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The purpose of this next section is to answer some of the parents most common questions that arise when they have an ill child. It will not answer all of your questions, but it may help you to avoid having to call the doctor each time your child appears to be sick, and to know when your child does need to be seen.
Normal oral temperature is about 37 degree C (98.6 degrees F). Rectal temperature usually runs slightly higher. Normal temperature is about 37.6 degree C (98.6-100.4 degree F). Rectal temperatures should be taken in children not capable of holding the thermometer by mouth. If you take an axillary, ear or forehead temperature that is abnormal, please confirm it with a rectal temperature. Please don't add or subtract degrees from the reading on the thermometer. Just note the actual reading and how you took it.
Knowing your child's temperature may be an important factor in determining the significance of his illness. However, it is only one of the several parameters we use to evaluate the child's illness and does not necessarily correlate with the severity of his condition. For these reasons we do encourage taking of temperature prior to calling or treating, but we wish to avoid excessive anxiety based on the degree of fever.
Fever is only a symptom of an underlying infection or illness and may actually be a protective mechanism to help the body fight the illness. The fever itself is not dangerous to the extent many parents believe. Brain damage is really not a side effect of fever due to infection, regardless of duration or degree of fever. Therefore, the inability to "break" or lower a fever will not cause brain damage. However, we do recommend treatment of a very high fever because it places significant additional fluid requirements on the young child that he may not be willing to take by mouth. Also a high fever generally makes the child uncomfortable and more irritable than he would be with just the illness alone.
Febrile seizures can occur at any degree of fever and are usually triggered by a rapid change in body temperature (either up or down). By themselves, febrile seizures do not cause brain damage. However, fever may cause increased thirst, fluid loss, decreased appetite, rapid breathing and heart rate, a flushed appearance and sweating. Sometimes, when a fever suddenly breaks, a child will chill or shiver.
Fever does not need to be treated in all instances, and is treated for comfort sake. For example, a child with a temperature of 102 degree F (39 degree C) but acting well need not be treated. We suggest treating the child if the temperature is over 101 degree F (38 degree C) and showing signs of discomfort. An elevated temperature may actually be beneficial as a mechanism for the body to fight infection.
In treating a fever, first dress the child lightly and avoid bundling as this may increase the temperature. We recommend acetaminophen or ibuprofen. Ibuprofen should not be used in children less than 6 months old.
Never treat a child under 3 months of age with a fever before first discussing his symptoms with your doctor who may wish to see him. All children under 2 months old with fever over 100.4 degree F (38.0 degree C) should be examined within a few hours.
Sponge bathing may be used to help relieve the discomfort of the fever between doses of medicine. Please use only lukewarm water and not alcohol. Both cold water sponging and alcohol sponging cause shivering, which raises your body temperature, besides being very uncomfortable. Lightly rubbing the skin with a warm wet washcloth will increase the circulation to the skin and promote heat exchange, without causing shivering.
You should avoid the use of aspirin especially if your child has an influenza-like illness or chicken pox because of an associated risk of Reye's Syndrome, a rare but often fatal necrologic disease.
Dosing schedules are meant to be a guide for the average size child at various ages and weights and are designed to ensure adequate doses of medicine at appropriate intervals and guard against possible overdose. Please call if you are confused about the appropriate dose for your child. Never give more medicine or more frequent doses.
Our dosage schedules are avaiable as printable PDF files on our Patient Education by Age page.
Vomiting and diarrhea are most often caused by a virus and vomiting usually precedes diarrhea. These problems, when routine, can often be managed at home by diet restriction and encouraging fluids.
