Common Pediatric Health Concerns This information is offered to help you deal with these common, but often frightening problems, as they arise. We hope you find this information to be valuable. Fever is a symptom, not a disease. Fever is the body's natural and good response to fighting infection. Fever turns on the body's entire immune system. The usual fevers children get are not harmful - even at 104 to 105 degrees. Most fevers are caused by viral rather than bacterial illness. Fever causes no harm until it reaches 107 degrees F. Fortunately the brain's thermostat helps the fever stay below this level. Either Ibuprofen (Motrin, Advil) or Acetaminophen (Tylenol, Tempra) are effective for reducing fever. We recommend using these medications only if your child is uncomfortable or has temperatures over 101 degrees F oral or rectal. The doses for these are printed on the packages, but can be confusing. We will be happy to review them with you.
Please call our office if your child under 2 months of age has a fever. Remember, Fever is not a Disease.
Diagnostic Findings Vomiting is the forceful ejection of a large portion of the stomach's contents through the mouth. The mechanism is strong stomach contractions against a closed stomach outlet. By contrast, regurgitation is the effortless spitting up of one or two mouthfuls of stomach contents, which is commonly seen in babies under 1 year of age. Cause Most vomiting is caused by viral infection of the stomach or eating something that disagrees with your child. Often, the viral type is associated with diarrhea. Expected Course The vomiting usually stops in 6 to 24 hours. Dietary changes usually speed recovery. Home Care for Vomiting Special Diet for Vomiting Clear Fluids for 8 Hours. Offer child clear fluids (not milk) in small amounts until 8 hours have passed without vomiting. For infants you can also use one of the oral electrolyte solutions (such as Pedialyte, Resopl, or TIcelyte). After this age, soft drinks (cola, lemon-lime, or ginger ale), are also acceptable. Stir until no fizz remains (the bubbles inflate the stomach and increase the changes of continued vomiting) Start with 1 teaspoon to 1 tablespoon, depending on age, every 10 minutes. Double the amount each hour. If your child vomits using this treatment, rest the stomach completely for 1 hour and then start over but with smaller amounts. The one-swallow-at-a-time approach rarely fails. Bland Foods after 8 Hours without Vomiting. After 8 hours without vomiting, your child can gradually return to a normal diet. For older children, start with foods such saltine crackers, whole wheat or white bread, bland soups (for example, "chicken with stars") rice, and mashed potatoes. For babies start with foods such as applesauce, strained bananas, and rice cereal. If your baby only takes formula, give 1 or 2 ounces less per feeding than usual. Usually your child can be back on a normal diet within 24 hours after recovery from vomiting. Diet for Breast-fed Babies. The key to treatment is providing breast milk in smaller amounts than usual. If your baby has only vomited once or twice, continue breast-feeding but nurse only one side each time for 10 minutes. After 8 hours have passed since your baby has vomited, return to both sides. If vomiting occurs three or more times, put your baby on an oral electrolyte solution. As soon as 4 hours elapse without vomiting, return to nursing, but again with smaller than usual amounts for 8 hours. Medicines. Discontinue all medicines for 8 hours. Oral medicines can irritate the stomach and make vomiting worse. If your child has a fever over 102 degrees F, use acetaminophen suppositories. Call our office if your child needs to be taking a prescription medicine. Common Mistakes in Treatment of Vomiting. A common error is to give as much clear fluid as your child wants rather than gradually increasing the amount. This almost always leads to continued vomiting. Keep in mind that there is no effective drug or suppository for vomiting and that diet therapy is the answer.
