Please read the following information carefully. If you have any non-emergent questions or comments, please discuss them with your doctor during your office visit. Since these topics cover in detail the most common pediatric complaints, please look at this information prior to calling our office or the pediatrician on call. If after reading this information, you still have concerns about your child, please do call us.
We are here to serve you. After 5 p.m., our phone calls are referred to the physician on call. If you do not hear back either from the on call Triage or pediatrician within 1/2 hour, please call again. We ask you to please cancel your Caller ID by pressing *87, when you expect a call from us after office hours.
Recommendations for Treating Common Pediatric Problems
Your child has a fever if his rectal temperature is over 100.3°F (38°C) or if his oral, axillary (armpit), or tympanic (ear) temperature is over 100.0°F. If your child feels hot to your touch, we ask that you actually take his temperature by one of the above means prior to your calling us. The body's average temperature when it is measured orally is 98.6°F (37°C), but it normally fluctuates during the day. Mildly increased temperature up to 101° F can be caused by exercise, excessive clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral temperature. If you suspect such an environmental cause for increased temperature of your child, cool him down and take his temperature again in a half hour.
Fever is the body's normal response to infections, most of which are viral illnesses but some are bacterial illnesses. Teething by itself does not cause fever. Fever helps fight infections by turning on the body's immune system. The usual fevers (100.3 to 104°F, which all children get, are not harmful. They generally last for 2 to 3 days. In general, the height of the fever doesn't relate to the seriousness of the illness. How sick your child acts is what counts. Fever causes no permanent harm until it reaches 106°F. Approximately 4 % of children between the ages of 6 months to 6 years will have a brief convulsion from an episode of fever. If this occurs, do not panic. If the seizure lasts less than five minutes, call us and bring your child to the office, if open, or go to the emergency room. If the seizure continues beyond 5 minutes, call for an ambulance. Although this type of seizure is generally harmless, your child must be seen promptly by a doctor to rule out more serious conditions.
Encourage your child to drink extra fluids. Popsicles and iced drinks are helpful. Body fluids are lost during fevers because of sweating. Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child. It will cause a higher fever and can be dangerous. During the time your child feels cold or is shivering (the chills), give him a light blanket. Sponging is usually not necessary to reduce fever, but do sponge him if the fever stays over 104°F 30 minutes after your child has taken acetaminophen and/or ibuprofen, and your child is uncomfortable. Sponge him immediately in emergencies such as heatstroke, delirium, a seizure from fever, or any fever over 106°F (41.1°C). If you do sponge your child, sponge him in lukewarm water (85 to 90°F). Use slightly cooler water (not ice water) for emergencies. Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface. Cooling comes from evaporation of water. If your child shivers, raise the water temperature or stop sponging until the acetaminophen or ibuprofen takes effect. Don't expect to get the temperature down below 101°F (38.3°C). Don't add rubbing alcohol to the water; it can be breathed in and cause a coma. A child with a documented fever should not attend school until free of fever for 24 hours.
There are many acetaminophen products - Tylenol, , Liquiprin, Panadol, and Tempra to name just few. There are also many dosage forms from infant drops, to oral suspensions given by a spoon, to tablets that are chewed or swallowed. Please read package labels carefully to give the correct number of milligrams (mgs). The dropper that comes with one product should not be used with other brands or dosage forms. Give the correct dosage (see table) for your child's weight every 4 to 6 hours, but not more often. Repeated dosages of the drugs will be necessary because the fever will go up and down until the illness runs its course. If your child is sleeping, don't awaken him for fever medicines unless he is very hot.
Remember that fever is helping your child fight the infection. Use drugs only if the fever is over 101°F, and preferably only if your child is also uncomfortable. If your infant is under 12 weeks of age and has a fever not associated with immunizations, call your doctor immediately and don't give acetaminophen.
Ibuprofen is similar to acetaminophen in its ability to lower fever. Its safety record is also similar. One advantage ibuprofen has over acetaminophen is a longer lasting effect (6 to 8 hours instead of 4 to 6 hours). Children with special problems requiring a longer period of fever control may do better with ibuprofen. Give the correct dosage for your child's weight every 6 to 8 hours (see table).
If instructed by your physician to alternate both products, one method is to do it as follows: Use both if the fever is over 103°F and does not go down using only one medicine. Give a fever medicine every 3 hours (acetaminophen every 6 hours and ibuprofen every 6 hours). If high fever persists for more than 24 hours, call our office. Be careful to avoid dosage errors.