If your child vomits twice or more over a few hours time, we suggest taking him off all solids and milk, and restrict him to a clear liquid diet. Clear liquids consist of electrolyte solutions such a Pedialyte or Enfaltye, defizzed soda pop, dilute juices, popsicles, and water. Pedialyte & Enfalyte are available at grocery stores and pharmacies, and are most useful for infants under 12 months of age. Please avoid giving your child anything by mouth until it has been at least 45 minutes to 1 hour since he vomited. It is best to begin with small amounts of fluid (1/2 to 1 oz) at a time and gradually offer larger amounts as the child tolerates. You may offer the fluids every 15-20 minutes. You may reintroduce solids if the child is hungry and has retained fluids for 4-6 hours. Milk is the hardest to digest and the last food to return to the diet. For nursing infants, most babies can be nursed through the illness. However, if the breast milk is repeatedly vomited, you may try the clear liquid regimen above. For nursing infants with severe vomiting, the mother will want to pump and store her milk for later use.
For diarrhea it is usually possible to maintain the child's regular diet. If the child's stools are very frequent and watery (5-6 per day for greater than one week), the child may be temporarily taken off of milk, as the digestive enzyme that breaks down the sugar in milk may be lost temporarily. Recent studies have shown that children maintained on a fairly regular diet get better faster than children placed on clear liquids. One food that may help diarrhea is yogurt with active cultures of bacteria that help to repopulate the digestive tract with healthy bacteria. Probiotics like Lactinex granules or Cullturelle(s) may be helpful to replenish healthy bacteria in the gut.
Medication to decrease diarrhea is of questionable value and is potentially harmful in certain circumstances, especially in children under 2 years of age. Some medications are toxic or can have serious side effects. Those that affect the motility of the intestine may actually prolong the illness or worsen it. Diarrhea is usually self-limited, but should it continue longer than 7 days, or the stools look bloody, you should call your doctor. Medication for vomiting is sometimes used. Please call your doctor if you feel your child may be becoming dehydrated or is having dry heaves. Early in the course of a vomiting illness, it's probably best to rid the body of the viral infected stomach contents.
One of the major concerns with vomiting and diarrhea is preventing dehydration. Signs of dehydration include a dry mouth, crying without producing tears, sunken eyes, and no urination for 8-12 hours. In addition, the dehydrated child usually refuses to play or smile. If you feel these signs are present we should be notified. If the child has a moist mouth with saliva, cries tears and is urinating at regular intervals, he is not significantly dehydrated. Usually, the older the child, the longer it takes to become dehydrated.
Viral upper respiratory infections (colds) are inevitable! You can expect your child to have up to 6-10 colds per year with symptoms of a runny nose, mild sore throat, cough, and often fever for several days. Colds generally last anywhere from 4-14 days. In an uncomplicated cold, the child starts to improve by about 7 days. If your child is in day care, has up to 10 colds per fall-winter-spring season, and each one lasts up to 14 days, he may .normally. be sick about half the time!
Colds are caused by viruses, and nothing yet has been found to hasten the body's clearing of the cold virus. Antibiotics treat only bacterial infections and are of no use for an uncomplicated cold. If fact we are finding the overuse of antibiotics for viral illnesses to be harmful in that we are seeing side effects and creating more resistant bacteria. So we try to make the cold victim more comfortable by relieving the symptoms. A cool mist vaporizer will decrease membrane irritation and dryness, and keep secretions looser so the child may cough or sneeze them out more easily. Increasing fluid intake will also help keep secretions looser. More fluids are needed if fever is present. Remember, if the fever is less than 101-102 F and the child is not uncomfortable, there is no reason to use acetaminophen or ibuprofen.
For infants, several drops of a saline solution (1/4 tsp. of salt in 4 oz of water), or a pre-made drop like "Ocean" or "Little Noses" unmedicated, placed in each nostril and either allowed to run through or aspirated gently with a bulb syringe, will help to clear the nasal passage. Be sure to suction gently so that the nasal membranes are not further irritated to produce yet more swelling, mucous, or bleeding. Sometimes, just letting the drops run on back, thinning the secretions, and allowing the infant to swallow them is the best approach.
Coughing is the body's protective defense mechanism against the accumulation of mucous and secretions in the lungs.
There are many different cold/flu/cough preparations available over the counter. Most utilize one or more of the six basic components.
