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*Please be aware that information provided on this website is for your further education only. It is not to replace the medical care you would receive from our office in response to specific symptoms and questions. If you have any questions, call the office.
Bowel Movements/Toilet Training
My child has a fever what should I do?
Contact the doctor if your child:
-has a temperature of 100.4 (rectal) in an infant under 8 weeks of age
-has had the fever for 3 days with no other symptoms
-has had the fever for 24-48 hours with other symptoms of illness (ie. cold symptoms, cough, urinary frequency, sore throat, etc.)
Fever is the body’s defense against illness and the body’s natural way of fighting infection. The main reason to reduce fever is to make the child more comfortable. If fever causes discomfort for your child, you may give acetaminophen (Tylenol) every four hours, or, if your child is over 6 months of age, ibuprofen (Advil, Motrin) every 6 hours. Do not alternate acetaminophen and ibuprofen to treat fever.
Dosages for acetaminophen and ibuprofen
My child is taking an antibiotic. Is it okay to use Tylenol or Motrin for fever? Tylenol or Motrin are safe to use while taking an antibiotic.
I think my child has infant acne. Baby acne, appears as red or white bumps on the forehead or cheeks. Baby acne develops within the first three to four weeks due to hormonal changes that stimulate oil glands. Rarely, baby acne may signal a hormonal problem. Infant acne usually clears up on its own usually within a few months. Simply wash your baby’s face with water and a mild baby soap daily, avoid lotions or oils, and never pinch or scrub the bumps. If baby acne doesn’t clear up within three months, tell your pediatrician.
How long will cold and flu symptoms last? Cold and flu are caused by viruses, not bacteria. Antibiotics DO NOT work for viruses. The symptoms of fever and sore throat generally improve within 4 days. The cough and nasal discharge may last 2 weeks or more. My child has a cough. What should I do? Coughs are an associated symptom of a cold. Most coughs appear after having upper respiratory symptoms (colds). In general, if your child does not have a fever, the cough is not affecting their activity or sleep, and is not causing respiratory difficulty the symptom should resolve in 5-7 days. Over the counter cough medicines can be used at bedtime to promote restful sleep. Use of a cool mist vaporizer in the child's bedroom will often help quiet the cough. Contact the doctor if your child: - has had a cough for several days and then develops a fever lasting longer than 24 hours. - has a cough that is nonstop or causing them to gag - is having any difficult respirations. (wheezing, panting, etc.)
How do I treat my child's nasal congestion? Most stuffy noses are blocked by dry mucus. Nose drops of warm tap water are good for loosening mucus. If you would prefer to use normal saline nose drops they are sold under the names, NaSal, Ocean or Ayr. You can make these at home by mixing 1/4 teaspoon salt into 8 ounces of water. It is important to clear the nose in young infants because they can't breathe through the mouth and suck at the same time. If your child is breast or bottle feeding, you must clear his nose so he can breathe while he is sucking. If your child is able to breast or bottle feed well, the nose is not stuffy and no treatment is necessary. For children who cannot blow their nose: Place 3 drops of warm water in each nostril. Wait about one minute and then use a suction bulb to suck out the loosened mucus gently. For older children who can blow their nose: Use 3 drops as necessary in each nostril while your child is laying down. Wait about one minute to loosen the dried mucus, then have your child blow his nose. This can be repeated several times in a row for complete clearing of the nasal passages. Your child is almost certain to have one nosebleed-and probably many-during there preschool years. Some preschoolers have several a week. This is neither abnormal or dangerous, but it is very frightening. If blood flows down from the back of the nose into the mouth and throat, your child can swallow a great deal of it, which in turn may cause vomiting. There are many causes of nosebleeds, most of which aren't serious. Beginning with the most common causes they include:
Treatment There are many misconceptions and folktales about how to treat a nosebleed. Here are a list of do's and don'ts: Do:
Release the pressure after ten minutes and wait, keeping your child quiet. If the bleeding hasn't stopped, repeat this step. If after ten more minutes of pressure the bleeding hasn't stopped, call your pediatrician or go to the nearest emergency room. Don't:
Call your pediatrician if you think your child has lost too much blood, the bleeding is coming from your child's mouth or he's coughing or vomiting blood, or if he has a lot of nosebleeds and a chronically stuffy nose. If your child is unusually pale or sweaty, or is not responsive, take your child to the emergency room. Prevention: If your child gets a lot of nosebleeds, ask your pediatrician about using salt water nose drops every day. Doing so may be helpful if you live in a dry climate or when the furnace is on. In addition, a humidifier or vaporizer will help maintain your home's humidity at a level high enough to prevent nasal drying. Also tell your child not to pick his nose. If he picks it at night or in his sleep, put him to bed wearing thin cotton gloves or socks over his hands. ~AAP
Head lice spend their entire lives on the human scalp, clinging to the hair while feeding, mating, and laying eggs. They are unrelated to hygiene or living conditions. Lice cannot jump or fly (they have no wings). Transmission is after close physical contact-head to head. The transfer of lice from host to an object to a new host is relatively rare. Though it is possible for lice to be transferred from a personal item; pillow, hat, towel, brush, it would have to be used immediately after it was used by an infested person. Lice cannot live off the human body for more than 24 hours. Diagnosis: The main symptom is itching. Diagnosis is confirmed by the presence of a live, mobile louse. The louse is about the size of a sesame seed and brown in color. Nits (eggs) are deposited on the hair shaft usually within 6mm of the scalp. These eggs will hatch in 7-10 days. Nits can remain stuck on the hair shaft for weeks or months after an infestation has been treated. A positive diagnosis is based on the presence of a live louse. If someone in the family is diagnosed with lice, the entire family should be checked. Treatment: Nits can be removed with a fine tooth comb. Part the hair into small strands and comb through hair. Examine the comb for any lice. If no live lice are found, repeat the procedure in 1-2 days. If live lice are found the first line of therapy is over the counter pediculicides (Rid, Nix, Lice Arrest, for example). Follow the package directions closely. Treatment is for external use only. A second treatment should be applied in 7-10 days, if a live louse is found, because 25-30% of lice eggs survive treatment. In general, these preparations are safe to use. Prescription treatment for lice is used only if infestation has not responded to over the counter treatment. Linens, towels, clothes worn 2 days before treatment should be washed in hot water and dried on high heat. The room should be vacuumed or wet mopped. Dry clean items that are not washable or seal in plastic bags for 2 weeks or place plastic bag in the freezer for 3 days. Remember to vacuum furniture and car seats. Soak brushes and combs in dishwashing detergent and hot water for one hour, rinse and dry.
My child has been ill, when can they return to daycare, school? Generally speaking, once a fever has been gone for 24 hours or he/she has been on an antibiotic for 24 hours, he/she is probably not contagious. Diseases have different incubation and contagion periods. The incubation period is the time between when a person is exposed to germs and when they develop symptoms. The contagion period is the window in which a person can pass germs to another person. Here is a guide for some common illnesses: Disease Incubation Period Contagion Period Bronchiolitis 4-6 days Onset of cough until 7 days Chicken Pox 10-21 days 1 day before lesions appear until all sores are crusted Colds 1-5 days Onset of runny nose until fever is gone Croup 2-7 days Onset of cough until fever is gone Fifth Disease 4-14 days 7 days Pinkeye 1-3 days Onset of pus until 24 hours on antibiotic eye drops Rotavirus 1-3 days 7 days after onset of diarrhea Sore throat, viral 2-5 days Onset of sore throat until fever is gone Sore throat, strep 2-5 days 24 hours after start of antibiotic. Vomiting (viral) 2-5 days Until vomiting stops
In general, most rashes are viral in nature or the result of contact with a skin irritant. Rashes often appear and disappear without any treatment. Call the office if your child has a fever with the rash, the rash is hive-like in appearance, or if the rash is spreading or appears infected. Hives are usually caused by an allergic reaction to medicine, food or plants. They can also appear with illness or as a result of stress. Hives are generally sharply defined, slightly raised areas surrounded by redness and are usually circular in appearance. Hives are accompanied by intense itching. Each eruption is transient, lasting no more than 8 to 12 hours, but they may be replaced by new ones in different locations. These eruptions may appear immediately after exposure to an allergen or they may be delayed for several days. New lesions may continue to appear for one week. Hives accompanied by swelling of the lips, face and/or hands may also occur. In severe reactions children may experience respiratory difficulty or swelling of the throat. If your child is experiencing any facial swelling or difficulty breathing seek medical attention immediately!
I think my child is constipated! What should I do?
Constipation is infrequent, hard stools. In general, bowel movements vary from day to day. Infrequent movements, 4 or more days without a bowel movement can be considered constipation. The exception is breastfed babies over 2 months of age who may pass normal, large, soft bowel movements up to 7 days apart.
Causes for constipation include a low fiber diet, increased intake of dairy products, prolonged waiting to use the bathroom, painful passage of stool, and toilet training.
Treatment: For infants over one month of age, adding 2-4 oz. of pear or apple juice/day generally leads to softer stools.
For older children: Increase fiber in the diet, encourage more fruits and vegetables especially prunes, raisins, peaches pears, apricots, beans and peas. Encourage a regular bowel pattern, increase daily water intake and decrease intake of constipating foods,( milk, yogurt, cheese, ice cream, white rice, bananas, applesauce and cooked carrots).
Follow-up with the doctor if symptoms persist after above measures or if bleeding noted with bowel movement, pain with bowel movement, vomiting with constipation, leaking of stool or abdominal pain.
When should I introduce solid food to my baby?
Between the ages of 4 to 6 months most babies are ready for solids. General guidelines to determine if your baby is ready:
ü Is drinking 26-32 oz. formula/day
ü Seems hungry after 8-10 breastfeeds/day
ü Has doubled their birth weight and is at least 4 months of age
ü Can hold his head up well and sit with support
ü Was sleeping through the night and now wakens for a feeding
How do I introduce solid food and how much?
We suggest starting with iron fortified rice cereal given off of a spoon, once/day. Most parents start this feeding prior to the last bottle or breastfeeding of the evening. To begin, use 1-3 Tablespoons dry cereal mixed with formula or breast milk to make an “applesauce” consistency. After 2-3 weeks you can give cereal two times per day. Barley and oatmeal cereal can also be offered after 2 weeks.
The next solids to introduce will be pureed fruits and vegetables. Begin with small amounts (1/2 jar) and advance amount based on your child’s needs. Only introduce one new single food in a day and no more than 2-3 in a week. Waiting at least 3 days between new foods allows you to observe for any allergic reactions. These reactions would include: increased gassiness, diarrhea, vomiting, mucus in the stool, rash around the mouth, wheezing.
ü The average daily intake for a 4-6 month old is: 4 tablespoons cereal, 1 jar of vegetables, and 1 jar of fruit. At this age they may also have 2-4 oz. of juice/day.
ü Avoid citrus juices until 6-10 months of age.
ü Meats can be introduced at 6-7 months of age.
ü By 9-10 months most infants are eating some table foods. Make sure food is soft and small enough to avoid choking.
ü Finger foods can be introduced at 9-10 months. Examples: dry cereals, slices of canned fruit, slices of bananas, crackers.
ü At 12 months of age children can be put on whole milk rather than formula as long as there is no milk allergy. Generally, 12-16oz. of milk/day is adequate.
ü Until the child is over 2 years of age avoid: honey, popcorn, peanuts/peanut butter, raisins.
My child has a splinter in their hand, what should I do?
If the splinters are small, soak affected part in warm, soapy water several times/day. Most splinters will work themselves out without any harm. If the splinter is large, you can try to remove with tweezers. Follow- up if with signs of infection: redness, tenderness, warmth at the site, fever.
My child just swallowed a magnet? Do I need to go to the ED? If your child has only swallowed one magnet it should pass through the intestines without problem. However, if your child has swallowed more than one magnet or another piece of metal they will need to be evaluated at the ED. This usually involves an x-ray to make sure the magnets and/or metal have not adhered and caused a perforation in the stomach or intestine. If your child develops abdominal pain after ingestion they need to be evaluated. Many magnets are found in plastic children's toys and can be detached easily. Always follow the manufacturer's safety guidelines when purchasing toys for your children.
What do I do if my child is stung or bitten by an insect?
Most insect bites cause local irritation and inflammation. In most children, localized swelling (area of the bite) may be noticed for several days.
If stung, remove the stinger if still visible in the skin.
Treatment: Apply ice to area.
Apply paste of baking soda to insect bites, paste of meat tenderizer to stings.
Can apply 1% Hydrocortisone cream to area 2-3 times/day for 3days.
Benadryl orally every 6 hours as needed for itching.
Call 911 if any breathing difficulty is noted.
Follow-Up: If swelling or redness increase after 48 hours, if with purulent drainage, if with red streaks in area of bite or with fever.
Can my child go swimming with an ear infection? It is okay to go swimming with an ear infection as long as the ear drum is not perforated. If your child has an outer ear infection (swimmer's ear), it is recommended to stay out of the water for 5-7 days.
I think my baby has colic. How do I stop the crying? Colic occurs in 10-15% of all newborns. It usually begins around 2-3 weeks of age and lasts until 3-4 months of age. Colic is defined as healthy infants who cry nonstop greater than three hours per day, more than three days per week. These infants have rhythmic episodes of crying usually in the evening lasting 3-5 hours. In order to determine if your child has colic discuss with your doctor to rule out other causes of the crying. If your child has colic, these measures may help: swaddle him to keep arms and legs from flailing, wear the baby in a sling several hours per day, use a motion swing, ride in a car or rocking to calm him, play constant "white noise" (fan, vacuum), have someone else take over for a while (spouse, friend) to reduce your stress so that you can handle the crying easier. And remember, all colic eventually ends!
When should I start brushing my child's teeth? Even before your child has teeth you can wipe their gums with gauze once per day. Once teeth have erupted you can begin brushing using a soft toothbrush and water. When they have a lot of teeth or around one year of age you can begin using a small amount of toothpaste. It is important to care for "baby teeth" because they are more susceptible to decay than permanent teeth. At the age of 2-3 years a visit to the dentist is recommended. Are vitamins necessary for my child? If your child is over the age of one year, and is eating a regular, balanced diet, vitamins are not necessary. If you feel your child is a picky eater, you may want to give him/her a chewable vitamin once per week.
How do I teach my child to swallow a pill? Start by placing the pill on the middle of the tongue, about one and a half inches in from the tip. Have your child suck on a straw or drink a glass of milk or water. To distract her, ask her to wave while she swallows. If the pill still doesn't go down, you can try burying it in a spoonful of jelly, pudding or applesauce.
How do I know if my child is ready for toilet training? Most children can be made ready for toilet training by 24 months of age. By the age of three years, most children will have trained themselves. The following signs indicate your child's readiness: - Your child understands what "pee", "poop", "potty", "dry", "wet", "clean" and "messy" mean. - Your child understands what the potty is used for. Let him observe parents, older siblings. - Your child prefers dry, clean diapers. - Your child likes to be changed. Praise him/her for coming to you when wet or dirty. - Your child understands the connection between dry pants and using the potty. - Your child can recognize a full bladder or the urge to have a bowel movement. This is evident when the child jumps up and down, holds his genitals, paces or squats down. My child refuses any attempts at potty training. What should I do now? The most common cause of resistance to toilet training is that a child has been reminded or lectured too much. Any child over two and a half years old who is not toilet trained after several months of trying is considered resistant to the process. Some helpful suggestions: - Transfer responsibility to your child. Stop talking about the subject and stop all reminders. He will soon decide to perform for attention rather than for nonperformance. - Give incentives for using the toilet. Praise, smiles, hugs, extra play time with you, stars on a calendar. - Remind your child to change his clothes if he is wet or soiled. - Don't punish or criticize for accidents. - Request caregivers or day-care staff to use the same strategy. Children who soil their underwear with small amounts of loose bowel movements several times per day are said to have "soiling" or "encopresis". These children are severely constipated or "blocked up". This leakage cannot be controlled until the large bowel movement is removed. Children can become constipated for many reasons including diet, pain with bowel movements or resistance to toilet training. If your child is experiencing these symptoms he should be examined by your physician to rule out any physical cause.
My child got a pencil puncture wound at school. There is no danger of lead poisoning because pencil "leads" are made of clay and graphite, which is carbon and nontoxic. The wound area should be cleansed and tetanus immunization status should be checked. Observe for signs of infection and be aware that the area may have a permanent black tattoo. My child just threw up, what should I do? Most vomiting is caused by a viral infection of the stomach and usually lasts 6 to 24 hours. The main concern with vomiting is to prevent dehydration. If your child vomits, do not give anything to drink for one hour. After the hour you may rehydrate slowly with clear liquids (Pedialyte for infants to 2 years), gatorade for children over 2 years of age. Start with a tablespoon of clear liquid every 15 minutes for an hour. If there is no further emesis, gradually increase the amount each hour. If your child vomits again, you must wait an hour before retrying any liquid, this gives the stomach a chance to rest. Remember, GO SLOW! Your child should remain on clear liquids for 12 to 24 hours before advancing diet. Observe for signs of dehydration: no tears when crying, no urine output in eight hours, dry, sticky mouth and lethargy. Call the office if vomiting lasts longer than 12 hours in infants under 6 months of age, longer than 24 hours in children 6 months to 2 years of age and longer than 48 hours in children over 2 years of age, or if with signs of dehydration.
My child has diarrhea, what should I do? Diarrhea is the sudden increase in the frequency and looseness of bowel movements. It is usually caused by a viral infection in the intestines. Diarrhea usually lasts from several days to a week. The main goal is to prevent dehydration due to loss of fluids. Replacement fluids include pedialyte, gatorade in children over 2 years of age, ginger ale, popsicles and jello. Avoid fruit juices as they may make diarrhea worse. The diet should be changed to foods high in fiber and starches (breads, crackers, rice, mashed potatoes, and noodles). The BRAT diet is recommended and foods include: bananas, applesauce, peeled apples, toast, saltine crackers, animal crackers, vanilla wafers, cream of rice, cream of wheat, pretzels, oatmeal, unsweetened dry cereal, baked potato, white rice, noodles and broth (chicken or beef). Call the office if your child has greater than 10 watery stools in a day, if the diarrhea lasts longer than 7 days, or if you notice blood or mucus in the stool.
Night terrors are dreams during sleep from which it is hard to awaken. Being overtired can trigger night terrors, so be sure your child goes to bed at a reasonable time. They usually occur within 2 hours of bedtime, and occur most often in children ages 1 to 8 years. Your child cannot be awakened and they do not realize you are there even though their eyes are wide open. The episode usually lasts 10 to 30 minutes and they won't remember it in the morning. What to do: Make soothing comments, speak slowly and repetitively. Protect your child from injury. Most night terrors occur at the same time every night. Awakening your child 15 minutes prior to the episode and keeping them awake for 5 minutes will often break the cycle of the night terror.
My child is sleepwalking. Should I be concerned? Sleepwalking is an inherited tendency to wander during deep sleep. It usually occurs within 2 hours of bedtime and will disappear by the time your child is an adolescent. If your child sleepwalks, return him to his bed, protect him from injury by using gates at stairways, and make sure he is well rested. Sleepwalking increases if your child is extremely tired. If your child sleepwalks at the same time every night you can try awakening him 15 minutes prior to the episode to see if you can break the cycle.
My child is a picky eater. What should I do? Almost every child goes through a stage like this. A picky eater will usually only eat a few foods and doesn't want to try new foods. Children are often picky because they like the extra attention this behavior gets them or because they are in the independent stage of a 2 year old. Some children really do hate the taste of certain foods. Try to relax because your child will eat just about everything soon. Continue to provide healthy foods at regular meals and snacks. Let your child do his or her job - eating - without too much pressure. Expect children to eat small amounts of food. The real test is if they are growing well. Expect some battles, it is their way to try to get some control over their world. Continue to set limits, serve a new food next to a familiar food, let your child see a new food a few times before trying to get them to taste it. Most 2 to 4 year olds are too busy to eat, try to plan a quiet activity to slow them down before meals. Don't make eating a battle or beg your child to eat. Don't threaten your child with what you will do if he doesn't eat. Don't give into your child just to get them to eat and don't jump up and cook something else to get your child to eat. Accept that eating is something you cannot control, and just provide nutritious foods to choose from. What other foods are good sources for calcium? How much calcium your body needs varies
according to age. You need the most calcium between 9 and 18 years of age. The
How to get calcium The best way to get the calcium that you need
is by eating and drinking foods that naturally contain calcium. Many foods
contain some calcium, but the best sources include the following:
What decreases calcium The following can hurt your bone health:
How to get more calcium There are many ways to get more calcium, such
as
If you make the right choices, the foods you eat or the things you drink can provide the calcium you need.
Does the iron in iron-fortified formulas cause constipation? The answer is no. In clinical studies with iron-fortified formulas researchers have not reported increased tolerance problems. In these studies, no difference in fussiness, cramps, spitting up, constipation, gas or colic were reported by parents. In addition, stool consistency and frequency were comparable in infants fed low iron and iron-fortified formula. Iron is very important in infant formulas because it is the nutrient most likely to be at low levels in an infant's diet. Iron-fortified formulas have been very important in decreasing the occurrence of iron deficiency in infancy.
My child has a broken tooth, what should I do? Rinse dirt from the injured area with warm water. Place cold compresses over the face in the area of the injury. Locate and save any broken tooth fragments. A small amount of orthodontic wax or sugarless gum can be placed over the rough edge until the dentist can be reached. Immediate dental attention is necessary.
What should I do for a cut lip or tongue? Apply ice to bruised areas. If there is bleeding, apply firm but gentle pressure with a clean gauze or cloth. Have your child suck on something cold (ice, popsicle). If the bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to the emergency room. To help prevent infection and aid in the healing process rinse the mouth with lukewarm water after meals.
How do I stop my child from biting? Biting is usually a chance discovery around 1year of age, when teething and mouthing are normal behaviors. It often continues because the parents initially think it is cute and the child thinks it is a game to get attention. Later, children may use it when they are frustrated and want something from another child. Biting becomes a primitive form of communication. Only after 2 or 3 years of age can it become a deliberate way to express anger and intimidate others.
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