The American Academy of Pediatrics recommends that children (through age 21 years) not take aspirin if they have chickenpox or influenza (any cold, cough, or sore throat symptoms). This recommendation is based on several studies that have linked aspirin to Reye's syndrome, a severe encephalitis-like illness. We do not recommend aspirin or aspirin containing products, e.g. Alka-Seltzer, for any fever. Please read product labels.
Call Us Within 24 Hours: if your child is 3 to 6 months old and has a fever (unless the fever is due to immunizations within 24 hours), if your child is over 6 months and has a fever between 104 and 105°F (40 and 40.6°C), if your child has had a fever more than 24 hours without an obvious cause or location of infection, if your child has had a fever for more than 3 days, or if the fever went away for over 24 hours and then returned.
Causes and Expected Course
Call Us Immediately: if your child is less than 3 months old and has a fever of 100.3°F (Unless he has received immunizations within 24 hours), or if the fever is over 105°F (40.6°C), or if your child looks or acts very sick.
Vomiting is the forceful emptying ("throwing up") of a large portion of the stomach's contents through the mouth and/or nose. In contrast, spitting up is the bringing up of one or two mouthfuls of stomach contents. Spitting up is very common in babies less than 1 year old.
Most vomiting is caused by a viral infection of the stomach or by eating something that disagrees with your child. The vomiting usually stops in 6 to 24 hours. Changes in the diet usually speed recovery. Often, a child whose vomiting is caused by a virus may also have diarrhea. This can continue for several days.
Offer small amounts of clear fluids (no milk or solid foods) until 8 hours have passed without vomiting. For infants, you can use an oral electrolyte solution such as Pedialyte or Kao Lectrolyte. For a child over 1 year of age, offer flavored Pedialyte or Gatorade. For a child over 2 years, give water, caffeine-free coca-cola, lemon-lime soda, or popsicles. Stir the soda until most of the fizz is gone (the bubbles inflate the stomach and increase the chances of continued vomiting). Start with 1 teaspoon to 1 tablespoon of the clear fluid, depending on your child's age and repeat every 5 to 10 minutes. After 2 hours without vomiting, gradually increase the volume of clear fluids. If your child vomits using this treatment, rest the stomach completely for 1 hour and then start over but with smaller amounts. This one-swallow-at-a-time approach rarely fails. After 8 hours without vomiting, your child can gradually return to a bland diet. Infants can start with such foods as cereals and strained bananas. If your baby only takes formula, give 1 or 2 ounces less per feeding than usual. Older children can start with such foods as saltine crackers, white bread, rice, and mashed potatoes and soups like chicken with stars, rice or noodles. Usually your child can be back on a normal diet within 24 hours after recovery from vomiting. For breast-fed babies, the key to treatment is providing breast milk in smaller amounts than usual. If your baby vomits once, make no changes. If your baby vomits twice, continue breast-feeding but nurse on only one side for 10 minutes every 1 to 2 hours. If your baby vomits three or more times, nurse for 4 to 5 minutes every 30 to 60 minutes. You can also offer the baby an electrolyte solution between breast-feedings for a short time (6 to 24 hours). As soon as 8 hours have passed without vomiting, return to normal nursing on both sides.
A common error is to give as much clear fluid as your child wants rather than gradually increasing the amount. This almost always leads to continued vomiting. Usually a suppository for vomiting is not necessary. Diet therapy is the answer. Be aware that oral medicines can irritate the stomach and make vomiting worse. If your child has a fever over 102°F (39°C), you may use acetaminophen suppositories. Call your physician if your child is vomiting and needs to continue taking a prescription medicine.
Call Us Immediately: If your child shows any signs of dehydration (such as no urine in over 8 hours, very dry mouth, no tears when crying), if your child vomits up blood or green liquid (bile), or if your child starts acting very sick.
Call Us During Office Hours: if the vomiting continues for more than 24 hours if your child is under age 2 years, or more than 48 hours if over age 2. Do not continue to give Pedialyte alone for over 24 hours without contacting us.
Please call us if you have other concerns or questions..
