Pediatric Advice

How your child is acting is more important than how high the fever is running. The terms lethargy and listless or acting sick can mean different things to different people. In order to tell how sick the child is acting when they have a fever, give an appropriate dose of acetaminophen or ibuprofen (see chart) and see how the child is acting about 1 to 2 hours after the dose. Many parents who call us find out they have not given enough acetaminophen or ibuprofen. The fever may not necessarily return to normal, but is often lower. Keep in mind that some children can be seriouly ill without any fever.

A baby or child is probably not seriously ill if:

• a baby will coo, make eye contact, smile or reach for an object
• a toddler will pay attention to activities, smile, walk around to get things
• an older child will engage in quiet activities like coloring or reading

A child is seriously ill if despite reducing the fever:

• a baby is not making eye contact, refuses to feed, cries or cannot be comforted
• a toddler refuses to play, cries inconsolably, moans, appears very weak, turns away and stares repeatedly or is very hard to awaken if sleeping
• an older child refuses to talk and won't interact or is unable to get out of bed
• keeps dropping off to sleep without periods of activity and difficult to arouse; remember sick children do tend to sleep more
  
  
  

  ©1997CallYour Ped.com, Encinitas California

Baby Bottle Tooth Decay (BBTD) is caused by prolonged contact with almost any liquid other than water. This can happen from putting her to bed with a bottle of formula, milk, juice, soft drinks, sugar water, sugared drinks, etc. Allowing her to suck on a bottle or breastfeed for longer than a mealtime, either when awake or asleep, can also cause BBTD.

When liquid from a baby bottle builds up in the mouth, the natural or added sugars found in the liquid are changed to acid by germs in the mouth. This acid then starts to dissolve the teeth (mainly the upper front teeth), causing them to decay. Baby Bottle Tooth Decay can lead to severe damage to your child's baby teeth and can also cause dental problems that affect her permanent teeth.

But there are steps you can take to prevent Baby Bottle Tooth Decay. Keep these pointers in mind as you care for your child's teeth:

• Never put your child to bed with a bottle. By 7 or 8 months of age, most children no longer need feedings during the night. Children who drink bottles while lying down also may be more prone to getting ear infections.

• Only give your baby a bottle during meals. Do not use the bottle as a pacifier; do not allow your child to walk around with it or to drink it for extended periods. These practices not only may lead to BBTD, but children can suffer tooth injuries if they fall while sucking on a bottle.

• Teach your child to drink from a cup as soon as possible, usually by 1 year of age. Drinking from a cup does not cause the liquid to collect around the teeth, and a cup cannot be taken to bed. If you are concerned that a cup may be messier than a bottle, especially when you are away from home, use one that has a snap-on lid with a straw or a special valve to prevent spilling.

• Keep your baby's mouth clean. This is an important part of preventing tooth decay. After feedings, gently brush your baby's gums and any baby teeth with a soft infant toothbrush.

• Use water and a soft child-sized toothbrush for daily cleaning once your child has 7 to 8 teeth.

By the time your toddler is 2 years of age, you should be brushing his teeth once or twice a day, preferably after breakfast and before bedtime. Once you are sure your child will spit, and not swallow, toothpaste, you should begin using a fluoride toothpaste. Use a pea-sized amount of toothpaste to limit the amount he can accidently swallow.

© Copyright 2000 American Academy of Pediatrics

• Do not push your child to ride a 2-wheeled bike until he or she is ready, at about age 5 or 6. Consider the child's coordination and desire to learn to ride. Stick with coaster brakes until your child is older and more experienced.
• Take your child with you when you shop for the bike, so that he or she can try it out. The value of a properly fitting bike far outweighs the value of surprising your child with a new bike.
• Buy a bike that is the right size, not one your child has to "grow into." Oversized bikes are especially dangerous.
• Your child needs to wear a helmet on every bike ride, no matter how short or how close to home. Many accidents happen in driveways, on sidewalks, and on bike paths, not just on streets.
• A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.

American Academy of Pediatrics, May, 2004

Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.

Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social and cultural reasons. Since circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks.

Many parents choose to have their sons circumcised because "all the other men in the family were circumcised" or because they do not want their sons to feel "different." Others feel that circumcision is unnecessary and choose not to have it done. Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised.

As noted above, research studies suggest that there may be some medical benefits to circumcision. These include the following:

• A lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.

• A lower risk of getting cancer of the penis. However, this type of cancer is very rare in both circumcised and uncircumcised males.

• A slightly lower risk of getting sexually transmitted diseases (STDs), including HIV, the AIDS virus.

• Prevention of foreskin infections.

• Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.

• Easier genital hygiene.

Just as there are reasons parents may choose circumcision, they are reasons why parents may choose NOT to have their son circumcised:

• Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.

• The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. Rarely, this can cause urination problems that may need to be surgically corrected.

• Some people believe that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. This has not been proven by any medical or psychological study.

Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases.

