Childhood Diseases

Education

The following information is provided so parents might better understand and more accurately follow the instructions given by our office for the care of their children.

Informational sections include: Chicken Pox, Cold and Coughs, Conjuntivitis, Croup, Earache, Fever and Gastoenteritis-Diarrhea and Vomiting.

Informational sections include: Head Trauma, Lyme Disease, Poisoning and Sore Throat.

Chicken Pox

Chicken pox is a disease of childhood caused by the varicella virus. It is very contagious. The chicken pox vaccine is recommended for all children over age one. The vaccine will prevent 90-95% of cases of chicken pox and also reduces the risk of shingles later in life. If exposed to chicken pox an unvaccinated child may develop symptoms from 10-21 days later. A child is contagious approximately 24 hours before he or she shows the typical rash of chicken pox. If the varicella vaccine is given within days after exposure to the disease, it may prevent the chicken pox or lessen the course of the disease.

Chicken pox often starts with a mild fever for 1-2 days followed by a rash. The spots start as small red spots with tiny water blisters. The blisters then break open and scab over in 1-2 days. New blisters continue to break out for 3-5 days. Once all of the blisters have scabbed over, the child is no longer contagious. Treatment for chicken pox is generally limited to treating the symptoms of itch and fever. For fever, acetaminophen may be given. Do not use ibuprofen (Advil or Motrin) or aspirin during the chicken pox, because of the possible risk of a serious illness called Reye’s Syndrome. For itching, topical treatments such as calamine lotion, aveeno lotion, and baking soda baths are helpful. Benadryl, or other antihistamines, also relieves the itching. Keeping the child’s nails short and clean also helps to minimize infection.

Call our office during office hours if:

You have questions on any of the treatment recommendations
The itch does not seem adequately controlled
You have questions about transmission of the chicken pox
Any of the chicken pox become red and tender or drain yellow pus
Your child has an earache
You have questions about the vaccine

Call our office immediately if:

Your child has persistent vomiting
Your child has a severe headache

Colds and Coughs

Upper respiratory infections or colds are very common. The average child will have about 6 to 8 colds per year, and each cold may last up to two and a half weeks. Colds are caused by viruses and cannot be treated with antibiotics to make them go away. Generally, the only treatment necessary is to make your child as comfortable as possible. This comfort care can be done by employing some of the following simple suggestions:

Encourage plenty of clear liquids of any kind.

Let your child get plenty of rest. To make sleeping more comfortable, elevate the head of your child’s bed or mattress.

Use a cool mist vaporizer or humidifier, especially during the heating season when houses are dry. Be sure to change the water daily to prevent growth of molds and bacteria.

Keep the nasal passages open with nose blowing (if old enough) or with a rubber bulb syringe or nasal aspirator if younger. Often salt water nose drops are helpful to loosen secretions and provide comfort. Some brand names are ‘Ocean’ or ‘Nasal’. A home mixed solution can be made with 1/4 teaspoonful of table salt mixed in 1/2 cup of water. Only a few drops are needed at a time.

Many of the over the counter cold medicines may help relieve congestion and quiet coughs in older children. These medications are no longer recommended for children under 6 years old. If you have questions on dosage, please see the table at the end of the booklet, or call during regular office hours to consult one of the nurses.

Acetaminophen (Tylenol, Tempra, APAP, Panadol) may be helpful in treating the fever and discomfort associated with a cold. Please do not give acetaminophen to children under 3 months of age without first consulting your physician.

Call our office during office hours to schedule an appointment if:

Nasal discharge lasts more than 21 days and the child is uncomfortable
Earache occurs with the cold
Fever occurs after the first 3 days of the illness
Wheezing or chest pain occurs with breathing

Call our office immediately if:

Your child under three months old has a fever over 100.4 rectally
There is difficulty breathing
Your child acts or looks very sick

Conjuntivitis

Conjunctivitis or “pink eye” is a common inflammation of the eye. It may be caused by environmental irritants, allergies or an infection, either viral or bacterial. Symptoms include itching, redness, watering or draining of one or both eyes. After sleeping the eyelids may stick together.