Cause and Expected Course
Diarrhea is the sudden increase in the frequency and water content of bowel movements (BMs). Mild diarrhea is the passage of a few loose or mushy BMs. Severe diarrhea is the passage of many watery, sometimes green BMs. The best indicator of the severity of the diarrhea is its frequency. The main complication of diarrhea is dehydration from the loss of too much body fluid. Symptoms of dehydration are a dry mouth, the absence of tears, decreased or infrequent urination (for example, none in 8 hours). The main goal of diarrhea treatment is to prevent dehydration.
Diarrhea is usually caused by a viral infection of the intestines (gastroenteritis). Sometimes, it is caused by bacteria like Salmonella or parasites like Giardia. Occasionally, a food allergy or drinking too much fruit juice or something unusual your child ate may cause diarrhea. Diarrhea may also be caused by antibiotics. Diarrhea from an antibiotic does not mean your child is allergic to that antibiotic. Diarrhea usually lasts several days to a week, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink enough fluids to replace the fluids lost in the diarrhea. Don't expect a quick return to solid bowel movements.
Increased fluids and dietary changes are the main treatment for diarrhea. Several diets are described below. The right diet for your child depends on the severity of the diarrhea and your child's age. Go directly to the section that pertains to your child. One to two loose bowel movements can mean nothing. Don't start dietary changes until your child has had several loose bowel movements.
If your baby has mild diarrhea, continue a regular diet with a few simple changes. Give full-strength formula but give smaller quantities at more frequent intervals. You may substitute one or two formula feedings with Pedialyte. If your baby eats solid foods, offer more rice cereal, mashed potatoes, applesauce, strained bananas, and strained carrots. Avoid all fruit juices because they make diarrhea worse.
If your child has moderate to severe diarrhea and dark urine or not much urine, give Pedialyte or Kao Lectrolyte. If your child doesn't like the flavor, buy flavored Pedialyte or add a bit of KOOL-Aid powder. Give as much of the special liquid as your baby wants. Diarrhea makes children thirsty, and your job is to satisfy that thirst and prevent dehydration. Never restrict fluids when your child has diarrhea. If your baby absolutely refuses Pedialyte, you may try Gator-Ade or decaffeinated coca-cola, 7-UP, and/or sweetened decaffeinated tea. Pedialyte is superior since these other drinks do not contain enough sodium. Fruit juice can make the diarrhea worse. We do not recommend making a homemade electrolyte solution because an error can cause salt poisoning.
After being given clear fluids for 4 to 8 hours, your baby will be hungry. You may retry full-strength formula, but offer it more frequently and in smaller quantities than you normally do. You may alternate feedings of formula with Pedialyte. If the diarrhea continues to be severe, try a soy formula or Lactofree. Often there is less diarrhea with soy formulas and Lactofree than with cow's milk formulas because these formulas do not contain milk sugar (lactose). If you start soy formula, plan to keep your baby on the soy formula until the diarrhea is gone for 3 days. If your baby is over 4 months old and has started baby foods you may add rice cereal, applesauce, strained bananas, and strained carrots.
For mild diarrhea, follow a regular diet with a few simple changes. Eat more foods containing starch. Starchy foods are easily digested during diarrhea. Examples are cereal, breads, crackers, rice, noodles, mashed potatoes, bananas and broiled chicken and hard-boiled eggs. Yogurt with live active cultures is also recommended. Drink more water. Avoid all fruit juices. Drink less milk and eat less milk products (except yogurt with live active cultures) for 24 hours. Avoid beans or any other foods that cause loose bowel movements.
For moderate to severe diarrhea, give your child flavored Pedialyte, water, or for variety Gatorade, sweetened decaffeinated tea and decaffeinated soda for the first 24 hours of watery diarrhea. On day 2, offer some milk as well as the above fluids. Most times, you can keep giving your child small feedings of table foods mentioned above while he has diarrhea.
Breast fed infants with diarrhea:
Cause and Expected Course
Formula fed infants (less than 1 year old) with diarrhea:
The causes of stomachaches are numerous, but frequently, stomach pains are caused by something simple like overeating, by gas from drinking too much soda pop, or by other types of indigestion. Sometimes a stomachache signals the onset of viral gastroenteritis (stomach flu), and vomiting or diarrhea soon follow.
The most common causes of recurrent abdominal pain are stress and worry. Over 10% of children have recurrent stomachaches from stress. Common causes of stress include changing schools, moving, death or serious illness in the family, divorce and major world events. The pain occurs in the pit of the stomach or near the belly button. The pain is low grade but real. Recurrent stomachaches can have numerous causes and deserve medical attention. With harmless causes, the pain is usually better or gone in 2 hours. With gastroenteritis, the cramps may precede each bout of vomiting or diarrhea. With serious causes, the pain worsens or becomes constant.