© Copyright 2001 American Academy of Pediatrics

Croup is an inflammation of the voice box (larynx) and windpipe (trachea). When a child has croup, the airway just below the vocal cords becomes swollen and narrow. This makes breathing noisy and difficult.

Some children get croup often, such as whenever they have a respiratory illness. Children are most likely to get croup between 6 months and 3 years of age. After age 3, it is not as common because the windpipe is larger, so swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common between October and March.

There are two different types of croup:

• Spasmodic croup is usually caused by a mild upper respiratory infection or allergy. It is often frightening because it comes on suddenly in the middle of the night. Your child may go to bed with a mild cold and wake up in a few hours, gasping for breath. He will also be hoarse and have a cough that sounds like a seal barking. Most children with spasmodic croup do not have a fever. This type of croup can reoccur.
• Viral croup results from a viral infection in the voice box and windpipe. This kind of croup often starts with a cold that slowly develops into a barking cough. As your child's airway swells and she secretes more fluid, it becomes harder for her to breathe. Her breathing will also get noisier, and it may make a coarse musical sound each time she breathes in. This condition is called stridor. Most children with viral croup have a low fever, but some have temperatures up to 104°F.

As your child's effort to breathe increases, he may stop eating and drinking. He also may become too tired to cough, although you will hear the stridor more with each breath. The danger with croup accompanied by stridor is that the airway will keep swelling. If this happens, it may reach a point where your child cannot breathe at all.

Stridor is common with mild croup, especially when a child is crying or moving actively. But if a child has stridor while resting, it can be a sign of severe croup.

Treating Croup

If your child wakes up in the middle of the night with croup, take her into the bathroom. Close the door and turn the shower on the hottest setting to let the bathroom steam up. Sit in the steamy bathroom with your child. Within 15 to 20 minutes, the warm, moist air should help her breathing. (She will still have the barking cough, though.)

For the rest of that night and 2 to 3 nights after, try to use a cold-water vaporizer or humidifier in your child's room. Sometimes another attack of croup will occur the same night or the next. If it does, repeat the steam treatment in the bathroom. Steam almost always works. If it does not, take your child outdoors for a few minutes. Inhaling moist, cool night air may loosen up the air passages so that he can breathe more freely. If that does not help, consult your pediatrician about other options. If your child's breathing becomes a serious struggle, call for emergency medical services. (In most areas, dial 911.)

Never try to open your child's airway with your finger. Breathing is being blocked by swollen tissue out of your reach, so you cannot clear it away. Besides, putting your finger in your child's throat will only upset her. This can make her breathing even more difficult. For the same reasons, do not force your child to throw up. If she does happen to vomit, hold her head down and then quickly sit her back up once she is finished.

Your pediatrician will ask if your child's breathing is better after the steam treatment. If it is not, your pediatrician may prescribe a steroid medication to reduce swelling in the throat or shorten the illness. Although it has not been firmly proven that this works, treatment with a steroid for 5 days or less should do no harm.

Antibiotics, which treat bacteria, are not helpful for croup because the problem is almost always caused by a virus or allergy. Cough syrups are of little use too, because they do not affect the larynx or trachea, where the infection is located. These also may get in the way of your child coughing up the mucus from the infection.

If you suspect your child has croup, call your pediatrician—even if it is the middle of the night. Also, listen closely to your child's breathing. Call for emergency medical services immediately if he:

• makes a whistling sound that gets louder with each breath
• cannot speak for lack of breath
• seems to be struggling to get a breath
• seems very pale or has a bluish mouth or fingernails
• has stridor when resting
• drools or has extreme difficulty swallowing saliva

In the most serious cases, your child will not be getting enough oxygen into her blood. If this happens, she may need to go into the hospital. There she may be put in a plastic tent, called a croup tent, to receive oxygen. She may also be fed through a vein and take medication by inhaling it. Sometimes a tube is inserted through the nose or mouth into the windpipe to bypass the swelling in the larynx and trachea. Your child may be hoarse for a while after the tube is removed, but this usually does not last. Luckily, these severe cases of croup do not occur very often.

© Copyright 2000 American Academy of Pediatrics

• Almost every child will get a diaper rash sometime in their life no matter how clean we try to keep them. They may occur with cloth or disposable diapers.
• Diarrhea is a common factor to trigger a diaper rash. It is typically caused by moisture, and skin irritation from bacteria in the stool or chemicals in the urine. This creates an irritant diaper rash that appears like a burn more predominately in the rectal area.
• Yeast (candidal) diaper rashes are also common. This comes from a moist, heated environment and typically looks red, sometimes raw or raised with small bumps. The bumps that look like pimples around the edge of the rash are called "satellite lesions." Yeast rashes usually occur more towards the front of the genitals - on the labia in girls, on the testes and groin area of boys and can even spread down the thighs.

