Sick Information

ILLNESSES
Preventative medicine stresses the importance of avoidance of illnes and injury and early diagnosis and treatment to lessen the chance of chronic disease. Doctors have the ability to prevent and treat several specific diseases; however, there are many other illnesses in which recovery and immunity are only gained by having the disease and producing antibodies against it. Therefore, it is expected that your child will have several colds, stomach viruses, and sore throats. There are a few general measures that apply to almost any illness which will help the body fight disease: rest, fluids and proper diet.

FEVER
Fever is helpful in combating illness and it alerts us to watch for other symptoms. The thermometer reading is not nearly as important as how badly the child feels. Do not be so preoccupied with the degree of the fever that you fail to recognize other symptoms which will help us find the reason for the fever and determine the appropriate treatment and follow up. Always take a rectal or oral temperature with a mercury or digital thermometer.

Infants less than 3 months of age are considered to have fever and are potentially very sick if the temperature is more than 100.4 rectally. Please notify us immediately (night or day) in this situation. Do not give any fever medicines before talking to us.

For children over 6 months of age, temperatures less than 104 degrees (rectal or oral only, not under the arm) can be managed by alternating Tylenol and Advil every 4 hours. This regimen should bring the fever down and keep the child relatively interactive and happy. You should call for a temperature over 103 despite medicine, fever lasting more than 3 days, or fevers in ill appearing children who do not appear better after Advil or Tylenol are given. Note: Advil and Motrin are both Ibuprofen.

Other measures that will help bring down the fever and make your child more comfortable:
1.Keep your child at rest.

2.Light fitting clothes are appropriate to allow heat to escape. Do not wrap in blankets.

3.Offer plenty of fluids and if he/she feels like eating, offer bland foods (i.e, crackers, bananas, toast, Cheerios). It is o.k. to give children with fever milk. If your child is not vomiting, milk is clearly acceptable. 4.Put your child in lukewarm water exposing the entire body to the cooling water for 20 to 40 minutes.

5.If fever is the only sign of illness, you need to watch for other symptoms. If your child has no localized pain, feels better after anti-fever drugs, and is drinking fluids, it is to his/her advantage to let the body fight the infection for 2-3 days. Antibiotics are only helpful in a minority of cases. If there is localized pain, fever past 3 days or you have an ill appearing child, we need to evaluate him/her. If you are unsure, please call us.

6.If your child is vomiting or refusing anti-fever drugs, rectal Tylenol suppositories are available over the counter. The dose in milligrams is similar to the oral form.

If fever is the only sign of illness, you need to watch for other symptoms. If your child has no localized pain, feels better after anti-fever medications and is drinking fluids, it is to his/her advantage to let the body fight the infection for 2-3 days. Antibiotics are only helpful in a minority of cases. If there is localized pain, fever past 3 days, or you have an ill appearing child, we need to evaluate him/her. If you are unsure, please call us.

The common cold
The young child will have more colds as he/she is in the process of building up antibody production with each successive illness. Colds are caused by viruses and are not cured by antibiotics. You should expect up to 7-8 colds per year in young children. Children who attend daycare are at greatest risk.

Symptoms of upper respiratory infections or colds

1. Fever up to 102 or 103 for 2 to 3 days.
2. Muscle aches and pains.
3. Mucous and watery discharge from the nose, sneezing, hoarseness and cough.
4. Occasionally mild headache.

Management of these symptoms

1. Use a cool mist humidifier
2. Give Tylenol or Advil for fever and aches. If your child is not drinking or eating well, Tylenol is the safest medication to use.
3. Use saline nose drops. Nose drops can be made with 1 cup of warm water and 1/4 tsp. of salt. Let the solution cool and place 2 drops down each side of the nose, wait several seconds and suction well with a bulb syringe. This should be done before putting the child to bed, before nursing or feeding, or any other time the nose appears blocked. Make a fresh batch daily or purchase over the counter nasal saline at your pharmacy. If the nose is just stuffy and there is little mucous, use the drops and don't suction.
4. The FDA and Academy of Pediatrics recommend not using cough and cold medications in children less than 6 years old. We may occasionally make exceptions to this advice as some children will do better at night if given a small dose of a cough medication.

When to seek medical advice

1. Symptoms lasting more than 7-8 days.
2. Fever more than 3 days.
3. Localizing signs such as pain in the ears, chest, or throat.
4. Return of fever several days after it has resolved. This may be a signal of a secondary bacterial infection and antibiotics may be in order.
5. When your child is ill appearing even when the fever is down.

Croup
Croup is a common viral infection that causes varying degrees of upper airway obstruction. The most common symptom is sudden onset of a loud barky cough often beginning late at night. Some children will have noisy breathing especially when taking air into the lungs (stridor). There are several things to do at home that may help:

1. Keep your child calm. Agitation makes obstruction worse. Hold your child upright.
2. If it is a cool night, try taking your child outside into the night air.
3. Run hot water in the bathtub and have your child sit in your lap near the tub. Let him or her breathe in the moist hot air.
4. Open the refrigerator or freezer and allow your child to breathe in the cool air and offer cold drinks and popsicles
5. If none of the above seem to help please call us. This is a very common reason for ER visits and we recommend going to your nearest ER if your child has stridor at rest or worsening symptoms after trying the home remedies.