Your child should lie down and rest until he feels better. A warm washcloth or heating pad on the abdomen for 20 minutes may speed recovery. Avoid giving your child solid foods; permit only sips of clear fluids. Keep a vomiting pan handy. Younger children are especially likely to refer to nausea as "a stomachache." Encourage sitting on the toilet and trying to pass a BM. This may relieve pain if it is due to constipation or impending diarrhea. Do not give any medications for stomach cramps unless you have talked with us. Especially avoid laxatives, enemas, and painkillers.
If your child has been evaluated by a physician and has stomachaches from worries, try to help your child worry less. Children with recurrent stomachaches tend to be sensitive, serious, conscientious, even model children. This can make them more vulnerable to the normal stresses of life, such as changing schools or moving. Help your youngster talk about events that trigger his pains and how he's going to cope with them. Make sure that your child doesn't miss any school because of stomachaches. These children have a tendency to want to stay home when the going gets rough. Teach your child to use relaxation exercises for mild pains. Have him lie down in a quiet place; take deep, slow breaths; and think about something pleasant. Your child should have a complete medical checkup before you conclude that recurrent stomachaches are due to worrying too much.
Call Us Immediately: If the pain is severe AND lasts more than 1 hour, if the pain is constant AND has lasted more than 2 hours, if the pain comes and goes (cramps) AND lasts more than 24 hours, or if the pain is in the scrotum or testicle or in the lower abdomen on the right side. Always call us if your child starts acting very sick.
Call Us During Office Hours: if this is a recurrent problem for your child or if you have other questions or concerns.
Cause and Expected Course
If your child has vomited more than twice, follow the recommended treatment for vomiting instead of this treatment for diarrhea until your child has gone 8 hours without vomiting.
Call Us Immediately: if there are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears), if more than a few specks of blood appears in the diarrhea, if the diarrhea is severe (more than 8 BMs in the last 8 hours), if the diarrhea is very watery AND your child also vomits the clear fluids three or more times. Always call us immediately if your child starts acting very sick.
Call Us During Office Hours: if mucus or pus appears in the BMs, if a fever over 100.3°F lasts more than 3 days, if diarrhea lasts more than a week.
Please call us if you have other concerns or questions.
VOMITING WITH DIARRHEA
A cold or upper respiratory infection is a viral infection of the nose and throat. Common symptoms are runny or stuffy nose, usually with fever, sore throat and cough, and sometimes hoarseness, red eyes, and swollen lymph nodes in the neck.
Colds can be confused with similar conditions, for example, vasomotor rhinitis and chemical rhinitis. With vasomotor rhinitis, patients have a profusely runny nose in the wintertime when they are breathing cold air. The nose usually stops running within 15 minutes after a person comes indoors. It requires no treatment beyond a handkerchief and has nothing to do with infection. Chemical rhinitis is a dry stuffy nose that results from using vasoconstrictor nose drops too often and too long (longer than 1 week).