Call the doctor immediately if:

• Large blisters more than one inch
• Acting sick

Call during office hours if:

• Rash is worsening despite home treatment after 3 days
• Blisters, sores or crusting develops

Home Treatment

Irritant diaper rash. Change diapers frequently and immediately after bowel movements. Wash with warm water and mild soap or you may use Vaseline to clean the skin. Allow the diaper area to air dry whenever possible. Carefully use a blow dryer on a low setting to help dry the area. Avoid airtight plastic pants. A barrier ointment like Desitin, Dyprotex or A & D ointment are helpful to protect the skin. Powders are not generally recommended because of the risk of a baby aspirating the powder into their lungs when it is being used.

Yeast (candidal) rash. Yeast infections are very common in babies. Yeast is present everywhere in our environment. It loves moist areas such as the diaper area. It can also be found in other areas like the creases under the arms and the neck of a chubby baby. It may also be present in the mouth and is called thrush when it occurs orally. If your baby has a yeast diaper rash, be sure to check the mouth also and call the doctor during office hours to receive a prescription for thrush. Thrush appears as white patches inside the cheeks, lips and on the tongue. Yeast diaper rashes needs an antifungal cream to cure it. These creams are available by prescription or over-the-counter. The over-the-counter cream contains clotrimazole and one brand of this is called Lotrimin.

©1997CallYour Ped.com, Encinitas California

1. Bathe with Dove unscented soap.

2. If above soap is not helping, then try one of the following soapless cleansers:

a. Cetaphil soapless cleanser.

b. Aquanil soapless cleanser.

3. Apply one of the following lotions after bath to moisten skin and as necessary:

a. Curel

b. Eucerin

c. Lubriderm

d. Moisturel

e. Aquaphor

f. Theraplex Emollient

4. Apply prescription medication as ordered.

While most fevers don't require a call to your pediatrician, there are certain circumstances when a fever could indicate something more serious.

Call your pediatrician immediately if your child has a fever and:

• Looks very ill, is unusually drowsy or is very fussy
• Has been in an extremely hot place, such as an overheated car
• Has additional symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
• Has a condition that suppresses immune responses, such as sickle-cell disease or cancer or is taking steroids
• Has had a seizure
• Is younger than 2 months of age and has a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher

A child older than 6 months of age who has a temperature below 101 degrees Fahrenheit (38.3 degrees Celsius) probably does not need to be treated for fever, unless the child is uncomfortable. Observe her behavior. If she is eating and sleeping well and is able to play, you may wait to see if the fever improves by itself.

In the meantime:

• Keep her room comfortably cool
• Make sure that she is dressed in light clothing
• Encourage her to drink fluids such as water, diluted fruit juices, or a commercially prepared oral electrolyte solution
• Be sure that she does not overexert herself

There are also medications you can give your child to reduce his temperature if he is uncomfortable. Both acetaminophen and ibuprofen are safe and effective in proper doses. Be sure to follow the correct dosage and medication schedule for your child. Remember, any medication can be dangerous if you give your child too much.

Ibuprofen should only be used for children older than 6 months of age. It should not be given to children who are vomiting constantly or are dehydrated. Do not use aspirin to treat your child's fever. Aspirin has been linked with side effects such as an upset stomach, intestinal bleeding and, most seriously, Reye syndrome.

If your child is vomiting and unable to take medication by mouth, your pediatrician may recommend a rectal suppository for your child. Acetaminophen suppositories can be effective in reducing fever in a vomiting child.

Read the label on all medications to make sure that your child receives the right dose for his age and weight. To be safe, talk to your pediatrician before giving your child any medication to treat fever if he is younger than 2 years of age.

An alternative to over-the-counter medications is to sponge your child with lukewarm water. Sponging may reduce your child's temperature as water evaporates from her skin. Your pediatrician can advise you on this method.

Your pediatrician may recommend that you try sponging your child with lukewarm water in cases such as the following:

• Your child's temperature is above 104 degrees Fahrenheit (40 degrees Celsius)
• She is vomiting and unable to take medication
• She has had a febrile seizure in the past

Do not use cold water to sponge your child, as this could cause shivering. That could increase her temperature. Never add alcohol to the water. Alcohol can be absorbed into the skin or inhaled, causing serious problems such as a coma.

Usually 5 to 10 minutes in the tub is enough time for a child's temperature to start dropping. If your child becomes upset during the sponging, simply let her play in the water. If she is still bothered by the bath, it is better to remove her even if she has not been in long enough to reduce her temperature. Also remove her from the bath if she continues to shiver because shivering may increase body temperature.

Do not try to reduce your child's temperature to normal too quickly. This could cause the temperature to rebound higher.

Be sure to call your pediatrician if your child still "acts sick" once the fever is brought down, or if you feel that your child is very sick. Also call if the fever persists for

• More than 24 hours in a child younger than 2 years of age
• More than three days in a child 2 years of age or older

Related Articles

• Fever — How to Take a Temperature
• Fever — Understanding a Fever
• Home Treatment of a Fever

© 2002 American Academy of Pediatrics

Sometimes despite your best efforts, a child will get into a harmful substance. In cases like these, it's important to stay calm and gather the information necessary to help your child. Here are some suggestions for handling different types of poisoning emergencies.

