the inner aspect outward. Use a new cotton ball for each eye. A cool compress on the eye may make the child feel more comfortable. Viral conjunctivitis will likely last four to seven days. Allergic conjunctivitis may be ongoing during allergy season and may respond to an over the counter oral anti-histamine drug (diphenhydramine). If the itching is extremely bothersome then we should evaluate your child in our office.

If thick, pus-like drainage occurs, a bacterial infection may be responsible. Anti-bacterial eye drops are indicated in the treatment of bacterial conjunctivitis.

Viral or bacterial conjunctivitis is contagious and good hand washing, especially after touching the face, is recommended to prevent its spread. Towels used for the child should be washed in hot water. Tissues used for the child should be discarded at once.

Irritation of the conjunctiva caused by smoke, chlorine or dirt in the eyes can most often be handled at home. Gently rinse the child?s eyes with water and wash her face. If irritation persists we should examine the child for a possible retained foreign body.

When to call our office?

If your child is under two years of age and develops thick, pus-like drainage from either or both eyes, we should examine her within 24 hours. Bacterial conjunctivitis in this age group can be associated with an ear infection. For older children please call during regular business hours to discuss treatment options with our experienced nursing staff.

If your child develops a high fever, drainage from the eye, swelling and /or redness around the eye, we should examine him the same day. There may be an infection in the soft tissues surrounding the eye.

If your child complains of severe eye pain or has changes in vision you should call us immediately.

Safe and sound: Help young children get a good night?s rest

When your child was an infant, you took every precaution to make sure he/she was safe in the crib. You placed the baby on its back to sleep, avoided over bundling and tucked the blanket below the chest and under the arms to keep it away from his/her face.

Parents should continue to take precautions to ensure that toddlers and young children remain safe during nighttime hours.

Children may be ready to graduate from a crib to a toddler bed or bed by age 2, according to George J Cohen, M.D., FAAP editor-in-chief of Guide to Your Child?s Sleep. ?When the child gets tall enough to get a leg up on the top of the crib rail, it is best to switch to a bed to avoid a tumble.?

Children who can climb out of their cribs and leave their bedrooms at night also risk injury when they wander the house unsupervised. Dr. Cohen recommends putting a bell on the child?s door to awaken parents if the child tries to leave the room. ?The child needs to learn to stay there until the parent comes to get him.?

Making sure that dangerous household items are unreachable both in daytime and nighttime hours is essential, he added.

The American Academy of Pediatrics and Dr. Cohen also offer these tips to help ensure your child is safe when sleeping.

• Do not give your child a pillow until age 2. Make sure the pillow is relatively small and firm.
• Use guardrails only to keep a child from falling out of bed, not to restrain the child in the bed.
• Check labels of sleepwear before buying to determine the proper size and fit for the child. Sleepwear size 9 months to size 14 is sold as either flame-resistant or snug fitting (nonflame-resistant). Nonflame-resistant sleepwear should be snug fitting, because loose-fitting sleepwear is more likely to catch fire.
• Check sleepwear labels and fabric softener package labels before washing flame-resistant sleepwear to make sure fabric softener will not reduce flame retardancy.
• Keep cribs/beds away from windows to avoid falls.
• Keep drapery cords and electrical cords out of reach to avoid strangulation and falls.
• Place bunk beds in a corner with walls on two sides. Never let a child under age 6 years sleep in the top bunk.

Trisha Korioth ? AAP News

Sore Throat

What are the symptoms of sore throat?

When a child complains of a sore throat it is usually one of many symptoms associated with an illness. The tonsils may be enlarged and redder than normal. Children too young to talk may refuse to eat or drink or they may cry during feedings.

What are the causes of sore throat?

Most sore throats are associated with a viral infection and will last 3 to 5 days. These sore throats will be accompanied by a runny, stuffy nose and cough and are caused by drainage and postnasal drip. They are worse in the morning and tend to get better during the day. This pattern occurs particularly if your child is a mouth breather because the throat can become dry and uncomfortable during the night. Viral infections do not respond to an antibiotic.

Strep Throat

Strep throat is caused by streptococcal bacteria and is usually accompanied by a fever. In addition, children may complain of a headache or stomachache and may even vomit. If you think your child has strep throat it is not urgent, but we will need to examine them in the office within 24 to 48 hours to see if a rapid strep test is indicated. These tests are done in 5 minutes and are very accurate. Occasionally, we may need to follow up the rapid strep test with a culture sent to the hospital lab. Treatment of streptococcal infection with an antibiotic may be done within 7 days to prevent complications.

How to treat a sore throat at home

You can care for most sore throats accompanied by a cold (a viral infection) at home. It may be helpful to have the child sip warm fluids such as chicken soup, which can be very soothing and tend to loosen secretions to make the child more comfortable. Children over the age of 4 can suck on hard candy or lollipops. Throat sprays tend not to be much more effective than hard candy and have medication in them which can cause side effects. Older children may find relief with gargling with warm, dilute salt water. You can give your child acetaminophen or ibuprofen for pain relief or for a fever over 102 degrees. If your child is very congested or is a mouth breather at night, it may help to use a cool bedside humidifier.

When to call our office

You should call our office for an appointment if the sore throat lasts more than 3 to 5 days, is accompanied by high fever, or anytime you have any concern about your child. If you believe your child has strep throat (see above) we should examine them in the office within 24 to 48 hours.

In addition if the child has the following symptoms we should see them immediately:

• Is unable to swallow
• Is having difficulty breathing
• Is acting very ill

Vaccines for Adolescence

Help keep adolescents healthy and safe with immunizations

New vaccines have recently become available and are recommended for all adolescents?meningococcal and pertussis vaccines. Three other vaccines (hepatitis B, varicella, and measles-mumps-rubella) are recommended for adolescents who did not receive them as children. Immunization has the potential to protect not only the health of adolescents but their friends, families, and communities.