Vomiting and Diarrhea
Acute gastroenteritis is usually caused by a virus and is self-limiting. Vomiting usually begins first, followed by diarrhea. It is best treated with dietary management. The following will help prevent your child from becoming dehydrated:

1. When your child begins to vomit repeatedly, stop any oral intake for at least one hour.
2. When no vomiting has occurred for one hour, offer 1/2 ounce of a clear liquid such as Pedialyte, Ricelyte, flat Sprite, or Gatorade. Offer only this small amount every 15 to 30 minutes. If your child appears thirsty between times, moisten their mouths with a wet cloth. The trick is to sneak small amounts past the stomach. If you give too much too fast, it will come back up.
3. After your child has tolerated 1/2 ounce of clear fluids every 15 minutes for several hours, move up to 1-2 ounces every 15-30 minutes.
4. After your child has tolerated clear liquids for 12 hours, you may begin to add lactose free milk or formula or soy milk back to their diets. With infants you may have to start with 1/2 strength formula.
5. The goal is to get back to a semi normal diet by 24 to 48 hours. After liquids are tolerated, start adding solid bland foods such as rice, toast, noodles, potatoes, bananas, applesauce, and other starches. Try to avoid fatty foods for several days. It is okay to add in some yogurt, lean meats, and vegetables as tolerated.
6. If your child begins to vomit again once you have started the above treatment, wait for 1 hour and start with the clear liquids.

Things to watch for and reasons call:

1. Urinating less than 3 times in 24 hours.
2. Persistent localized abdominal pain or severe pain.
3. Bright red or tarry stools.
4. Persistent vomiting despite following the above suggestions.
5. More than 10-15 stools a day or diarrhea longer than 7 days.
6. Infants are more easily dehydrated so it is important to watch for: listlessness, sunken eyes, noticeable weight loss, poor fluid intake, decreased urination (less than once every 8 hours), and dry mouth.

A playful child who is eating, drinking, and playing well, who happens to have diarrhea does not usually require any intervention.

Chicken pox
Chicken pox is a common self-limiting disease that may cause fever for up to 3 days and an itchy/blistery rash. Use Tylenol for the fever and oral Benadryl for the itching. Do not give Ibuprofen or aspirin to children with chicken pox. The main complication we see is infection of the pox lesions. Wash your child with Dial soap frequently and cut and clean the fingernails to help prevent infection. Please inspect the lesions daily and call us day or night if there is expanding redness around any of the lesions, fever more than 3 days, or if your child is ill appearing. Children are contagious until all areas are scabbed over. Call us during office hours if you suspect your child has chicken pox and is well appearing.

Injuries and Accidents
Most injuries which occur in childhood will require the same general first-aid:

1. Clean with soap and water.
2. Ice application for discomfort.
3. Observation with the child at rest.
4. Tylenol for pain.

Lacerations
Generally speaking, if a wound is gaping open, it needs to be checked. Please call if you have any concern. Wash well with soap and water. If the wound is dirty (cut outdoors or a nail puncture wound), your child will need a tetanus booster if it has been more than 5 years since the last DTaP, DT, Tdap, dT, or tetanus shot. This is not an emergency and can wait until office hours.

Scrapes, cuts, abrasions
Wash thoroughly with soap and water and apply Neosporin. Call if a red area develops around the wound after 1-2 days or it begins to leak pus.

Burns
Flush profusely with cold water. Call if it is severe or involves the face or groin. Use Tylenol for pain. Do not apply grease to the burn.

Animal bites
Wash immediately with lots of soap and water. Call to see if larger bites (ones that gape) need to be stitched. Phone calls about tetanus shots should wait until office hours. Some bites may show signs of infection in the first 18-24 hours such as swelling and red streaks. Apply hot compresses and Neosporin and call during the day for an appointment. Certain types of bites such as cats, bats, mice, rodents, or bites by unknown dogs may need further attention and a discussion about the risk of rabies.

Head injuries
Although most head injuries are minor, all are potentially serious. Pump knots on the forehead are normal and can be immediate and large. IF ANY OF THE FOLLOWING OCCUR, CALL US FOR ADVICE:
Unconsciousness
Vomiting more than one time
Persistent disorientation
Visual disturbance
Personality change
Most children bump their heads, cry, then want to sleep. It is fine to let them sleep, but wake them every 2-3 hours to make sure they recognize you and act appropriately. If you have any questions, please call.

Insect bites and stings
Immediately apply a paste of baking soda or meat tenderizer to the site. Local swelling is expected and ice can be helpful. Benadryl may be given every 6 hours also. Call if there is any swelling of the mouth or lips or any difficulty breathing.

The bites can become infected. Apply Neosporin and keep fingernails short and clean to help prevent infection. Call for increasing redness after 24 hours or pus.

Tick bites
Tick bites are worrisome to parents. Ticks usually only spread disease if they have been attached 24 hours or more. Remove the ticks by using a pair of tweezers and pulling the whole tick off with gentle tension. You may also pull and turn the tick in a clockwise manner. Try to place the tweezers very near the area of attachment. Call if your child develops rash, fever, or joint pain after a tick bite.

Ingestions
Call us after calling poison control if your child ingests anything worrisome. The poison control's number is 1-800-222-1222 and should also be posted by the phone at home. The best form of treatment is prevention.