Cold viruses are spread from one person to another by hand contact, coughing, and sneezing. Colds are not caused by cold air or drafts. Because there are up to 200 viruses that cause colds, most healthy children get at least six colds a year. Usually the fever lasts less than 3 days, and all nose and throat symptoms are gone in a week. A cough may last 1 to 2 weeks. Watch for signs of secondary bacterial infections such as earaches, yellow drainage from the eyes, sinus pressure or pain (often indicating a sinus infection), or difficulty breathing (often a sign of pneumonia). Babies, especially those under 3 months of age, with a persistent cough frequently have bronchiolitis and/or pneumonia, please call the physician on call. If you have a young infant, make sure that the she does not get dehydrated. A blocked nose can interfere so much with the ability to suck that dehydration can occur
Not much can be done to change how long a cold lasts. However, we can relieve many of the symptoms. Most stuffy noses are blocked by dry mucus. Blowing the nose or suction alone cannot remove most dry secretions. Using saline nose drops and then suctioning or blowing out the fluid in the nose can help. Use a clean eyedropper to put drops into the nose. For the infant who cannot blow his nose, place 3 to 4 drops of saline in each nostril before each feeding. Several times a day you may use a soft rubber suction bulb to gently suck out the loosened mucus. Remember that a baby cannot breathe through the mouth and suck at the same time. If your child is breast-feeding or bottle-feeding, you must clear his nose out so he can breathe while he's sucking. It is also important to clear your baby's nose before you put him down to sleep. For the older child who can blow his nose, use 3 to 4 drops in each nostril while your child is lying on his back on a bed. Wait 1 minute for the water to soften and loosen the dried mucus. Then have your child blow his nose. This can be repeated several times for complete clearing of the nasal passages
The use of cold preparations does not change the duration of a cold, but may help the child feel more comfortable. We do not recommend using these medications in babies under 9 months of age. Avoid using multi symptom products, especially those that contain Tylenol. Use Tylenol by itself for fever or discomfort. Use cold medication for nasal symptoms and use cough medicine for cough. By using combination products, you are giving unnecessary medications. Even if your child has fever, cold and cough, these multi symptom preparations may not have the ideal amount of medication for each symptom. There is also a greater chance of side effects from these drugs. Decongestants can make your child jittery or keep him from sleeping at night. Antihistamines can make him drowsy. Cold medicines have no impact in the duration of the cold. Use acetaminophen (Tylenol) for a cold only if your child also has a fever, sore throat, or muscle aches. There are over 400 cold and cough preparations on the market. In general, the over the counter preparations contain the same ingredients as prescription preparations, but in weaker concentrations. We strongly recommend that you limit your choices to a few preparations and that you carefully follow the directions on the label. Do not give leftover antibiotics for uncomplicated colds because they have no effect on viruses and may be harmful.
Prevention of colds:
Cause and Expected Course
The cough reflex expels air and secretions from the lungs with a sudden explosive noise. The cough can be dry and hacking or wet and productive. A coughing spasm is more than 5 minutes of continuous coughing.
Most coughs are caused by a viral infection of the trachea (windpipe) or bronchi (larger air passages in the lungs). These infections are called tracheitis and bronchitis, respectively. Most children get such a viral infection a couple of times a year as part of a cold. Keep in mind that coughing clears the lungs and protects them from pneumonia. The role of milk in thickening the secretions is doubtful.
Usually bronchitis causes a dry tickly cough that lasts 2 to 3 weeks. Sometimes the cough becomes loose (wet) for a few days, and your child coughs up a lot of phlegm (mucus). This is usually a sign that the end of the illness is near.
Cause and Expected Course
Earaches are usually caused by bacterial infections of the middle ear (the space behind the eardrum). They are usually complications of colds. The congestion caused by a cold blocks off the Eustachian tube (the passage connecting the middle ear to the back of the throat). If the Eustachian tube is blocked long enough, fluid accumulates in the middle ear and becomes infected. Your child's ear becomes painful because this trapped, infected fluid puts pressure on the eardrum, causing it to bulge. Other symptoms are irritability, poor sleep and fever.
Most children will have at least one ear infection, and over one fourth of these children will have repeated ear infections. In 5% to 10% of children, the pressure in the middle ear causes the eardrum to rupture and drain a yellow, cloudy or bloody fluid. This small hole usually heals over the next week. Children are most likely to have ear infections between the ages of 6 months and 2 years, but they continue to be a common childhood illness until the age of 8 years. If the following treatment is carried out, your child should be fine. Permanent damage to the ear or to hearing is very rare.
Give your child the antibiotic as prescribed by your doctor. This medicine will kill the bacteria that are causing the ear infection. Do not miss a dose because your child is sleeping. Plan ahead. If a prescription reads every 8 hours, and you know your child will be sleeping at a time a dose is scheduled, give the prescription as follows. Give the first dose of the day as soon as your child awakens. Give the last dose just prior to time of sleep. Give the mid day dose somewhere midway between the first and last dose. If your child goes to school or a baby sitter, arrange for someone to give the afternoon dose. If the medicine is a liquid, store the antibiotic in the refrigerator and use a measuring spoon to be sure that you give the right amount. Give the medicine until the bottle is empty or all the pills are gone. Do not save the antibiotic for the next illness because it loses its strength. Even though your child will feel better in a few days, give the antibiotic until it is completely gone or for the number of days prescribed. Finishing the medicine will keep the ear infection from flaring up again.
Acetaminophen and/or ibuprofen can be used to help with the earache or fever over 101°F (39°C) for a few days until the antibiotic takes effect. These medications usually control the pain within 1 to 2 hours. Earaches tend to hurt more at bedtime. Sometimes an anesthetic eardrop will be prescribed to help relieve the pain.
Your child can go outside and does not need to cover the ears. Swimming, but not diving, is permitted as long as there is no perforation (tear) in the eardrum or drainage from the ear. Air travel or a trip to the mountains is safe; just have your child swallow fluids, suck on a pacifier, or chew gum during descent. Your child can return to school or day care when he or she is feeling better and the fever is gone. Ear infections are not contagious.
Your physician will schedule a return appointment in 2 to 4 weeks for your child. At that visit, the eardrum will be looked at to be certain that the infection has cleared and that more treatment isn't needed. Your physician may also want to test your child's hearing. Follow-up exams are very important, particularly if the infection has caused a hole in the eardrum or if you child has a history of frequent ear infections.
Prevention of ear infections
If your child has recurrent ear infections, it's time to look at how you can prevent some of them. The following list includes ways you can help your child prevent ear infections. If some of the following items apply to your child, try to use them or talk to your physician about them. Protect your child from second-hand tobacco smoke. Passive smoking increases the frequency and severity of infections. Be sure no one smokes in your home or at day care. Reduce your child's exposure to colds during the first year of life. Most ear infections start with a cold. Try to delay the use of large day care centers during the first year by using a sitter in your home or a small home-based day care. Breast-feed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections. Avoid bottle propping. If you bottle-feed, hold your baby at a 45° angle. Feeding in the horizontal position can cause formula and other fluids to flow back into the Eustachian tube. Allowing an infant to hold his own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between 9 and 12 months of age will help stop this problem. If your toddler constantly snores or breathes through his mouth, he may have large adenoids. Large adenoids can contribute to ear infections. Talk to your physician about this.
Call Us Immediately: if your child develops a stiff neck or is more lethargic than usual during sick times or if your child acts very sick.
Call us within 24 hours: if your child complains of persistent ear pain, if the fever or pain is not gone after your child has taken the antibiotic for 48 hours, or if you have other questions or concerns.
Your child will complain that his throat hurts. Children too young to talk may have a sore throat if they refuse to eat or begin to cry during feedings. When examined with a light, the throat is red.
Cause and Expected Course
Most sore throats are caused by viruses and are part of a cold. About 10% of sore throats are caused by the streptococcal "strep" bacteria. A throat culture or rapid strep test is the only way to know whether a sore throat is caused by strep bacteria or a virus. Without treatment, a strep throat can have serious heart and kidney complications. Tonsillitis (temporary swelling and redness of the tonsils) is usually present with any throat infection, viral or bacterial. The presence of tonsillitis does not have any special additional meaning.
Children who sleep with their mouths open often wake up in the morning with a dry mouth and sore throat. It feels better within an hour of having something to drink. Use a humidifier to help prevent this problem. Children with a postnasal drip from draining sinuses often have a sore throat from clearing their throat often.
Sore throats caused by viral illnesses usually last 3 or 4 days.
Strep throat responds well to penicillin or other antibiotics. After a child has been taking medication for strep for 24 hours, he is no longer contagious. Your child can then return to day care or school if his fever is gone for 24 hours and he's feeling better.
Local pain relief
Children over age 1 can sip warm chicken broth or apple juice.. Swollen tonsils can make some foods hard to swallow. Provide your child with popsicles and a diet of soft foods for a few days if he prefers it. Give your child acetaminophen or ibuprofen for the sore throat or for a fever over 101 degrees F (39 degrees C).
Common mistakes in treating sore throat
Avoid expensive throat sprays or throat lozenges. Not only are they no more effective than hard candy, but many also contain an ingredient (benzocaine) that may cause an allergic reaction. Do not use leftover antibiotics from siblings or friends. Leftover antibiotics should be thrown out because they deteriorate faster than other drugs. Also, antibiotics only help sore throats caused by strep. They have no effect on viruses, and they can cause harm. They also may make it more difficult to find out what is wrong if your child becomes sicker.. If given antibiotics, finish the full course.
Call Us Immediately: If your child is drooling or having great difficulty swallowing, your child is having difficulty breathing, or your child is acting very sick.