Administering vaccines can be easy and inexpensive when delivered as part of a preventative visit to a healthcare provider. For families with health insurance, all or most of the cost is usually covered. Lower-income families may be eligible to get the vaccines at no cost through a program called Vaccines For Children (VFC). To learn more about the VFC program, visit the website cdc.gov/vaccines/programs/vfc/index.html or contact your state VFC coordinator listed at cdc.gov/vaccines/programs/vfc/contacts.html

Vaccines and the Diseases they Prevent

Immunizations can prevent many of the diseases that pose serious threats to adolescents.

PERTUSSIS (WHOOPING COUGH)

• Highly contagious with prolonged cough. If transmitted to infants, may be life-threatening.
• Tetanus-diphtheria-acellular pertussis vaccine (Tdap) adds pertussis disease protection while maintaining tetanus and diphtheria protection.
• Adolescents 11-18 years of age should receive a single shot of Tdap. Adolescents who received tetanus-diphtheria booster (Td) should receive Tdap 5 years after they received Td.

MENINGOCOCCAL INFECTIONS

• Extremely serious disease that can rapidly progress to meningitis, pneumonia, and death
• Meningococcal conjugate vaccine (MCV4) provides protection against these infections.
• Adolescents should receive a single shot of this vaccine during their 11-12 year old check-up or when they enter high school or college.

HEPATITIS B

• Can cause different kinds of liver disease, including cancer
• Adolescents who did not receive the hepatitis B vaccine during childhood should receive the three-shot course of this vaccine.

VARICELLA (CHICKENPOX)

• Highly contagious and can be a serious and sometimes life-threatening disease
• Adolescents who have not had chickenpox or the vaccine should receive this vaccine at their 11-12 year old check-up. If anyone is uncertain about having had this disease, a blood test can determine immunity.

MEASLES, MUMPS, & RUBELLA

• Historically among the most serious vaccine-preventable diseases
• Adolescents who did not receive the two-shot course of measles-mumps-rubella vaccine (MMR) during childhood should receive this vaccine at their 11-12 year old check-up.

ADDITIONAL VACCINES

Some adolescents with specific health risks may need additional vaccines such as hepatitis A, influenza, and pneumococcal.

For more information on vaccines, visit the CDC website or Contact Center:

• cdc.gov/vaccines/index.html
• cdcinfo@cdc.gov
• 800-CDC-INFO (232-4636) in English, en espa?ol-24/7

Vomiting

Most people are familiar with the ?stomach flu? and may have even had it once or twice themselves. However, watching your child go through it is entirely different. After changing several sets of sheets in one night you will definitely be wondering what you can do to help. For this reason, vomiting is also one of our most common after-hours calls.

The most common reason children suddenly develop repeated vomiting is infection by a virus. There are many different viruses that can cause ?stomach flu.? With many of these viruses the vomiting is severe for the first 12 hours and then slows down. Infants and young children can still have a few episodes of vomiting each day for 3-7 days. Diarrhea may start right away or may develop after 24 to 48 hours. There may be a fever and your child may complain of a stomachache and refuse to eat.

Other causes of vomiting should be easily recognized and are handled differently than will be outlined in this section. For example if your child had a head injury and now has persistent vomiting, he/she should have an urgent evaluation. Sometimes children who have a cold will cough and gag on sputum, and this makes them vomit occasionally. This can usually just be observed. Infants can have regurgitation or ?spitting up.? This is usually considered a normal feature of infancy and will be outgrown. Vomiting associated with a high fever and sore throat, or lower right-sided abdominal pain may not be due to ?stomach flu? and should be evaluated.

How to handle vomiting at home

After vomiting your child?s stomach needs rest! You should wait 1-2 hours before attempting to give your child anything by mouth. If there is no more vomiting during this time you could try 1-2 tsp of clear liquids (Pedialyte?the best fluid for infants, diluted apple juice, water) every 10-15 minutes for several hours. If this stays down after two hours then double the amount of fluid you are giving (2-4 tsp every 10-15 minutes). If giving increased fluid goes well then try more volume, a Popsicle or jello. Don?t add solid food until your child has been doing well on clear liquids for 12 hours. Then try a few cheerios or crackers and wait to see what happens. If the vomiting returns at any point, then start the process over.

Many times children are thirsty after vomiting so much. They would guzzle down a full sippy cup if you gave it to them. However, their stomach is irritated and can?t handle that much. All that fluid will come right back up, making the situation even worse. By giving tiny amounts of clear liquids the stomach will be able to absorb this fluid rather than reject it, and you will be helping to prevent your child from becoming dehydrated.

Parents often are concerned that their child isn?t eating anything during this type of illness. Your child will make up for any calories or weight they have lost after the illness is over. During the vomiting illness the primary concern is keeping your child from becoming dehydrated. You will have the best chance of doing this by following the plan outlined above.

When to call or come in to the office

Watch for signs of dehydration in your child. In an infant the soft spot might appear sunken, there may be no tears, the mouth might feel sticky or somewhat dry, and the baby would be listless. In an older child watch for listlessness, sunken eyes, cool hands and feet. You might also call for advice or make an appointment to come to the office if the vomiting is just not letting up, or you are unable to start giving any fluids because of the frequency of the vomiting. In the office we will simply be talking to you and examining your child. In most cases we do not find dehydration, and we can send you home with reassurance and advice. If your child is dehydrated and there seems to be no way of rehydrating him/her at home then we will send you to the hospital so your child can be given intravenous (iv) fluids.