Swallowed Poison

If you find your child with an open or empty container of a nonfood item, your child may have been poisoned. Stay calm and act quickly.

First, get the item away from your child. If there is still some in your child's mouth, make him spit it out or remove it with your fingers. Keep this material along with anything else that might help determine what your child swallowed.

Take the poison container with you to help the doctor determine what was swallowed. Do not make your child vomit because it may cause more damage.

If a child is unconscious, not breathing, having convulsions or having seizures, call 911 or your local emergency number right away.

If your child does not have these symptoms, call the poison center at 1-800-222-1222. You may be asked for the following information:

• Your name and phone number.
• Your child's name, age and weight.
• Any medical conditions your child has.
• Any medicine your child is taking.
• The name of the item your child swallowed. Read it off the container and spell it.
• The time your child swallowed the poison (or when you found your child), and the amount you think was swallowed.

If the poison is very dangerous, or if your child is very young, you may be told to take him right to the nearest hospital. If not, you will be told what to do at home.

Poison on the Skin

If your child spills a dangerous chemical on her body, remove her clothes and rinse the skin with room temperature water for at least 15 minutes, even if your child resists. Then call the poison center at 1-800-222-1222. Do not use ointments or grease.

Poison in the Eye

Flush your child's eye by holding the eyelid open and pouring a steady stream of room temperature water into the inner corner. It is easier if another adult holds your child while you rinse the eye. If another adult is not around, wrap your child tightly in a towel and clamp him under one arm. Then you will have one hand free to hold the eyelid open and the other to pour in the water. Continue flushing the eye for 15 minutes. Then call the poison center at 1-800-222-1222. Do not use an eyecup, eyedrops or ointment unless the poison center tells you to.

Poisonous Fumes

In the home, poisonous fumes can come from:

• A car running in a closed garage
• Leaky gas vents
• Wood, coal or kerosene stoves that are not working right
• Space heaters, ovens, stoves or hot water heaters that use gas

If your child is exposed to fumes or gases, have her breathe fresh air right away. If she is breathing, call the poison center at 1-800-222-1222 about what to do next. If she has stopped breathing, start cardiopulmonary resuscitation (CPR) and do not stop until she breathes on her own or someone else can take over. If you can, have someone call 911 right away. If you are alone, wait until your child is breathing, or after one minute of CPR, then call 911.

Important Information About Syrup of Ipecac

Syrup of ipecac is a drug that was used in the past to make children vomit after they had swallowed a poison. Although this may seem to make sense, this is not a good poison treatment. You should not make a child vomit in any way, including giving him syrup of ipecac, making him gag or giving him saltwater. If you have syrup of ipecac in your home, flush it down the toilet and throw away the container.

Related Articles

• How to Poison-Proof Your Home
• Protect Your Child From Poison

© 2003 American Academy of Pediatrics

1.  Irrigate the nose with saline (5-6 drops each nostril).
2.  Use a long tip nasal bulb syringe.
3.  Insert the tip of the bulb in one of the nostrils (think about where the opening of the tip is pointing).  Opening needs to point behind the nose, not above the nose at the forehead
4.  Close the opposite nostril that you are not using off when suctioning.
5.  Need to suction 3 to 4 times per day when there is nasal congestion.

While you often can tell if your child is warmer than usual by feeling his forehead, only a thermometer can tell if he has a fever and how high the temperature is. There are several types of thermometers and methods for taking your child's temperature.

Mercury thermometers should not be used. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this toxin.

Rectal

If your child is younger than 3 years of age, taking his temperature with a rectal digital thermometer provides the best reading.

1. Clean the end of the thermometer with rubbing alcohol or soap and water. Rinse it with cool water. Do not rinse with hot water.

2. Put a small amount of lubricant, such as petroleum jelly, on the end.

3. Place your child belly down across your lap or on a firm surface. Hold him by placing your palm against his lower back, just above his bottom.

4. With the other hand, turn on the thermometer switch and insert the thermometer 0.5" to 1" into the anal opening. Hold the thermometer in place loosely with two fingers, keeping your hand cupped around your child's bottom. Do not insert the thermometer too far.

5. Hold in place for about one minute, until you hear the "beep." Remove the thermometer to check the digital reading.

Oral

Once your child is 4 or 5 years of age, you may prefer taking his temperature by mouth with an oral digital thermometer.

1. Clean the thermometer with lukewarm soapy water or rubbing alcohol. Rinse with cool water.

2. Turn on the switch and place the sensor under his tongue toward the back of his mouth.

3. Hold in place for about one minute, until you hear the "beep." Check the digital reading.

4. For a correct reading, wait at least 15 minutes after your child has had a hot or cold drink before putting the thermometer in his mouth.

Ear

Tympanic thermometers, which measure temperature inside the ear, are another option for older babies and children.