During Regular Hours if:
Definition Diarrhea is the sudden increase in the frequency and looseness of bowel movements. Mild diarrhea is the passage of a few loose or mush stools. The best indicator of the severity of the diarrhea is the frequency. A green stool also points to very rapid passage and moderate to severe diarrhea. The main complication of diarrhea is dehydration from excessive loss of body fluids. Symptoms are a dry mouth, the absence of tears, a reduction in urine production (e.g. none in 8 hours), and a darker, concentrated urine. It's dehydration you need to worry about, not the presence of diarrhea. Cause: Diarrhea is usually caused by a viral infection of the intestines (gastroenteritis). Occasionally it is caused by bacteria or parasites. Diarrhea can be due to excessive fruit juice or to a food allergy. If only one or two loose stools are passed, the cause was probably something unusual your child ate. Expected Course: Diarrhea usually lasts from several days to a week, regardless of the treatment. The main goal of therapy is to prevent dehydration by giving enough oral fluids to keep up with the fluids lost in the diarrhea., Don't expect a quick return to solid stools. Since one loose stool can mean nothing, don't start dietary changes until there have been at least two. Home Care: Diet Dietary changes are the mainstay of home treatment for diarrhea. The optimal diet depends on your child's age and severity of the diarrhea. Go directly to the part of the information that pertains to your child. Special Diets for Diarrhea Mild Diarrhea and Child of Any Age
Bottle-Fed Infants and Frequent, Watery Diarrhea Oral Rehydration Solutions (ORS) for 6 to 24 Hours. Children with severe diarrhea need ORS to prevent dehydration. Examples are Infalyte, Kao-Lectrolyte, or Pedialyte. These over-the-counter products are available in all pharmacies or supermarkets. (ORS is not needed for diarrhea unless it's severe.) Give as much ORS as your baby wants. Diarrhea makes children thirsty, and your job is to satisfy that thirst and prevent dehydration. Never restrict fluids whey your child has diarrhea. Until you get one of these special solutions, continue giving your baby full-strength formula in unlimited amounts. (Avoid giving your baby Jell-O water mixtures or sports drinks. Reason: inadequate sodium content.) If you can't get an ORS, ask your doctor about making a homemade ORS as follow: Mix 1/2 cup of dry instant rice cereal with 2 cups (16 ounces) of water and 1/4 level teaspoon of salt. Be careful not to add too much salt. Continue giving your baby ORS for at least 6 hours. Between 6 and 24 hours, switch back to formula when your baby becomes hungry, the diarrhea becomes less watery, and the child is making lots of urine. Returning to Formula. After being given ORS for 6 to 24 hours, your baby will be hungry, so begin regular formula. If the diarrhea continues to be severe, begin with a soy formula. If you give cow's mil formula and the diarrhea doesn't improve after 3 days, change to a lactose-free formula (milk-based lactose-free ). Often there is less diarrhea with lactose-free formulas than with cow's milk formulas. If your baby's bowel movements are very watery, mix the formula with 1 or 2 ounces of extra water per bottle for 24 hours. Then after 24 hours go back to full-strength formula. Adding Solids. Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 4 months old, has had diarrhea for over 24 hours, and wants to eat solid food, give her the following starchy foods until the diarrhea is gone: any cereal, mashed potatoes, applesauce, strained bananas, strained carrots, and other high-fiber foods. Breast-Fed Infants and Frequent, Watery Diarrhea Definition of Diarrhea. No matter how it looks, the stool of the breast-fed infant must be considered normal unless it contains mucus or blood or develops a bad odor. In fact, breast-fed babies can normally pass some green stools or stools with a water ring around them. Frequency of movements is also not much help. As previously stated, during the first 2 or 3 months of life, the breast-fed baby may normally have as many stools as one after each feeding. The presence of something in the mother's diet that causes rapid passage should always be considered in these babies (e.g., coffee, cola, or herbal teas). Diarrhea can be diagnosed if your baby's stools abruptly increase in number. Additional clues are if your baby feeds poorly, acts sick, or develops a fever. Treatment
Older Children (over 1 Year Old) and Frequent, Watery Diarrhea
Home Care: Other Aspects Common Mistakes. Using boiled skim milk or any concentrated solution can cause serious complications for babies with diarrhea because they contain too much salt. Kool-Aid and soda pop should not be used as the only foods because they contain little or no salt. Use only the fluids mentioned. Clear fluids alone should only be used for 6 to 24 hours because the body needs more calories than they can provide. Likewise, a diluted formula should not be used for more than 24 hours. The most dangerous myth is that the intestine should be "put to rest"; restricting fluids can cause dehydration. Keep in mind that there is not effective, safe drug for diarrhea and that extra water and diet therapy work best. Prevention. Diarrhea is very contagious. Hand washing after diaper changing or using the toilet is crucial for keeping everyone in the family from getting diarrhea. Diaper Rash from Diarrhea. The skin near your baby's anus can become "burned" from the diarrhea stools. Wash it off after each bowel movement and then protect it with a thick layer of petroleum jelly or other ointment. This protection is especially needed during the night and during naps. Changing the diaper quickly after bowel movements also helps. Overflow Diarrhea in a Child Not Toilet Trained. For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery stool. Use disposable superabsorbent diapers temporarily to cut down on cleanup time. Use the ones with snug leg bands or cover the others with a pair of plastic pants. Wash your child under running water in the bathtub. Someday she will be toilet trained.
Note: If your child has vomited more than once, treatment of the vomiting has priority over the treatment of diarrhea until your child has gone 8 hours without vomiting. During Regular hours if
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