Colds

These are almost always caused by viruses, so antibiotics do not cure them.  Basic treatment consists of extra fluids, rest, elevating the head of the crib or bed, and medication for discomfort or fever (see section on fever and pain). You can expect your child to have an average of 6-8 viral illnesses per year after infancy. A cold can lead to more serious complications, so some signs to watch for are: earache, severe persisting cough, sore throat with fever, redness or pus in the eyes, swelling of the eyelids, difficulty breathing, lethargy, high fever or difficulty feeding. Cold symptoms worsening or not beginning to improve after 7 to 10 days warrant an examination in our office.

Infants With Colds

A cool mist vaporizer may be helpful. A hot steam vaporizer is not suggested because it may be knocked over accidentally and scald the child. Additives such as Vicks are not better than plain water.

To loosen mucus, saltwater nose drops can be used.  They can be purchased at most pharmacies (Ocean, Nasal) or made up at home by carefully measuring 1/2 tsp. of salt in 4 ounces of lukewarm water.   Put 2 drops of saltwater in each nostril, one nostril at a time, wait a few seconds, and then gently remove the water and mucus with a rubber suction bulb.

It is not advisable to give over-the-counter cold medicines to infants in the first 12 months of life unless recommended by your doctor.

Abdominal Pain

This is very common and can be caused by many things, most of which are not serious. Medical evaluation is indicated if the pain is:  

1.  Severe; 

2.  Constant for 2 or more hours; 

3.  Localized in one place; 

4.  Associated with loss of appetite, refusal to drink or decreased urinating; 

5.  Associated with fever, prolonged or bloody vomiting, or bloody or black stools.

If none of these are present, then you can wait and see how your child feels for 1-2 days.  Please contact us if the pain persists.

Fever

and/or

Pain

Fever is a normal body process by which we defend against disease.  Fever is considered to be present in older infants and children if there is an oral temperature greater than 100°F or a rectal temperature greater than 101°F. If your child is less than 3 months old and has a rectal temperature greater than 100.4°F please call us immediately!   Fever in older children can be helpful rather than harmful unless it is very high (greater than 104°F or so) or if it rises very quickly.   We suggest that you use acetaminophen  (Tylenol, Tempra, Panadol, etc.)or ibuprofen (Motrin, Advil, etc.) to control a fever greater than 102°F or to treat your child’s discomfort. Please do not exceed the dosages listed below unless specifically advised to do so. Luke-warm water sponge baths also may make the child more comfortable, but do not give alcohol sponge baths.  Convulsions (seizures) can occur with very high sudden fever but only rarely. Febrile seizures are usually brief (less than 5 minutes) and do not cause any brain damage. If your child does have her first convulsion, do not panic. Calmly position her on her side on the floor and call for an ambulance (911).

Aspirin is no longer recommended for use in children (except in certain situations, at which time the doctor will discuss this with you).  This is because aspirin use in children has been associated with Reye’s Syndrome, a serious neurological disease.  When your child requires a medication for pain or fever be sure to use only those containing acetaminophen or ibuprofen.

Most ear infections occur in the middle ear space. Because infections usually spread to the middle ear from the inside, rather than from the outside of the ear, covering the ears with hats, scarves, or earmuffs will not prevent ear infections. An infection in the middle ear can become a serious problem, and in some cases results in hearing problems.  Therefore, when a child complains of an earache please have his ears checked by us.  Remember, it is common for an ear infection to be present even when there is no fever!   When signs of an ear infection develop during the night and your child does not appear seriously ill, you can try giving some medication for pain (acetaminophen, ibuprofen), a decongestant, and apply either heat or cold to the outside of the ear (whichever feels better for the child). Be certain to have us check the ears the next day, even if the pain seems to have subsided.

Earaches and Ear Infections

Rashes

Rashes can be caused by many different factors.  See the section on facial rashes for some common causes.

Heat rash is commonly seen as small, red spots or bumps usually appearing around the neck and chest. If your baby is sweaty then heat rash is likely. Powdering the baby after thorough drying can help.   Be sure to place the powder in your hand first and then apply it to the body. Please do not sprinkle the powder directly onto the baby from the container (so as to avoid inhalation). Also, avoid overdressing the baby.

Diaper rashes can usually be treated without prescribed medication (see section on Skin). Please contact us if your baby has a severe diaper rash or one that persists longer than 5 days.

Any rash with fever or any rash with a purple coloration should be evaluated in our office.

Teething

The average child cuts his first tooth at about 6-8 months of age, and, on the average will have one new tooth per month thereafter until she has 16 teeth.  (Remember that these are averages; each child is different.)   Infants less than 6 months will sometimes appear to be teething. As the teeth move through the gums towards the surface, they may cause some discomfort even though they may not be ready to erupt.  The discomfort can be partially relieved with pain medication (acetaminophen, ibuprofen), a cold teething ring, a cold wet washcloth, or preparations such as Oragel (works briefly only).