1. Gently put the end of the thermometer in the ear canal. Press the start button. You will get a digital reading of your child's temperature within seconds.

While it provides quick results, this thermometer needs to be placed correctly in your child's ear to be accurate. Too much earwax may cause the reading to be incorrect.

Underarm (Axillary)

Although not as accurate, if your child is older than 3 months of age, you can take his underarm temperature to see if he has a fever.

1. Place the sensor end of either an oral or rectal digital thermometer in your child's armpit.

2. Hold his arm tightly against his chest for about one minute, until you hear the "beep."

3. Check the digital reading.

Other methods for taking your child's temperature are available. They are not recommended at this time. Ask your pediatrician for advice.

© 2002 American Academy of Pediatrics

Many infants are born with incomplete development of the tear duct drainage system (nasolacrimal duct). As a consequence of this blockage, tearing and repeated infections (conjunctivitis) tend to occur. Since tears, which are being constantly produced, cannot drain into the nose, there is a “spillover.” Infections, associated with discharge or crusting, commonly develop as bacteria grow within the blocked system. In the vast majority of children these “blocked tear ducts” open within the first few months following birth. Management consists of daily finger pressure to the area of the lacrimal sac and antibiotic medication to combat infection as necessary. If signs of obstruction (wetness, tearing, infection) persist as the child approaches age 5-7 months, then a simple surgical procedure (probing and irrigation) may be required. Earlier intervention is recommended in few with sever infection. The procedure is typically accomplished in the office and is extremely effective.

Diagnostic Findings

--Continuously watery eye
--Tears running down the face even without crying
--During crying, nostril on blocked side remains dry
--Onset not red and eyelid not swollen (unless the soggy tissues become infected)

Cause

Your child probably has a blocked tear duct on that side. This means that the channel that normally carries tears from the eye to the nose is blocked. Although the obstruction is present at birth, the delay in onset of symptoms can be explained by the occasional delay in tear production until the age of 3 or 4 weeks in some babies. Both sides are blocked 30% of the time.

Expected Course

This is a common condition, affecting 6% of newborns. Over 90% of blocked tear ducts open up spontaneously by the time the child is 12 months of age. If the obstruction persists beyond 12 months of age, an ophthalmologist (eye specialist) can open it with a probe.

Home Care for Preventing Infection

Because of poor drainage, eyes with blocked tear ducts become easily infected. The infected eye produces a yellow discharge. To keep the eye free of infection, massage the lacrimal sac (where tears collect) twice daily. Always wash your hands carefully before doing this. The lacrimal sac is located in the inner lower corner of the eye. This sac should be massaged to empty it of old fluids and to check for infection. Start at the inner corner of the eye and press upward using a cotton swab. (Caution: Massaging downward is not helpful and may lead to infection.) If the eye becomes infected, it is very important to begin antibiotic eye drops.

Call Our Office

Immediately if:

--the eyelids are red or swollen.
--A red lump appears at the inner lower corner of the eyelid.

During office hours if:

--The eyelids are stuck together with pus after naps.
--Much yellow discharge is present.
--Your child reaches 12 months of age and the eye is still watering.
--You have other concerns or questions.

Instructions for Pediatric Patients, 2^nd Edition, 1999 by WB Saunders Company
Written by Barton D. Schmitt, M.D. pediatrician and author of Your Child’s Health

After the first bath, your newborn will normally have a ruddy complexion from the extra high count of red blood cells. He can quickly change to a pale or mottled-blue color if he becomes cold, so keep him warm. During the second week of life, the skin normally becomes dry and flaky. This guideline covers seven rashes and birthmarks. Save time by going directly to the one that pertains to your baby.

Acne of Newborn

More than 30% of newborns develop acne of the face, mainly small red bumps. This neonatal acne begins at 3 to 4 weeks of age and lasts until 4 to 6 months of age. The cause appears to be the transfer of maternal androgens (hormones) just before birth. Since it is temporary, no treatment is necessary. Baby oil or ointments will just make it worse.

Drooling Rash

Most babies have a rash on the chin or cheeks that comes and goes. This is often due to contact with food and acid that has been spat up from the stomach. Rinse the baby’s face with water after all feedings or spitting up.

Other temporary rashes on the face are heat rashes in areas held against the mother’s skin during nursing (especially in the summertime). Change your baby’s position more frequently and put a cool washcloth on the area. No baby has perfect skin. The babies in advertisements wear makeup.

Erythema Toxicum

More than 50% of babies get a rash called erythema toxicum on the second or third day of life. The rash is composed of ½ to 1 inch red blotches with a small white lump in the center. They look like insect bites. They can be numerous, keep occurring, and be anywhere on the body surface. Their cause is unknown; they are harmless and resolve themselves by 2 weeks of age (rarely 4 weeks).