Children rub their itchy eyes often and then play with toys or friends, thus passing the infection to others. Bedding, face cloths and towels are other common ways to pass on the infection. Keeping the hands washed, the eyes wiped clean, and using antibiotic ointment or drops as prescribed by the doctor will help prevent spread.

Treatment generally includes cleansing the eyes with a warm face cloth or cotton balls several times a day. Antibiotic eye medications are often used if the drainage becomes thick or pus like. These are often prescribed over the telephone.

Call the office for an appointment if:

Your child has a high fever
Your child complains of pain or decreased vision
Your child complains of unusual sensitivity to light
The eyelid is tender and swollen or red and painful

Croup

Croup is a viral infection of the larynx, or voice box, and upper portions of the respiratory tract. The barking cough, hoarseness, and noisy breathing are caused by swelling around the vocal cords. Because the illness is caused by viruses, antibiotics will not help. Croup generally affects children between 3 months and 6 years of age. Typically the child awakens in the middle of the night with a barky cough, rapid noisy breathing and fever. There is no specific cure for croup, but there are many ways to make you and your child more comfortable.

Encourage your child to drink plenty of fluids including cold juices and popsicles to ease the sore throat.

Use of cool moist air such as a walk in the night air or cool humidifier often provide relief. If these do not help, try warm steam such as from the shower. Make your bathroom into a steam room by closing the door and running the shower on hot. Sitting quietly often calms a child as well.

Call the office during office hours if:

Your child is unable to drink enough fluids
A high fever is present
Your child complains of ear pain or others symptoms

Call the office immediately if:

Your child has severe difficulty breathing despite the above treatments
Your child is drooling (beyond his or her usual), spitting or having difficulty swallowing
Your child’s lips are blue
Your child acts or looks very sick

Earache

Ear infections are common in children. There are two common types of ear infections: otitis media – middle ear infections, and otitis externa – outer ear infections or swimmer’s ear.

Middle ear infections occur as a result of fluid building up behind the ear drum. Bacteria are often the infecting agents in middle ear infections, and therefore oral antibiotics are often used for treatment. Many children experience ear pain as a symptom of an ear infection, cold, sore throat or teething. Because all ear pain is not necessarily an infection we can not diagnose ear infections over the phone. If your child has an earache at night, we recommend that you try to control the pain by some of the following means and call the office in the morning for an appointment. Simple treatments of ear pain include a pain reliever such an acetaminophen or ibuprofen (see the dosage chart near the end of this booklet for your child’s dose), upright position to lessen the pressure behind the ear drum, and a warm heating pad or hot water bottle,. Control of the pain is important to allow for a better night’s sleep.

The treatment of middle ear infections in children over two years old may not require antibiotics at all, as long as the child can be made comfortable with pain relievers. A large percentage of these infections will resolve on their own. For babies and toddlers, antibiotics are usually recommended.

Otitis Externa, “swimmer’s ear” is an infection of the outer ear or the ear canal. This generally occurs after swimming when water is left in the ear canal. The moisture allows bacterial to thrive and an infection follows. The ear is painful all the time, but especially if you tug on the ear lobe. Prevention can often be accomplished by using 3-5 drops of swimmer’s ear drops to dry out the canal. If prevention is not successful, antibacterial ear drops will treat the infection.

Call the office during office hours for an appointment if:

Your child complains of ear pain – please tell the nurse if the pain is made worse by tugging on the ear lobe.

Fever

Most children at some time have a high temperature elevation, commonly called a fever. This is often a sign of infection but is not dangerous to your child. Fever is the body’s natural way of fighting off infection. Normal body temperature varies depending on the individual child, the time of day, and the part of the body where the temperature is taken. Please be sure to tell us how you took the temperature and the reading on the thermometer. It is not necessary to add or subtract because of how you took it. Rectal temperatures are generally the most accurate in children. Ear or tympanic thermometers are not accurate and are not recommended.

The main purpose in treating a fever is to make the child more comfortable. Fever may cause your child to be uncomfortable, cranky or sleepy. They often loose their appetite and may even vomit. The degree of fever does not necessarily represent the severity of illness. The best ways to make your child comfortable include treatment with an antipyretic – anti-fever medicine such as acetaminophen or ibuprofen. Do not use aspirin for children and teenagers because of the risk of a serious illness called Reye’s Syndrome. Dressing your child lightly, giving a warm bath (not cold or alcohol because these lower the temperatures too quickly) and encouraging the child to drink plenty of fluids also help.

A few children will have a seizure with a fever. The most important treatment at home is to protect the child from injury by watching him or her closely and turning the head to the side in case of vomiting.

Call our office during hours if:

Your child complains of ear pain or a sore throat
Your child has steady abdominal pain or joint pains
Your child complains of severe headaches
Your child has pain with urination
Fever has been present for more than 72 hours (3 full days)

Call our office immediately if:

Your child under 3 months old has a fever over 100.4 rectally
Your child has a temperature of 105 or higher
Your child has a seizure with a fever
Your child is extremely ill appearing despite treatment for the fever

Gastoenteritis-Diarrhea and Vomiting

Diarrhea and vomiting are common in children. They are most commonly symptoms of gastroenteritis, often called stomach flu. The illness generally lasts a few days and is often accompanied by stomach ache and fever. Our main concern with gastroenteritis is the prevention of dehydration, which simply means keeping up with the fluid lost by diarrhea and vomiting. As long as a child has a moist tongue (not lips), cries tears and is urinating 3 times per day, he is not dehydrated. Some simple home treatments of gastroenteritis include:

Allow 1-2 hours to pass after the vomiting before trying to give the child anything by mouth. Even Acetaminophen may start the child’s vomiting again. After the vomiting has subsided and an appropriate amount of time has passed, start giving the child sips of clear liquids. The best drinks are pediatric electrolyle solutions, like Pedialyte . These are specially made drinks with proper amounts of sugar and salt. If the taste is too salty for your child you may add a packet of Koolaid to cover the taste. Pedialyte is also available in bubble gum, grape and fruit flavors some children prefer. If you do not have these, you may try diluted apple juice, flattened soda, popsicles or sports drinks, but they often make diarrhea worse.

Initially start clear liquids with a teaspoon every 5-15 minutes and after 3-4 tolerated sips gradually increase the amount offered to a tablespoon, an ounce and 2 ounces. Do not allow a child to drink several ounces at once, or vomiting will likely result. It is often difficult to reason with a thirsty child and have them take only sips.

After several hours of clear fluid intake you may proceed to a bland diet including crackers, dry toast and dry cereal. For babies, breast milk or Pedialyte may be given, and you may return to formula after several hours of Pedialyte are tolerated.

After starting to feed your child remember to use easily digested foods such as applesauce, bananas, rice, noodles, chicken, turkey, toast and crackers for a few days.

Call our office during office hours if:

The diarrhea persists more than 10 days
Abdominal cramps come and go for more than 12 hours
A fever is present more than 72 hours
Mucous or pus is present in the stools
Your child has been exposed to a bacterial diarrhea-especially with travel or daycare

Call our office immediately if:

Your child has not urinated in more than 8 hours, unless he or she would not ordinarily do so – such as at night in older children
Crying produces no tears
Severe abdominal cramps or pain persist for hours
Blood appears in the vomit or diarrhea
Vomiting is green in color (unless it is the food that was green)
Your child acts or looks very sick
Your child is confused, delirious, difficult to awaken or was recently injured in the head

Head Trauma

Head injury is a common childhood accident. Fortunately most head trauma in children, though understandably alarming to parents, does not result in a significant injury. A blow to the head usually causes swelling and bruising. A cold compress or ice pack can be applied for 15-30 minutes to minimize swelling.

Prevention of head injuries is the most important treatment. Always be careful of children near stairs or climbing on furniture. Do not use walkers. They are very dangerous because they can tip over and cause head injuries. Helmets should always be worn with biking and other outdoor activities such as skating, roller blades, skate boarding, sledding, skiing and snow boarding. Trampolines are dangerous and should not be used at home.

Anytime your child has been knocked unconscious you should contact us immediately. If the child has not lost consciousness, it is usually safe to observe the child at home. It is best to allow them to continue their usual activities – eating lightly, playing and sleeping so that a change from their normal behavior can be recognized. During the first 12-24 hours from a serious head injury, children should be awakened every 3-4 hours during sleep to make sure they awaken normally and will respond to their name.

Call our office immediately if:

Your child appears confused, disoriented, drunk or has bizarre behavior
You are unable to arouse your child
Your child is uncoordinated or stumbling
Your child has incoherent speech
Your child complains of double vision or loss of vision
Your child’s pupils are not the same size
Your child has difficulty hearing or you note fluid draining from the ear
Your child vomits repeatedly
Your child has weakness of the arms or legs
The head injury occurred with a fall from a significant height or at a high speed

Lyme Disease

Lyme disease is a common concern for parents in our area. Lyme disease is an infection caused by transmission of bacteria from deer ticks. The deer tick, which is about the size of a period on this page, is usually attached for at least 24 to 48 hours before transmitting the disease. The ticks crawl to protected areas, such as under collars, cuffs or in hair. Not all deer ticks are infected with Lyme disease and not all infected ticks will transmit disease. The first sign of the disease is usually a red “Bull’s Eye” rash that develops within a few weeks after the bite. When diagnosed early, Lyme disease can be easily treated with antibiotics. The site of a tick bite should be periodically be checked for a rash for 1 month after the bite.

The best treatment for Lyme disease is prevention. The most important prevention is to wear appropriate clothing when going into tick infested areas, such as the woods, fields or marshes. Long pants tucked into socks and long sleeves are most helpful. Insect repellents containing DEET should be applied to either the skin or to the clothing. Children should use concentrations under 10%. For infants and toddlers, instead use Bite Blocker as a DEET-free alternative. Every day after exposure to ticks or tick infested areas, the whole family should be inspected for ticks. By checking daily, Lyme disease can be prevented since the ticks must be attached 24-48 hours to transmit disease. The best way to remove an attached tick is to rub counter clockwise with a soapy wet cotton ball, or pull it out with tweezers. Older children who have a deer tick embedded >24hrs may be treated with a dose of antibiotics to prevent Lyme disease.

Call the office during office hours if:

Your child develops a “Bull’s Eye” rash
You child develops joint pain after a tick bite
You have questions about what symptoms to watch for

Poisoning

Accidental poisoning is one of the most common emergencies affecting young children. Poisoning is year round concern. Prevention is most important, and means removing all poisonous products, including chemicals, cleaning fluids and medications from a child’s reach. Keep cleaning fluids and medicines locked up and do not store them in low cabinets.

In case of poisoning, do not call our office. Call the Poison Control Center 1-800-222-1222. They will then tell you what to do next. It is always a good idea to have this number posted on your phones and even programmed into a speed dial button. For stickers containing this number, please ask at our office.

Sore Throat

Sore throat is a common complaint in children and adults. They make all of us miserable at one time or another. There are two types of throat infections – viral and bacterial. The most important bacterial infection of the throat is the streptococcal or ‘strep throat’.

The majority of throat infections are caused by viruses and not the strep bacteria. Unfortunately, the symptoms and severity of the sore throat are so similar that we cannot accurately tell them apart without a throat culture. Strep throat is not an emergency and treatment to prevent serious complications such as rheumatic fever need not be started immediately. Both strep and viral infections are contagious while the child feels ill and while the child has a fever. After treatment with antibiotics for at least 24 hours, a child with strep throat is considered no longer contagious. Because viral infections are not helped by antibiotics, we do not prescribe antibiotics without first doing a throat culture.

Treatment of sore throats at home includes pain medication such as Acetaminophen. Encourage your child to drink lots of fluids to keep the throat moist. A humidifier often helps sore throat pain by keeping the throat moist during sleep.

Call our office during office hours if:

The throat has been sore for more than 48 hours
There are swollen or tender lymph nodes in the neck
There was recent contact with a person with strep throat
Your child has a sunburned looking sand-papery rash
You see yellow or white spots on the tonsils while looking in the throat with a light

Call our office immediately if:

There is severe pain which is not relieved by treatments above
Your child is drooling, spitting or having difficulty swallowing
Your child can not fully open his mouth
Breathing is difficult and not due to a stuffy nose
Your child acts or looks very sick

Education