Recent studies show that while teething may cause some irritability and sleep disruption, it will not cause fever over 100.5°F. Teething does not cause illness. Other causes should be considered.

Vomiting and Diarrhea

Vomiting and diarrhea are often caused by a virus. This kind of vomiting usually lasts less than 24 hours but the diarrhea may persist for 5-10 days. High fever is common early in the illness. The only way to treat “stomach flu” is to change the diet for a short while. Please follow the following guidelines:

Day #1

If diarrhea only, skip to Day #2.

If vomiting, give nothing by mouth for 1 hour.  Then start giving clear fluids only. Infants should have Pedialyte. Older children may have Pedialyte or Pedialyte popsicles, flat ginger ale, Gatorade, clear soup, white grape juice or popsicles. Start with only 1-2 teaspoons every 5-10 minutes and slowly increase the amount and the time interval between feedings.

For most of the first day you should continue to give small (up to 3 oz. at a time) but frequent amounts of clear fluids. Do not give any food, formula, or milk. Nursing babies may continue to breast feed, but try to offer shorter frequent feedings.

If the child has been keeping fluids down for several hours, you may slowly begin to introduce some of the following “binding” foods:

    • bananas

    • rice or rice cereal

    • apples or applesauce

    • toast with jelly

    • noodles (plain with no sauce)

    • potato (mashed or baked-plain)

    • saltine crackers

    • dry Cheerios (or other plain cereal)

Day #2

Notify our office if vomiting persists!

Infants
Start soy formula (Isomil or Prosobee) if diarrhea is still severe.
Otherwise, start regular formula.
Breast-fed babies should continue to nurse.

Older Children
Start regular formula (or soy formula if diarrhea still severe) if child on formula prior to illness. Continue to give good amount of clear fluids.

Begin to expand diet to include most of the child’s normal foods (recent studies show that this helps the intestines heal more quickly).

Milk and milk products (cheese, yogurt, ice cream)may make diarrhea worse initially. You may try to give some in small amounts as they also do aid in healing the intestines. Do stop themif the diarrhea increases severely.

Do not give any fatty foods (butter, margarine, mayonnaise, etc.) Some juices often make diarrhea worse (especially apple juice).

Days 3-7

Continue formula.

DO NOT continue to restrict diet to “binding” foods only. Slowly increase the diet towards regular foods.

Give only small amounts of milk products for about one week, and then increase gradually. Stop all milk products if the diarrhea seems worse.

If you have changed to a soy formula, you may slowly change back to regular formula after about one week.

NOTIFY OUR OFFICE  IF:

  • The baby is less than 6 months old.

  • Vomiting persists for more than 24 hours.

  • High fever (persists).

  • You find blood in the diarrhea or vomit.

  • The child is unable to keep down even small sips of clear fluid.

  • The child shows signs of dehydration (dry mouth and skin, sunken eyes, no tears, no urine for 6-10 hours, difficult to arouse).

Constipation

Constipation is present when a child has stools (bowel movements) that are hard “like rocks” and difficult to pass. The child may have one or several constipated stools a day, or may skip several days. Remember- it is not constipation when a child merely skips having a stool for several days and then has stools that are soft.  It is normal for many infants and children not to have a bowel movement every day.

Some constipating foods:

  • Rice and rice cereal

  • Bananas

  • Apples and applesauce

  • Dairy products (especially cheese)

  • Changing from formula to regular milk

  • Too much MILK

What to do: (Please do NOT change your baby’s formula without consulting with us first.)

Infants under 3-5 months:

  • If already on solid foods, reduce the amount of constipating baby foods (see above).

  • In addition to the baby’s regular formula feeds, offer 4 ounces of water with 1 tablespoon dark Karo syrup added, only once daily. (Do not exceed one tablespoon,  as Karo is high in sodium.) You may prefer to use prune juice in place of the Karo syrup and water mixture.

Babies over 4-5 months:

  • Eliminate constipating foods.

  • Offer more fluids other than milk (water, juices).

  • Offer more “P” fruits (and their juices):
    Peaches
    Prunes
    Plums
    Pears
    aPricots

  • If the baby is over 6 months of age, only 16-24 ounces of milk is necessary each day.  Remember– too much milk can cause constipation.

Older children:

  • In addition to the above measures, encourage the child to eat
    more high-fiber foods- fresh fruits and vegetables, bran, etc.

  • Children can sometimes become constipated if they are anxious about toilet-training, so relax…and forget about  toilet-training for a while.

  • If the child is already toilet-trained, reward him for sitting on the toilet for 10 minutes after breakfast and dinner.

CALL OUR OFFICE:

  • If constipation continues despite all the above measures.

  • Before giving your child any laxatives or suppositories.

  • If persistent abdominal pain.