- relieves itchy, watery eyes and sneezing, and dries excessive mucous production. These include chlorpheniramine, brompheniramine and diphenhydramine.
- will inhibit the cough reflex and reduce the frequency of cough, especially a dry, irritating, unproductive cough. The most common one is dextromethorphan.
- helps reduce swelling of mucous membranes, thereby relieving congestion. These include pseudoephedrine and phenylephrine.
- helps looses mucous and facilitates the flow of mucous out of the respiratory tract. The common ones are Guaifenesin and Mucinex.
- reduces fever and discomfort. It also comes as a suppository for children who are vomiting. These are available without a prescription but you may need to ask the pharmacist as they are kept in the refrigerator.
- also reduces fever and discomfort. This is only available in oral form, and is dosed every 6 hours. Alternating this drug with acetaminophen is sometimes recommended, but not well studied. Please discuss this practice with your doctor.
The FDA now recommends not using any cold/cough preparations under 6 years of age.
A chronic cough, especially at night, may be a sign of allergies and/or asthma, and should be discussed with your doctor during office hours.
Knowing when the child's illness needs medical attention is the most important concern in managing upper respiratory illnesses at home. Elevated temperature by the time the illness should be subsiding is one important signal that a complication may be developing. Trouble breathing, deep cough and wheezing are others. Absolute indications for a doctor's attention include extreme listlessness, fussiness or stiff neck. Earache most often follows the onset of a cold and is usually the sign of a middle ear infection, which may require antibiotics to clear. Sore throat, not associated with cough or runny nose, in a child over 18 months to 2 years of age may indicate that the child has a streptococcal infection in the throat, which requires antibiotics.
We must examine any child with the above symptoms before prescribing any medications, both to more accurately know which possible complication exists, if any, and to prescribe the most effective therapy. Not all children with earache have ear infections. In this era of antibiotic resistance it is important we do not treat your child unnecessarily.
Croup is a descriptive term for what is usually a viral illness in a young child who has a barking cough (which sounds somewhat like a seal bark at the zoo.) The odd cough sound is caused by swelling and inflammation of the vocal cords and the upper trachea, or windpipe. The cough is usually worse at night, and often starts suddenly in the night, which adds to the anxiety produced for the patient and the family.
You can often relieve the cough at home by several simple measures. A cool mist vaporizer (hot water vaporizers will work equally well, but the child runs the risk of scaliding should he come in direct contact with it) directed into the child's crib is helpful. If you do not have a vaporizer, you can sit with the child in the bathroom made steamy by a hot shower for 5-10 minutes. Also taking the child into a place with cool air (outside or near an open window) may provide some relief.
If your child develops croup, look for these warning signals - rapidly increasing or labored breathing, high fever, agitation which you cannot calm, bluish-gray color, barking sound with each breath, and excessive use of the stomach muscles to breathe. Also be concerned if he must sit up to breathe, has drooling, and refuses to swallow. If your child should have any of these signs, then he may have a more serious form of infection, and you should notify us immediately.
RSV - Respiratory syncytial virus is a highly contagious illness with varied symptoms. Infants and young children are the most susceptible to the severe manifestations. The illness starts out like a cold and rapidly the infant develops wheezing and labored breathing. Often they require hospitalization for respiratory therapy and extra oxygen. There is no effective anti-viral medication once a child has the disease, but there is a preventive injectable medication for certain infants, those who are premature, have chronic lung or heart disease, or immune depression. Treatment at home consists of maintaining hydration, nasal saline drops and suctioning, and keeping the child upright.
Middle ear infection is probably the most common complication of a cold. Every young child may not be able to localize the pain of ear infection well, and of course, cannot tell you in words where he hurts. Symptoms may include fussiness, pulling or digging at the ears, or fever. Many infants vomit or have diarrhea associated with ear infections. Many mothers of children with recurrent ear infection get to know the individual symptoms their child usually shows with an ear infection. If any of the above signs or symptoms are noted, the child should be seen in the next available clinic hours. Only by directly seeing the ear drum can we be certain of an ear infection and the need for antibiotics. For the most part children with otitis (ear infection) need not be seen on an emergency basis. Antibiotics do not relieve the pain for at least 24 hours, and sometimes pain medications will be prescribed.
The antibiotic should be given for the full prescribed time, even though symptoms should lessen or resolve in 48-72 hours, to ensure that all the infection is cleared. Occasionally a child will need a longer course of the same, or a different medication. Fluid that remains in the middle ear can predispose the child to recurrent ear infections, and can interfere with the normal movement of the ear drum and consequently affect hearing. Persistent cases of acute infection (lasting 30 days despite treatment) or frequently recurring bouts of acute otitis may need referral to an ear, nose and throat specialist. Your doctor will discuss this with you if the need arises.
Allergy is the most common chronic condition in childhood. Allergic symptoms are caused by the body's overreaction to certain agents in the environment, such as pollens, dusts, molds, animals, foods and chemicals. Allergic symptoms primarily involve the respiratory tract, skin, and gastrointestinal tract.
Respiratory symptoms include persistent runny and itchy nose and eyes, sneezing, cough, itchy mouth and throat, itchy and stopped up ears, and occasionally wheezing. Skin symptoms include hives or welts, or eczema. Eczema is a scaly, dry and crusty, or sometimes weepy, itch skin condition which may be aggravated by certain clothing (wool), weather, and chemicals including soaps. Gastrointestinal symptoms may include vomiting, diarrhea and abdominal pain. These may also be due to food intolerance rather than allergy. Food allergies or intolerance may be taken care of by avoidance of the offending food. Food intolerance may be outgrown.
The child whose "cold symptoms" are persisting for several weeks or more may have some respiratory allergies and may benefit from oral medications including antihistamines and decongestants, nasal sprays, or some environmental changes you can make at home. If the symptoms are severe, and are not mostly relieved by the above interventions, we may refer the child to an allergists for possible immunotherapy, or allergy shots. Remember, allergies cannot be "cured" - but we do manage to relieve many of the symptoms and make the allergies easier to live with.
Chickenpox is a viral illness that is very contagious. The incubation period is 11 to 21 days from the day of exposure. Most children develop a runny nose and fever 10-14 days after exposure. Then within 24 hours, successive crops of rash appear. The spots begin as red bumps which rapidly develop clear fluid-filled blisters and then pustules followed by crusts. The fluid within these blisters contains the virus, and is contagious, as are the child's respiratory secretions. The rash usually starts on the trunk and scalp and then spreads to the arms and legs. New lesions continue to erupt for 3-6 days. The child is contagious until all lesions are crusted over (usually 7-10 days.) Usually chickenpox is a relatively mild illness, however it can occasionally be quite serious, usually in adults or older children.
Measures you can use to relieve your child's symptoms include baking soda or oatmeal (Aveeno) baths, cool soaks to affected skin, loose comfortable clothing, cutting fingernails short, and calamine lotion. If more relief is needed, Benadryl may be given.
The most common complication of chickenpox is bacterial skin infection of the pox lesions. If after several days of the illness, the lesions are appearing to enlarge and are becoming more red, pus-filled and painful, call the office. Also if the child appears to be getting worse; decreased activity, decreased appetite, and increased fever, then he may be getting a secondary infection, and you should call your doctor.
Impetigo is a superficial bacterial infection of the skin, characterized by painless oozing sores, commonly on the face and extremities, that progress to crusted lesions of a golden color. It is caused by staph or strep bacteria. Sometimes it will clear with meticulous cleansing of the area with soap and water followed by application of an antibiotic ointment (such as Neosporin) three times a day. Often, however, these measures fail and treatment with oral antibiotics or a prescription strength ointment (Bactroban) is required. Impetigo is contagious, so children should not return to school or daycare until they have been taking antibiotics for at least 24 hours. The antibiotic should be taken for the full 10 days to ensure that all the bacteria are eradicated.