Forceps or Birth Canal Trauma

If delivery was difficult, a forceps may have been used to help the baby through the birth canal. The pressure of the forceps on the skin can leave bruises or scrapes or can even damage fat tissue anywhere on the head or face. Skin overlying bony prominences (such as the sides of the skull bone) can become damaged even without a forceps delivery by pressure from the birth canal. Fetal monitors can also cause scrapes and scabs on the scalp. The bruises and scrapes will be noted on day 1 or 2 and disappear by 1 to 2 weeks. The fat tissue injury won’t be apparent until day 5 to 10. A thickened lump of skin with an overlying scab is the usual finding. This may take 3 or 4 weeks to resolve. For any breaks in the skin, apply an antibiotic ointment (over the counter) four times a day until healed. If it becomes tender to the touch or soft in the center or shows other signs of infection, call our office.

Milia

Milia are tiny white bumps that occur on the faces of 40% of newborn babies. The nose and cheeks are most often involved, but milia are also seen on the forehead and chin. Although they look like pimples, they are smaller and not infected. They are blocked-off skin pores and will open up and disappear by 1 to 2 months of age. No ointments or creams should be applied to them.

Any true blisters (little bumps containing clear fluid) or pimples (especially of the scalp) that occur during the first month of life must be examined and diagnosed quickly. If they are caused by the herpes virus, treatment is urgent. If you suspect blisters or pimples, call our office immediately.

Mongolian Spots

A Mongolian spot is a bluish-gray flat birthmark found in more than 90% of Native American, Asian, Hispanic, and Black babies. Mongolian spots occur most commonly over the back and buttocks, although they can be present on any part of the body. They vary greatly in size and shape. Most fade away by 2 or 3 years of age, although a trace may persist into adult life.

Stork Bites (Pink Birthmarks)

Flat pink birthmarks (also called capillary hemangiomas) occur over the bridge of the nose, the eyelids, or the back of the neck in more than 50% of newborns. The birthmarks on the bridge of the nose and eyelids clear completely by 1 to 2 years of age. Most birthmarks on the nape of the neck also clear, but 25% can persist into adult life. Those on the forehead that run from the bridge of the nose up to the hairline usually persist into adult life. Laser treatment during infancy should be considered.

Instructions for Pediatric Patients, 2^nd Edition, 1999 by WB Saunders Company
Written by Barton D. Schmitt, MD, pediatrician and author of Your Child’s Health

Every child, like every adult, has frightening dreams that cause him or her to wake up scared. While no one really knows what causes nightmares, most experts feel that scary dreams develop as youngsters resolve internal conflicts and inner fears that surface during normal child development. In addition, real-life events, such as scary movies or violent television shows, can precipitate nightmares.

Parents usually become aware of their youngster’s nightmare once the episode is over and the child runs out of his or her bedroom crying and sobbing. On the other hand, older children begin to understand what a nightmare is and usually put themselves back to sleep without wakening the parents. Nightmares generally occur during the second half of the night when dreaming is most intense.

When a nightmare wakes up a child, the frightened youngster needs physical contact, comfort and reassurance. Following the episode, most children can tell their parents exactly what the bad dream was about, giving parents the opportunity to reassure their youngster that it is only a bad dream. Plan on staying with your child a few minutes until he or she is calm, becomes drowsy, and is ready to go back to sleep. In the morning, talk to your child about things that might be bothering him or her since nightmares are more common in children who are under some unusual stress. To the youngster a severe nightmare is real, so expect several nights of awakening or worrying about going to sleep at night following an episode.

If a child is having frequent nightmares, parents should review their youngster’s activities both during the day and at night. There is a lot going on in today’s world that is difficult for young children to handle. Make sure he or she is not watching too many scary or violent television programs. The distinction between fantasy and realty is often blurred in children. Images produced by violent movies and graphic television programs will stay with kids.

Another common sleep disorder that occurs in children is night terrors, known medically as “pavor nocturnus.” In contrast to nightmares, night terrors develop earlier in the night and usually begin one to four hours after falling asleep. Parents find their child sitting up in bed, screaming and trashing about but not entirely awake. The heart is racing and the eyes are wide open, sometimes even talking to their parents yet not responding to questions. During the episode, the youngster is usually not even aware of the parents’ presence, and may even push the parent away, sobbing and flailing more if touched or disturbed. The child is inconsolable for sometimes up to 30 minutes until finally relaxing and falling back to sleep on his or her own. In the morning, the youngster usually has no memory of the incident.

Night terrors are more common in children between the ages of 3 and 8 and the condition is often inherited. The episodes are not harmful and disappear as the child grows older. Night terrors seem to get worse when the child is over tired or is on an irregular schedule.

Parents should resist trying to comfort or hold their child during a night terror. Since the child is still partly asleep, comforting the youngster could wake him or her, making the child even more disoriented. Instead, watch to make sure he or she is safe from injury until returning to normal sleep. It is important to warn baby sitters and grandparents about night terrors and how to handle the situation, since the episode can be upsetting and scary to a caregiver.