Call Us During Office Hours: To make arrangements for a throat culture for any child who has had a sore throat for more than 24 hours (especially if the child also has a fever). The throat culture is not urgent, however, since treating a strep infection within 7 days of when it begins can prevent its serious complications.
We are available 24 hours a day, 7 days a week. We offer Urgent Care appointments on Saturdays
Older children (over 1 year old) with diarrhea:
Do not use boiled skim milk. This is very dangerous and can cause serious complications for babies with diarrhea because it contains too much salt. Remember that restricting fluids can cause dehydration, but giving nothing but clear fluids for more than 2 days may also cause green, watery bowel movements called "starvation stools". Extra fluids with a gradual return to a bland diet are usually all that is needed. Diarrhea is very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea. The skin near your baby's anus can become irritated by the diarrhea. Wash the area near the anus after each bowel movement and then protect it with a thick layer of petroleum jelly or other ointment. This protection is especially needed during the night and during naps. Changing the diaper quickly after bowel movements also helps. For very large watery BMs, use disposable super absorbent diapers to cut down on cleanup time. Use the diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under gentle running water in the bathtub
Bowel movements of a breast-fed infant can vary from watery to soft. They may look like mustard to cottage cheese. Bowel movements like this must be considered normal unless they contain mucus or blood or develop a bad odor. During the first 2 or 3 months of life, the breast-fed baby may normally have one BM after each feeding. However, if your baby's BMs abruptly increase in number, your baby probably has diarrhea. Other clues are poor eating, acting sick, and a fever. Remember that something in the mother's diet, for example, coffee, cola, or herbal teas, may cause a breast-fed baby to have more frequent or looser bowel movements. If your breast-fed baby has diarrhea, treatment is straightforward. Continue breast-feeding but at more frequent intervals. Don't stop breast-feeding your baby because your baby has diarrhea. For severe (watery and frequent) diarrhea, offer Pedialyte between breast-feedings for 6 to 24 hours especially if your baby is urinating less frequently than normal. If your baby is taking solids, you may try small feedings of those foods listed above. You may have to stop breast-feeding temporarily if your baby is too exhausted to nurse and needs intravenous (IV) fluids for severe diarrhea and dehydration. Pump your breasts to maintain milk flow until you can breast-feed again (usually within 12 hours).
A cold is caused by direct contact with someone who already has a cold. Frequent hand washing is the most important method of limiting the spread of colds. Over the years we are all exposed to many colds and develop some immunity to them. Complications from colds are more common in children during the first year of life. Try to avoid undue exposure of young babies, especially those less than 3 months of age, to other children or adults with colds, day care nurseries, and church nurseries. Vitamin C, unfortunately, has not been shown to prevent or shorten colds. Large doses of vitamin C (for example, 2 grams) cause diarrhea.
Call Us Immediately: If breathing becomes fast and heavy, if your baby under 3 months of age has a persistent cough, or if your child starts acting very sick.
Call us within 24 hours: if the fever lasts more than 3 days, the runny nose lasts more than 10 days, the eyes develop a yellow discharge, the cough is getting worse. Call us if you can't unblock the nose enough for your infant to drink adequate fluids or if you think your child may have an earache or sinus pain. You must get a throat culture if your child's throat becomes sore.
Warm liquids usually relax the airway and loosen up the mucus. Start with warm apple juice or warm herbal tea. (Avoid this if your child is less than 4 months old.) Do not add liquor. Cough-suppressant drugs reduce the cough reflex. However, the cough reflex helps protect the lungs. Use cough-suppressant drugs only for coughs that interfere with sleep, school attendance, or work. They also help children who have chest pain from coughing spasms. We recommend over the counter Robitussin DM or Delsym. See "the use of cold preparations" above. Follow the directions on the package label. Remember that cough medicines have no effect on the duration of the cough. Dry air tends to make coughs worse. Dry coughs can be loosened up by encouraging your child to drink a lot and by using a humidifier in your child's bedroom. Don't let anyone smoke around your coughing child. Remind the teenager who smokes that his cough may last weeks longer than it would without smoking. Milk does not need to be eliminated from the diet. Restricting it improves the cough only if your child is allergic to milk. Never stop breast-feeding because of a cough.
Call Us Immediately: if breathing becomes fast or labored or if your child starts acting very sick.
Call Us During Office Hours: If a fever (over 100.3°F, or 37.8°C) lasts more than 3 days, if the cough lasts more than 7 days, or if you have other concerns or questions.