Lice are a common hair infestation with a tiny insect affecting children and adults. It can be passed by contact with infested clothing, combs, towels, etc. Symptoms may include itching of the scalp. The lice lay eggs (or nits) on the hair shaft near the scalp. Treatment involves the use of Nix Creme Rinse or other anti-louse medications as directed to kill the lice and nits. All nits should be removed with a fine tooth comb, tweezers, or your fingers. Clothes and bedding, combs and brushes, should be washed simultaneously to prevent reinfestation. Regular shampoos and good personal hygiene do not prevent lice infestation.
Scabies is a skin infestation with a tiny mite, or insect, that is contracted from other children with the infestation. The mite burrows in the skin where it lives off of tissue fluids, mates and lays eggs. The rash associated with it can mimic other kinds of rashes and is extremely itchy. The rash looks like red bumps and is often found in the waistline area, in the web spaces between the fingers, and on the inner surface of the wrists, or other places where the clothing contacts the body more snugly. Treatment is with an insecticide lotion, usually Elimite Cream, to eradicate the insect. Also medications to help control itching are often recommended.
Scarletina is strep throat with a rash. The rash looks like fine red spots or bumps that often appear first on the neck and upper chest, and spread to involve the trunk, groin area, arm pits and sometimes the wrists, inner elbows and upper thighs. It can be itchy and may have the feel of fine sandpaper. Children with strep throat usually complain of a sore throat, fever, headache, stomach ache and often nausea and vomiting. If your child has these symptoms, please make an appointment for an office visit and a strep screen. The incubation period for strep throat is usually 2-5 days.
Insect bites of many insects produce red, raised, itchy bumps in children. Chiggers, mosquitoes and fleas are most commonly involved. Treatment includes the use of cool soaks, trying not to scratch, oral Benadryl, or topical anti-itch preparations such as Calamine.
Ticks are small insects which bite by burrowing their heads underneath the skin. Care must be taken when removing ticks, so that the entire insect is gently pulled out of the skin. They are best removed by slow constant traction with a pair of tweezers. There is no place for applying alcohol or ointments, or a hot match! If your child develops a high fever or a rash after a tick bite, please call the office.
Lyme Disease may follow the bites of certain types of ticks that are infected with the organism Treponema borrelia. The tick must be actively feeding in the skin for 24-48 hours before transmission of any infection is likely. So the best prevention is frequent checking of the child's skin when he is outside in the warmer months, or at least once a day. With Lyme Disease, three to thirty days after the bite, an expanding red circular rash develops that may become quite large. At the same time, or weeks later, there may be symptoms of joint pain, fatigue, headache, loss of appetite, nausea and muscle soreness. Treatment is simple if caught early, and consists of penicillin or tetracycline. Please call the office if you think you may have this rash.
Insect repellents containing DEET (N,N,N-diethyl-meta-toluamide) are the most effective products. We recommend that the concentration of DEET be less than or equal to 10%. The insect spray should be applied by an adult, and not put on skin underneath clothing, and not on the hands of young children. Also avoid the eyes, mouth, and any irritated skin surfaces. It may be applied to the clothing. Once the child returns indoors, wash off the repellent with soap and water and wash any clothing to which the spray was applied. Do not use repellent on infants under 2 months of age. Instead, keep them inside, or dress them in long sleeves and long pants tucked into shoes or socks. Remember, high concentrations of insect repellents are toxic to people too.
Poison Ivy is a common outdoor plant to which many children and adults are sensitive. The oil called urushiol is the offending chemical, and is the same chemical in other sensitizing plants. A red itchy rash with blisters is produced when the skin of a sensitized person comes into contact with the plant oil. Prompt washing with soap and water after exposure to the plant can often prevent the rash from developing. The rash caused by poison ivy is not contagious. Further spread of the lesions occurs because of continued exposure to oil from the plant. The best treatment is avoidance. If, however, your child comes into contact with poison ivy, the following measures should be taken.
Boils are sore red bumps that extend deeper in the skin and are nearly always infections with staph. They may occur as complications of acne, small cuts in the skin, insect bites, etc. Treatment consists of warm soaks to the area, to bring the boil to a "head", and oral antibiotics. Sometimes they need to be surgically drained. Boils, especially if they are recurrent, should be brought to the attention of your doctor.
Hives are raised, itchy often "blotchy" and can occur almost anywhere on the body and may be caused by a multitude of things. Common causes include allergy and reactions to many types of viral and bacterial infections. Hives are bothersome but not serious when they are not associated with any other symptoms. If your child develops hives while on an antibiotic please discontinue the antibiotic immediately and notify our office. If you are unsure your child has hives, he should probably be seen by a doctor for diagnosis. Treatment to relieve the itching and swelling includes cool soaks and Benadryl. The exact cause of hives can only be determined about half the time. If symptoms are not controlled by the above measures, call your doctor.
Roseola is a viral illness typically affecting children between 6 months and 3 years. It is characterized by a high fever of 104-105 degrees F for 3-4 days which resolves abruptly. Within 24 hours, a rash (small flat red spots) appears on the trunk and neck. It is generally a self-limited condition that despite the height of the fever, does not severely limit the child, and usually has no complications.
Fifth's Disease is a viral illness which affects children primarily. It is characterized by the sudden onset of a bright red coloration of the cheeks (the so-called "slapped cheek" appearance), followed by a more generalized red rash on the trunk and extremities. The rash gradually fades over days leaving a lacy-like pattern, and may itch. There is generally no fever and the illness usually resolves without complication. Some children experience a non-specific low-grade fever, malaise and sore throat a week prior to the onset of rash. By the time the rash appears, the child is no longer contagious. Children with Fifth's Disease should avoid being around pregnant women.
Hand, Foot, and Mouth Disease (Coxsackie) is a viral illness characterized by a rash that consists of small oval blisters on the palm of the hand, sole of the foot, in the mouth and often on the buttocks of children. There is often a high fever, sore throat and muscle aches. It is contagious. The treatment is symptomatic only. Acetaminophen or ibuprofen may relieve fever as well as sore throat pain. We also recommend sore throat sprays and throat lozenges for children who are old enough. Encourage lots of fluids and monitor the child's hydration. Popsicles may also help with sore throat pain.
Pinworms are common parasites that live in the intestine and often cause symptoms of an itchy anal region and restless sleep. The worms migrate to the anal opening at night and deposit their eggs, causing the preceding symptoms. The worms sometimes can be seen in the stool. They look like small white rice-sized particles that move. If you see these, or suspect that your child may have pinworms, please call during office hours.
Sunburn is painful and predisposes the child to the development of premature aging of the skin and to skin cancer. In adults, the incidence of several skin cancers is directly related to blistering sunburns in childhood, and cumulative sun exposure of the skin. Therefore, the best treatment is prevention. We recommend the use of a sunscreen (SPF 15 or greater) whenever children are out in the sun. For mild sunburn, tepid baths and a moisturizing lotion to prevent drying of the skin may be helpful. For blistering sunburns the child may need to be seen by his doctor. Children under the age of 6 months are not recommended to be in the sun, especially between the hours of 10 a.m. - 3 p.m. If the child must be out in the sun for some reason, please do apply the sunscreen to exposed areas. It is best to cover as much of the skin surface with light clothing as is practical.
Nosebleeds are relatively common in children, especially in the winter when the air is dry and following colds. Pressure should be applied to the nose (pinch the nostrils shut) steadily for at least 5 minutes, watching the clock, until the bleeding stops and a clot forms. Trauma to the nasal mucous membranes should be minimized (i.e. avoid blowing the nose hard and picking at the nose.) The use of a cool mist vaporizer may be helpful if the air is dry. Saline nose drops or spray or saline gel applied gently in the nose is also helpful, to decrease irritation and cracking, so the nose will not re-bleed.