Of course, there will be those situations when your child is neither having a nightmare nor night terror. The child may be seeking attention or special privileges may evoke the behavior. There are certain precautionary steps parents can take. First, give the child some time to go back to sleep (ten minutes is a good period). Then, go into the child’s room, reassure him or her that everything is okay, and put him or her back to bed. Make the visit boring and do not reward the child for waking up by bringing him or her into your room or offering food.

For many parents, a child’s bedtime is the most feared time of the day. Their infant wakes up three times a night for a feeding or their toddler either resists going to bed or keeps getting up after being put to sleep. It is important for parents to teach their children where to sleep, such as their own bed, and when to sleep, namely that special time for sleeping called nighttime. Sleep disorders can easily be prevented when parents allow their child to fall asleep on their own and go back to sleep on their own during periods of normal night wakings. Feeding the infant at night, allowing the child to stay awake until exhausted, or lying down with the child in their bed are approaches that usually prolong sleep problems and establish patterns of behavior that are difficult to eliminate later.

When children develop good sleeping habits they will get more than a good night’s sleep. They will also be taught one of life’s most important lessons. Namely, one gains independence by depending on himself or herself and can get through times of stress without always having to count on others.

Copyright © 2000 KidsGrowth.com, LLC

As children grow and develop, their need to suck usually goes away, most often by the time they are 6 to 8 years old. Also, with increases in peer pressure, children are more able to control their behavior. However, parents sometimes want this behavior to stop before peer pressure becomes an issue.

If you want to break your older child's sucking habits, the first step is to ignore them! Most often, they will disappear with time. Harsh words, teasing, or punishment may upset your child, and the habit will get worse. Punishment is not an effective way to get rid of habits.

Older children (more than 3 years of age) may use sucking to relieve boredom. Try getting your child's attention with an activity that she finds fun. Rewarding good behavior is the best way to produce a change. Praise and reward your child when she does not suck her thumb or use the pacifier. Star charts, daily rewards, and gentle reminders, especially during the daytime hours, are also very helpful.

If these measures do not work and your child wants to stop, your pediatrician might recommend trying a reminder such as covering the thumb with a plastic strip or "thumb guard" (an adjustable plastic cap that is taped to the thumb). Your child should be directly involved with the treatment chosen. Before using these methods, be sure to explain them to your child. If they make your child afraid or tense, stop them at once.

If your child's teeth are affected by the behavior and you have tried all the methods described above, talk to a pediatric dentist. Some dentists will install a device in the mouth that prevents the fingers or thumb from putting pressure on the palate or teeth. In fact, this device usually makes it so unpleasant to place the thumb or finger into the mouth that your child removes his thumb or finger.

Severe emotional upsets or stress-related problems might cause your child to suck his thumb or use a pacifier for a long time. It is also possible that your child may be one of the very few who cannot seem to stop. However, most children stop daytime sucking habits before they get very far in school. This is because of peer pressure. These same children might still use sucking as a way of going to sleep or calming themselves when they are upset. This is usually done in private and causes no harm either emotionally or physically. Putting too much pressure on your child to stop this type of behavior may cause more harm than good. Even these children eventually stop the habit on their own.

© Copyright 2000 American Academy of Pediatrics

Around ten months of age, you may notice that you're child becomes much more "clutchy" about leaving you. When you're out of her sight, she'll know you're somewhere but not with her, and this will cause her great distress. She'll have so little sense of time that she won't know when, or even whether, you'll be coming back. Once she gets a little older, her memory of past experiences with you will comfort her when you're gone, and she'll be able to anticipate a reunion.

But for now she's only aware of the present, so every time you leave her sight, even to go to the next room, she'll fuss and cry. When you leave her with someone else she may scream as though her heart will break. At bedtime she'll refuse to leave you to go to sleep, and then she may wake up searching for you in the middle of the night. This developmental stage is known as separation anxiety. It can be a tough stage for both of you but it also marks the dawning realization for your child that each object is unique and permanent, and that there's only one of you.

Separation anxiety usually peaks between ten and eighteen months, and then fades during the last half of the second year. In some ways, this phase of your child's emotional development will be especially tender for both of you, while in others it will be painful. After all, her desire to be with you is a sign of her attachment to her first and greatest love, namely you. The intensity of her feeling as she hurtles into your arms is irresistible, especially when you realize that no one, including your child herself, will ever again think you are quite as perfect as she does at this age. On the other hand, you may feel suffocated by her constant clinging, while experiencing guilt whenever you leave her crying for you. Fortunately, this emotional roller coaster eventually will subside along with her separation anxiety.

If your child has a strong, healthy attachment to you, her separation anxiety probably will occur earlier than in other babies, and she'll pass through it more quickly. Instead of resenting her possessiveness during these months, maintain as much warmth and good humor as you can. Through your actions, you're showing her how to express and return love. This is the emotional base she'll rely on in years to come. The following suggestions may help ease separation anxiety.

• Your baby is more susceptible to separation anxiety when she's tired, hungry, or sick. If you know you're going out, schedule your departure so it occurs after she's napped and eaten. Try to stay with her as much as possible when she's sick.
• Don't make a fuss over your leaving. Instead, have the person staying with her create a distraction (a new toy, a visit to the mirror, a bath). Then say goodbye and slip away quickly.
• Remember that her tears will subside within minutes of your departure. Her outbursts are for your benefit to persuade you to stay. With you out of sight, she'll soon turn her attention to the person staying with her.
• Help her cope with separation through short practice sessions at home. Separation will be easier on her when she initiates it, so when she crawls to another room (one that's baby-proofed), don't follow her right away; wait for one or two minutes. When you go to another room for a few seconds, tell her where you're going and that you'll return. If she fusses, call to her instead of running back. Gradually, she'll learn that nothing terrible happens when you're gone and, just as important, you always come back when you say you will.
• If you take your child to a sitter's home or a child-care center, don't just drop her off and leave. Spend a few extra minutes playing with her in this new environment. When you do leave, reassure her that you'll be back later.

© Copyright 2000 American Academy of Pediatrics
Excerpted from "Caring for Your Baby and Young Child: Birth to Age 5" Bantam 1998

The ear canal is the tube that ends at the eardrum. This is where wax build-up occurs. When the ear canal is exposed to water from baths or swimming, the ear canal which is simply skin, may become infected with bacteria. The canal may appear red and swollen. The main symptom is pain with movement of the ear or touching the ear or pushing on the area in front the ear. This is commonly called an outer ear infection, swimmer's ear or otitis externa.

Tidbits:

• Swimmer's ear does not usually require an urgent call to the doctor after-hours. Acetaminophen or ibuprofen can be used for pain in the middle of the night.

Home Treatment:

Antibiotic ear drops. If your child has a swimmer's ear, presciption antibiotic drops with or without steriods in the drops are usually prescribed. If the case of a severe swimmer's ear, the physician may place a "wick" which is like a piece of cotton for a few days, so the drops will stay in the ear canal better and reach deeper into the ear canal. Occasionally, oral antibiotics will be used in severe cases or will be prescribed if there is an accompanying middle ear infection. Drops are usually used for 5 days and the child should not swim or get water in the ear during this time.

Prevention. Some children are prone to swimmer's ear and there are over-the-counter drops that may be used after swimming to help prevent swimmer's ear. This helps to dry the ear canal and creates acidity where bacteria will not grow as easily. Drops may be made at home by combining half vinegar and half rubbing alcohol.

©1997CallYour Ped.com, Encinitas California

First of all, there's a difference between real vomiting and just spitting up. Vomiting is the forceful throwing up of stomach contents through the mouth. Spitting up (most commonly seen in infants under 1 year of age) is the easy flow of stomach contents out of the mouth, frequently with a burp.

Vomiting occurs when the abdominal muscles and diaphragm contract vigorously while the stomach is relaxed. This reflex action is triggered by the "vomiting center" in the brain after it has been stimulated by:

• Nerves from the stomach and intestine when the gastrointestinal tract is either irritated or swollen by an infection or blockage

• Chemicals in the blood (drugs, for example)

• Psychological stimuli from disturbing sights or smells

• Stimuli from the middle ear (as in vomiting caused by motion sickness)

Causes of Spitting Up

The common causes of spitting up vary according to age. During the first few months, for instance, most infants will spit up small amounts of formula, usually within the first hour after being fed. This "cheesing," as it is often called, is simply the occasional movement of food from the stomach, through the tube (esophagus) leading to it, and out of the mouth. It will occur less often if a child is burped frequently and if active play is limited right after meals. This spitting up tends to decrease as the baby becomes older but may persist in a mild form until 10 to 12 months of age. Spitting up is not serious and doesn't interfere with normal weight gain.

Causes of Vomiting

After the first few months of life, the most common cause of vomiting is a stomach or intestinal infection. Viruses are by far the most frequent infecting agents, but occasionally bacteria and even parasites may be the cause. The infection also may produce fever, diarrhea, and sometimes nausea and abdominal pain. The infection is usually contagious, so if your child has it, chances are some of her playmates also will be affected.

Occasionally, infections outside the gastrointestinal tract will cause vomiting. These include infections of the respiratory system, infections of the urinary tract, otitis media and pneumonia, as well as meningitis, appendicitis and Reye syndrome.

Warning Signs of Vomiting

Some conditions that cause vomiting require immediate medical treatment, so be alert for the following trouble signs, whatever your child's age, and call your pediatrician if they occur.

• Blood or bile (a green-colored material) in the vomitus

• Severe abdominal pain

• Strenuous, repeated vomiting

• Swollen abdomen

• Lethargy or severe irritability

• Convulsions

• Signs or symptoms of dehydration, including dry mouth, absent tears, depression of the "soft spot" and decreased urination

• Inability to drink adequate amounts of fluid

• Vomiting continuing beyond twenty-four hours

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics