General
What is a fever and what do I do for a fever?
I think my child has a wart on her finger, what should I do?

Baby
I think my baby has a cold, what should I do?
I think my baby is teething, what can I do for her?
How do I take care of my baby's teeth?
My 5 month old has not passed a stool in 2 days, how do I treat constipation?
My baby spits up a bit after every meal, is something wrong?
My 3 months always has a gooey, watery eye, is it infected?
My baby has a diaper rash, what can I do for it?
When can I travel with my baby?
My baby has very dry, sensitive skin, could it be eczema?
My baby was so easy, but now at 6 weeks old, he cries every night, is this colic?
What is Croup?

Toddler
Can my toddler survive on goldfish crackers and milk?
How can I prevent dehydration in my child with the "stomach flu"?

Child
My child gets nosebleeds lately, is something seriously wrong?
The school nurse found head lice on my child, what do I do?
My child was just stung by a bee, what should I do?
How do I comfort my child who has the chicken pox?

Teenager
My teenager is starting to get acne, what should we do?



What is a fever and What happens to my child’s body when he/she has a fever?

A fever is a body temperature that is higher than normal. Fever occurs when the body’s internal “thermostat” raises the body temperature above its usual level. This body “thermostat” is regulated in the part of the brain called the hypothalamus. The hypothalamus makes sure that our bodies maintain a certain temperature — usually around 98.6° Fahrenheit or about 37° Celsius.

A body temperature (including your child’s body temperature) may fluctuate during the day — a little lower in the morning and a little higher in the evening and can also increase as activity level increases. The temperature may fluctuate as much as 2° during the day. The hypothalamus may “reset” the body’s temperature to a higher degree in response to an infection, illness or some other cause-researchers believe increasing the heat is the body’s way of fighting the “germs” that cause infections- possibly making the body a less hospitable place for “germs” to live and reproduce. The white cells of the body produce a substance called interleukin-1when they digest a germ. Interleukin-1 induces the formation of prostaglandins- prostaglandins are the substances that act on the hypothalamus resetting the body thermostat to a higher level- resulting in a fever. Fever is a “friend”.


*Dosage Table for Acetaminophen (Tylenol, Tempra, FeverAll, Panadol) (HTML or Word Document)

**Dosage Table for Ibuprofen (Motrin, Advil) (HTML or Word Document)


It is very important to realize that fever itself is not an illness-only a symptom of one. In addition, fever itself is not a sign that your child needs an antibiotic-in fact it is usually a viral illness (an illness that just has to “run its course” — usually producing fever for 48-72 hours and then subsiding) and not a bacterial illness that would necessitate an antibiotic.

Fevers are generally harmless and help your child fight infection. Fever is a good sign because it signals that your child’s immune system is working and the body is trying to get rid of the infection. When your child has a fever, her heart and breathing will speed up slightly in addition to your child feeling slightly warm. She/he may appear flushed and perspiration may be present as well. There may be shivering, muscle aches, lack of appetite and general weakness. The “height” of the fever is not related to the “seriousness” of the illness. Just because your child has a fever of 104°F, this does not means that it is going to climb higher- like 106° for example. Temperatures of 104°F are common in children >12 months and are not an emergency — check out the information provided in this article or call the office for advice.

What causes fever? What is a viral/bacterial illness? How long can I expect the fever to last?

Again, it is important to remember that fever is a symptom- fever itself is not an illness. Fever may be caused by bacteria, a virus, a parasite, or heat stroke. Fever may also be caused by overdressing (especially infants because it is more difficult for them to regulate their body temperature) or by immunizations. A viral illness is the most common kind of illness that causes a fever. A virus may cause an illness such as a cold or the flu. Symptoms of a viral illness often come on quickly (over hours to a day or two). Viruses are infectious agents just like bacteria are. They reproduce fast, but only in a host cell (your child’s nose, mouth, or throat), and cannot carry on their own body functions without the help of the host (in this case the human body). Viral infections usually associated with minor illnesses are usually not serious and go away without medical treatment. Antibiotics are not used to treat a viral illness and will not help it go away any faster- the illness typically just has to “run its course”.

A “constant runny nose” (even yellow or green nasal discharge) is almost always attributed to a virus. The average number of upper respiratory viral illnesses that a young child gets each year is 6-10; even more if the child attends “play groups” or is in daycare. These viral illnesses sometimes overlap to create the “constant runny nose” phenomenon. A “supportive care” approach is encouraged as the body fights the virus on its own. Most of the common viral illnesses have a 2-5 day “incubation period”, which is the time after a child is exposed to the virus, but isn’t showing any symptoms yet. Most viruses are first brought into the child’s body through the nose and mouth from germs on the hands; so the first symptoms usually appear there- runny nose, cough, congestion, and sore throat. As the body fights the virus, the symptoms may increase over the next 3-4 days- this stage of the illness can be more severe than the first day or two. After this time, the body’s immune system typically has won the war, and the severity of symptoms will trail off within the next few days to a week. A bacterial illness is one that can cause such problems as streptococcal sore throat, pneumonia, and meningitis among others. Bacteria are treated with antibiotics. Bacteria may produce a fever that may last for longer than 72 hours. This is another reason why your child should be seen if the fever is present for longer than 72 hours.

How do I take my child’s temperature?

A parent can usually tell if their child is warmer than usual by feeling his/her forehead and how high the temperature is- this is termed “tactile temperature”. However, it may be important to find out the exact temperature in most instances: if your child is less than a year of age (especially infants <3 mos), if your child feels “really hot”, if the temperature has persisted past 48 hours, if the fever is accompanied by a rash or any other symptom, if the child looks very ill or is unusually fussy or is very drowsy, if your child has a condition that suppresses immune responses like cancer or sickle cell disease, or if your child has had a seizure.

Mercury thermometers should not be used at any time to measure fever. They have been replaced by digital thermometers and are no longer available in stores. The American Academy of Pediatrics (AAP) encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this poison. Don’t throw your mercury thermometer in the trash because of the likelihood of environmental contamination. Check with your local pharmacy or health department to see if they will dispose of it for you. Body temperature may be taken rectally (bottom), orally (mouth), axillary (underarm), and aurally (ear).

How to measure a rectal temperature
Rectal temperatures taken with a rectal digital thermometer are the gold standard (the most accurate) way of measuring body temperature-especially if your child is younger than 3 years of age and especially younger than 6 months of age.

1. Clean the end of the thermometers 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 K-Y jelly on the end.

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

4. With the other hand, turn on the thermometer switch and insert the thermometer ½-1” into the anal opening. Hold the thermometer in place with 2 fingers, keeping your hand cupped on your child’s bottom.

5. Hold in place for about 1 minute or until you hear the “beep”. Remove the thermometer to check the reading.

How to take an oral temperature
Oral temperatures may be taken once your child is 5 or 6 years of age; you may prefer taking his temperature by mouth with an oral digital thermometer. For an accurate reading, no hot or cold drinks for at least 15 minutes before you take the oral temperature.

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

2. Turn on the switch and place the sensor under your child’s tongue toward the back of the mouth.

3. Hold in place for about one minute or until you hear the “beep”. Check the digital reading.

How to take an axillary temperature
An axillary temperature or “under the arm” temperature is not as accurate and cannot be used if your child is less than 3 months old. Contrary to packaging instructions, please do not add or subtract a degree for an axillary temperature- when reporting your child’s temperature to the office- state the temperature and how the temperature was obtained.

1. Place the sensor end of either an oral or rectal digital thermometer in your child’s arm pit.

2. Hold the arm tightly against your child’s chest for about one minute or until you hear the “beep”. It is very important to have consistent skin contact with the tip of the thermometer for an accurate reading.

3. Check the digital reading.

How to take a tympanic temperature
Tympanic/ear thermometers are another way to measure body temperature for older babies and children- easy, quick and effective for a screening measure. The ear thermometers work by detecting infrared radiation from the ear drum. Ear temperature readings are not accurate in children <6 months-there may be discrepancies in the results, depending on technique, amount of ear wax, etc.

1. Gently put the end of the thermometer in the ear canal. Try to aim the thermometer at your child’s nose. Press the start button. A digital reading appears in seconds.

2. Always use a clean tip cover for each reading.

Other methods of measuring temperature are available and are not discussed here because they are not recommended at this time. Examples of these temperature measuring methods are: pacifier, temporal artery, forehead, etc.

How do I treat the symptom of fever?

A fever may be a serious sign of illness in a child less than 3 months of age and fever-reducing medication should not be administered — please call the office.

You may want to make sure that your child is dressed in light clothing, encourage fluids such as water, diluted fruit juices, or a commercially prepared oral electrolyte solution such as Pedialyte®, or Liquilytes®. Avoid giving extremely fatty foods or others that are difficult to digest as fever may decrease digestive activity. There is no reason why your child cannot have the milk he/she normally drinks. If the room is warm and stuffy, cool the air with a fan, but not too much to create shivering.

There are also medications that may be given to a child to help reduce temperature if he/she is uncomfortable. Any drug that reduces fever is called an “antipyretic”. An antipyretic works by blocking the formation of prostaglandins from fever. Because a child without a fever does not have interleukin-1 circulating (white blood cells are not digesting the germ cells and so this substance is not formed), prostaglandins are subsequently not formed which is why an antipyretic does not reduce temperature in a person who does not have a fever. Both acetaminophen (if child > 3 months) and ibuprofen ( if child > 6 months) are safe and effective in proper doses. Be sure to administer the correct dose to your child for each medication — use the dropper provided with each particular medication and do not switch droppers between medications. It is not recommended to “alternate” or “piggyback” both of these medications unless otherwise directed. Acetaminophen may be given every 4 hours. Ibuprofen should only be used for children older than 6 months of age and can be dosed every 6 hours. Please see the dosing charts. Do not use aspirin to treat your child’s fever. Aspirin has been linked with serious side effects in children, including Reye’s Syndrome.

What is a febrile seizure?

4-6% of children (usually 6 mos-5 years) may experience a “febrile seizure” as the body’s temperature rises. These seizures may last for 1-10 minutes and are frightening to observe but rarely cause any harm to the child. Febrile seizures are a brief loss of unconsciousness followed by involuntary jerking movements of the body associated with a fever. During the seizure, the child may abruptly stiffen his body and roll his eyes up, followed by a jerking or twitching of the limbs and body. These seizures usually occur during the first 24 hours of an illness, often before a parent knows that their child has a fever or is even ill. Usually a seizure is related to the rate of rise in temperature than to the height of the temperature. If your child is experiencing a febrile seizure, here are some tips to help you:

1. Calm down!! Your child will be fine.

2. Move the child to a carpeted surface if possible, so that he/she does not hit any sharp or hard objects during the seizure.

3. Remember: children with seizures are not at risk of swallowing their tongues. Therefore do not put anything in your child’s mouth.

4. If the seizure lasts more than 4 minutes, call 911. If your child’s seizure lasts less than 4 minutes call Pediatric Associates after your child is comfortable and resting.

5. It is normal for your child to be very sleepy after the seizure.

Children who have had one febrile seizure may be at risk of another. The parents of a child who has experienced a febrile seizure should have aggressive fever management – Tylenol (acetaminophen) every 4 hours - OR - Motrin (ibuprofen) every 6 hours. Febrile seizures are not a form of epilepsy, a neurological condition.

When do I call Pediatric Associates of Rockford?

It has always been our philosophy that you know your child better than anyone, if you have a question-always call! If your child <3 months old and has a temperature of 100.4°- you should call the office immediately! If the fever has been present for more than 72 hours (even if your child is acting well), it is important that you request an appointment to have your child seen in the office. Other reasons why you should request an appointment include:

1. If the temperature is high (=105°)

2. If the fever has appeared after your child has had symptoms for a couple of days

3. Severe sore throat or consistent sore throat accompanying the fever

4. Breathing seems heavy or labored

5. Vomiting frequently with fever

6. Pain with urination with fever

7. Dehydration (no tears, no urine for at least 6 hours)

8. Excessive fatigue

9. Stiff neck or neck pain

10. Headache with fever

11. Rash (especially a purple rash) accompanying the fever.

How can I tell if my child’s illness is serious or not?

When you call the office, the medical personnel are usually interested in how the illness is affecting your child’s ability to do what he she does best. Is your child still interested in playing, drinking well enough to urinate, is alert and smiling at you, has a normal skin color, and looks well when the temperature comes down- if the answer is yes to one or all of these- you probably do not need to worry too much. A child who has a fever will lose his/her appetite- this is an expectation. Do not worry so much about her solid food intake-focus on increasing fluids. Offer whatever he/she normally drinks (including milk/formula).

When can my child go back to school/child care?

It is wise to check with your provider; however a good rule of thumb is that your child remains out of school until fever free for 24 hours, and is feeling well enough to participate in any activity

I think my child has a wart, what should I do?
Warts are very common during childhood. They can appear anywhere on the skin, but most commonly seen on the feet and hands. Warts are caused by the human papilloma virus. Warts can be spread to others but they are not highly contagious. A wart will disappear without treatment in 2-3 years, but can spread and grow in size. Home treatment for warts will probably take a 2-3 month commitment. This type of treatment is recommended for uncomplicated warts. Dermatological treatment for warts is recommended for a large wart, multiple or clustered warts, warts that are infected, or warts on the face or lips.

What is a wart? What causes warts?
Warts are a type of infection caused by viruses in the human papilloma virus (HPV) family. There are at least 70 types of HPV viruses. These viruses are present everywhere—they are one of the most common childhood skin conditions. Warts can grow on all parts of your body. They can grow on your skin, on the inside of your mouth, on your genitals and on your rectal area. Some types of HPV tend to cause warts on the skin, while other HPV types tend to cause warts on the genitals and rectal area. Some people are more naturally resistant to warts and don’t seem to get them as much as others. Under a magnifying glass the roughened surface of a wart often looks like a tiny cauliflower. The little black dots sometimes seen are the ends of blood vessels that the wart has recruited to bring it food. Contrary to well-established belief, the underside of a wart is smooth and round, and the entire wart is confined to the epidermis—the outermost layer of the skin-and does not grow into the dermis. There are no 'roots'! Even though a wart does not have roots, warts can be difficult to destroy.

Description of Warts:

* Firm, raised, round, rough, and non-tender growth on the skin—may look like cauliflower
* Usually present for a while before parent's awareness
* Most often seen on the hands and feet
* Warts on pressure points of the foot can be tender
* Normal skin lines (fingerprints) are interrupted by the wart but a callus has normal skin lines over the top of it
* Black or dark brown dots can sometimes be seen within the wart

Can warts be passed from one person to another person? Are they contagious?

Yes. Warts on the skin may be passed to another person when that person touches the warts. It is also possible to get warts from using towels or other objects that were used by a person who has warts. Warts are typically spread when the virus touches a part of the skin where the outer protective layer is broken, either by minor trauma or by moisture. This happens most commonly on the fingers, elbows, knees, and the bottoms of the feet. Warts on the bottom of the feet are called plantar warts—named for the plantar surface (sole) of the foot. Plantar warts can be especially painful. Plantar warts often make running, jumping, and even walking, uncomfortable. The tenderness can change posture and cause strain elsewhere in the body.


Will warts go away without treatment?
The answer is sometimes yes and sometimes no. Sometimes, warts disappear on their own, although it may take many months, or even years, for the warts to go away—the body’s immune system expels the virus and the wart disappears. About 25% are gone within 3-6 months and 65% disappear within 2 years. Warts will not leave scars, though some of the more aggressive wart therapies might. Some warts will not go away on their own no matter how long they are observed. It is not known why some warts disappear and others don't.

Do warts need to be treated?
Generally, yes. Most warts will eventually go away on their own, expelled by the body's immune system. About 25% are gone within 3-6 months and 65% disappear within 2 years. However, warts can bleed and cause pain when they're bumped. They also can cause embarrassment, for example, if they grow on your face. Treatment may also decrease the chance that the warts will be spread to other areas of your body (possibly where they are more difficult to treat) or they can be spread to other people. Treatments abound, varying from as gentle and simple as placing some medicine on before bed, to as high-tech and powerful as superpulsed carbon-dioxide-laser vaporization. The most important factor to consider when treating warts is there is no single best treatment. If the treatment is successful, the bulk of the wart is destroyed, but the body’s immune system must be engaged and must destroy the remainder of the wart.

Home treatment is recommended for most warts. Physicians use many options to treat warts (surgery, lasers, chemical cautery, electrodesiccation, lasers, and even chemotherapy) but freezing is the most common. Gentle freezing repeated every week or two—usually at least 4 times—is the more effective than a single aggressive attempt to freeze. Some of the methods that physicians use to treat warts may leave a scar.

How do I treat my child’s wart at home?
Treatments that may be carried out in the home may include over the counter treatments such as occlusive treatments. The active ingredient in most over-the-counter remedies is salicylic acid, a natural substance found in many plants (willow bark) and most fruits. It can be applied either as a liquid or a patch. With regular application, many warts will disappear within 12 weeks. These topical treatments often work best if the surface of the wart is disrupted with warm soaks and/or an emery board before application and after the treatment course is finished. Don't try any home remedies or over-the-counter drugs to remove warts on the genital area, however.

Over the counter wart home treatment:
1. Soak child's foot/hand in tub to soften wart for at least 15 minutes

2. Remove the dead surface (pale, white skin) of the wart by gently rubbing the wart with the rough side of a disposable emery board. Try not to cause bleeding.

3. Apply a patch or a drop or two of acid directly to the wart

4. Cover the wart with a bandaid, then a generous amount of adhesive tape on top of the bandaid. The patch and acid must have skin contact at all times

5. Leave in place for 48 hours and then repeat steps 1-5 every other day, do not skip any treaments

A study conducted in Washington in 2002 has found that the ordinary common silver duct tape (YES –DUCT TAPE!) has superior activity to cryotherapy (freezing/liquid nitrogen). Overall, 85% of the duct tape patients were wart-free after 8 weeks. Most duct-taped warts disappeared within 28 days. Therefore, duct tape appears to be effective as a safe and nonthreatening treatment for warts in children.

Directions for duct tape treatment:
1. Make sure that the treatment area is clean and dry (you may use rubbing alcohol on the area and allow it to dry!)

2. Apply a piece of duct tape cut to fit the entire wart and surrounding area.

3. Leave the tape on for 6 days.

4. Early on the 7th day, remove the tape, soak the area in water and then rub the wart with an emery board or pumice stone (only use for this purpose!)

5. After 12 hours without duct tape, put a fresh piece on the wart and leave on for 6 days again. If the tape falls off – apply a fresh piece.

6. Continue the cycle for 2 months or until the wart is gone.

How can I prevent a wart and/or not make an existing wart worse?

* Use only disposable emery boards for treatment - do not use it to file nails
* Encourage child not to pick or bite at warts
* Wear beach shoes at the pool and health club showers
* Be consistent with the treatment regimen—warts are generally difficult to eliminate—strict adherence to treatment directions is paramount

When should I call the office?

* The warts are very large or if multiple warts are present
* The warts are very tender or on the face or genitals
* The wart looks infected
* You have used home treatment for 6 weeks and are not seeing improvement
* You give up and want a dermatologist referral. Our physicians do not remove warts in our office.
* You have other questions or concerns

Is there specific treatment for the very painful plantar wart?
Plantar wars are warts of the sole or plantar surface of the foot. Since plantar warts are under pressure they grow inward causing pain on the bottom of the foot. Plantar warts can be differentiated from a simple callus by characteristic dark spots in the center and the characteristic “normal foot print” (like the finger print) lines are disrupted. Unfortunately, no ideal treatment for plantar warts exists.

Duct tape treatment described above has been studied as the most effective treatment at this time for the resolution of this type of wart. If after several cycles of duct tape treatments, the wart is still there—please call the office for advice.


I think my baby has a cold, what should I do?
A "cold" or upper respiratory infection (URI) is a viral infection that is easily spread from person to person. The average healthy child will get 6-8 URI's per year, more if a child attends daycare or playgroups.

Symptoms will last 7-10 days and include:

* Runny or stuffy nose (clear, yellow, or green mucus is normal)
* Sometimes a cough, hoarse voice, sore throat, swollen glands
* Usually a fever (less than 102 F)

Home Treatment:

* Use a bulb syringe and a saline nose drop or spray to gently remove nasal secretions or crusting as often as needed to help baby breathe
* Encourage fluids...a baby who can breathe through his nose will drink and sleep better, breast milk and formula are fine to give
* Place a cool-mist humidifier in the baby's room
* Take baby into a steamy bathroom for 10-15 minutes, or give a warm bath

Medications:

* Antibiotics DO NOT work for viral infections like colds and flus
* Over-the-counter cold medications offer little to no benefit for babies and young children, it is best to avoid their use
* Acetaminophen or ibuprofen (6 mo and older) may be given for fever or discomfort, but this will not cure a cold or shorten the course

Prevention:

* Avoid undue exposure to other children at health clubs, playgroups and those restaurants with all the "toys", especially the 1st year of life
* Frequent hand washing!!!

Call our office if:

* Your baby has a cold and/or fever and is 3 months old or younger
* Your baby has difficulty breathing and does not improve after suctioning the nose
* Your baby acts very sick or is getting worse
* The fever is 102F or higher or fever lasting more than 2-3 days
* Cold symptoms lasting more than 10 days
* Your baby will not drink or sleep
* Your child has discharge from eyes, increasing sore throat or earache
* You have other questions or concerns


I think my baby is teething, what can I do for her?
Teething is part of normal development of infancy that causes few problems in most babies. The first tooth may appear as early as 3 months but it may be as long as a year before the first pearly white erupts. Teeth usually come 2 at a time about every 2 months until the age of 2 years. Since teething is a continuous process, lasting almost 2 years, many unrelated illnesses are blamed on teething.

Signs and symptoms of teething:

* Minor discomfort
* Swollen, irritated gum, may have tinge of blood as tooth breaks gum
* Baby rubs at gums, wants to chew on everything

Teething does not cause:

* Fever
* Sleep problems
* Diarrhea
* Vomiting
* Diaper rash

Home Treatment:

* Massage swollen or irritated gum with your finger
* Give baby a chew toy or wet frozen washcloth
* Acetaminophen may be given for a few days
* Do not use pain relief teething gels, they can be dangerous

Call our office if:

* You think your baby is sick, not just teething
* You have other questions or concerns

How do I take care of my baby's teeth?
With the addition of fluoride in our water supply, tooth decay is becoming less of a problem for today's kids than for previous generations. However, fluoridated water alone will not keep decay at bay. Good oral hygiene is just as important. Parents need to start an oral hygiene program when a baby is about 4 months old, even before the first tooth has erupted.

What to do:

* At about 4 months of age, wipe your baby's gums everyday with your finger covered with a piece of gauze. Massage all the surfaces to acquaint your baby with this new sensation and routine
* A small soft toothbrush with plain water should be used when your baby has several teeth or by 1 year of age
* Toddlers should have their teeth brushed twice a day with a pea-sized amount of toothpaste to help remove debris, plaque and bacteria
* Parents should brush their children's teeth until about 5 to 6 years of age to assure that all surfaces are cleaned, letting children take their turn first, followed by the parents can make this task easier
* After 6 years of age, most children possess the knowledge and dexterity to thoroughly brush their own teeth twice a day and floss daily

A Fluoride Source:

* City water and water in most of the surrounding suburbs have adequate fluoride, so if your child drinks tap water then additional fluoride is not needed
* Bottled water may not have enough fluoride to protect against tooth decay, ask your bottler for the fluoride content, a supplement may be needed (Adequate fluoride content is 0.7-1.2 parts per million)
* Filtered water may not have enough fluoride to protect against tooth decay, ask the manufacturer if fluoride is removed by the filtering process, a supplement may be needed

A Tooth Healthy Diet:

* Do not let your baby go to bed with a bottle of anything but water, the sugars from milk and juice can rot the teeth as your child sleeps
* Avoid sweet, sticky foods (raisins, caramel, gummy candy)
* Have sweet foods with meals not as snacks

The Dentist:

* All children should have the first dental exam at 2 years of age
* Some children will see a dentist sooner for problems
* Ask the dentist about sealants when your child is getting permanent teeth

My 5 month old has not passed a stool in 2 days, how do I treat constipation?

Constipation is defined as the infrequent and painful passage of hard stools. It is commonly misunderstood by many parents, especially during the first year of a child's life. Newborns will have multiple stools a day, and as the newborn matures, the frequency decreases. By the age of 2 months, a breast-fed infant may only have a stool from once a day to once a week. This is normal and the stool will be soft and larger in volume than before. Formula-fed infants will also slow in frequency, but not as infrequent as their breast-fed peers. Babies are often thought to be constipated when they grunt, push, strain, draw up their legs and turn red in the face when having a bowel movement. This behavior is normal for babies and will improve as the baby learns to sit or stand. (A position that facilitates the passage of a bowel movement.) Between the age of 4-6 months, solid foods are introduced to a baby. This addition to their diet can lead to changes in bowel movements and constipation.

Signs and Symptoms of Constipation in Infants:

* Passage of hard, painful stools AND
* Infrequent stools - usually 4 or more days without a bowel movement
* Possibly tiny amounts of bright red blood on the hard stool

Home Treatment for Infants:

* Use a rectal thermometer to stimulate a bowel movement
* Use a glycerin suppository to stimulate and soften the stool
* Give 1-2 ounces of apple or prune once to twice a day
* If baby is 4 months or older and on solids, give apricots, prunes, peaches, pears, beans, peas twice a day - limit carrots, bananas, squash, rice, and apples. Sometimes a formula change is needed - ask your pediatrician
* Continue to breastfeed as usual

Prevention:

* Watch the diet, not too many constipating foods in the same day
* Some babies need daily servings of prune juice (1oz) or prunes for a few months until they overcome this problem

Call our office if:

* Your baby has extreme pain or if pain persists more the 1-2 hours
* Your baby is still constipated after using home treatment plan for a few days
* Your baby continues to have bloody streaks in more than 1 or 2 stools
* You see a tear or fissure at the anus that won't heal
* Despite use of preventative measures, your baby is constipated
* You have other questions or concerns

My baby spits up a bit after every meal, is something wrong?
Spitting up (regurgitation) is extremely common in the first year of life, usually starting at a few weeks of age and resolving by about 1 year of age, sometimes longer. Spitting up results from a small amount of stomach contents backing up the esophagus shortly after a feeding. In babies, the valve at the top of the stomach is "weak", which allows for this process to occur. In most cases it is harmless and does not distress the baby or cause weight loss. It actually becomes more of a laundry issue for many parents.

Signs of Regurgitation:

* Volume of "spit up" is 1 to 2 mouthfuls
* Baby is not distressed
* Usually occurs after a feeding
* Baby is growing normally

Home Treatment:

* Feed smaller amounts - overfeeding will lead to regurgitation
* Space feedings at least every 2-3 hours
* Burp baby during feedings
* Do not diaper too tightly
* Avoid pressure on abdomen after feedings
* Keep in a more upright position after a feeding
* Elevate the head of the crib an inch or so
* Use lap pads and burp cloths - powdered formulas stain less

Call our office if:

* Notice any blood in the "spit up"
* Notice choking episodes or coughing after a "spit up"
* Do not see an improvement after using the home treatment plan
* Think your baby is not gaining weight
* Think your baby is sick, overly fussy, or has projectile "spit ups"
* You have other questions or concerns

My baby always has a gooey, watery eye, is it infected?

A blocked tear duct (nasolacrimal duct obstruction) is a common finding in young infants. The symptoms usually appear late in the newborn period as tear production begins. One or both sides can be affected and this is often confused with an eye infection. Most blocked tear ducts will open spontaneously by 9 months of age. If your infant continues to have this problem after 9 months, a referral to a pediatric ophthalmologist will be made for evaluation. Babies with blocked tear ducts tend to get eye infections due to poor drainage and may need an antibiotic eye drop intermittently.

Signs of a blocked tear duct:

* Continuous or intermittent watery eye(s)
* Tears overflow from the eyelid, even without crying
* Onset at about a month of age
* Eye is not red, swollen, tender
* Wakes with mucus (maybe light yellow or white) in eye that does not return after wiping until the next nap/bedtime
* May have dryness or stuffiness in the nostril on the affected side

Home Treatment:

* Gently wipe away dried secretion from eye(s) with moistened cotton balls
* Massage the affected side 4 times a day - using your little finger or Q-tip, gently stroke from the inner corner of the eye towards the nose about 10 times to promote drainage in the duct
* Use saline nose drops in the nostril of the affected side if stuffy and dry

Watch for signs of infection:

* Thick yellow or green drainage from eye(s) that returns within minutes of wiping eye
* Redness or swelling of the eye(s) or eyelids
* Eye(s) matted with copious discharge after waking

Call our office if:

* You notice any signs of infection in the eye(s)
* You think the problem is getting worse despite home treatment
* Your baby is older than 9 months
* You have other questions or concerns

My baby has a diaper rash, what can I do for it?

Almost every child will get diaper rash at least once before potty training. Most diaper rashes are not serious and treatment is simple. Contact with moisture, ammonia from urine, and bacteria from bowel movements can cause the common diaper rash. Diarrheal illnesses also lead to diaper rash. Occasionally, antibiotic therapy can lead to diaper rash. Most diaper rashes respond to over-the-counter ointments, but some (like yeast diaper rashes) need a special medication.

What diaper rash looks like:

* Common contact-type diaper rash is pink to red and covers the convex areas of skin, it usually does not go into the skin creases
* Yeast (monilial) diaper rash is usually red, irritated, and has separate smaller areas of rash like pimples, it usually goes into the skin creases

Home Treatment:

* Keep area clean and dry with frequent diaper changes
* Allow diaper area to remain open to air for a few minutes with each diaper change
* Avoid use of diaper wipes to eliminate additional chemical irritation
* Rinse baby's bottom with warm water, use mild soap after a bowel movement, but rinse well
* Apply a thick layer of zinc oxide cream (Desitin or Calmoseptine) with each diaper change, taking care not to harshly rub skin to remove cream from previous application - this is a barrier to protect the skin from further irritation
* Do not use powder or cornstarch
* If you suspect a yeast diaper rash, a cream such as Nystatin may be prescribed. Over-the-counter creams may be applied on top of the prescription cream to provide better coverage

Call our office if:

* The rash has blisters, open sores, crusting, is bleeding, or looks infected
* The rash does not improve at all after 3 days of treatment at home
* The rash spreads beyond the diaper area
* The rash is bright red and mainly around the anus
* The rash is accompanied with a fever
* You have other questions or concerns

When can I travel with my baby?

There is nothing scientific about traveling with a young baby. It is best to use common sense, such as a newborn does not need to go to the rainforests of South America. However, young infants travel nicely by car for visits with relatives. When travelling overseas with a child, it is best to consult a local travel clinic to obtain the latest information about required vaccines. The Center for Disease Control (CDC) has traveler's information on their website at www.cdc.gov for the public's use.

Going out in a stroller:

* Newborns can go out when dressed for weather conditions
* Dress baby according to the weather, remembering their body temperature is like an adults, so many layers are not needed in mild temperatures
* Put a hat on your baby when it is cool or cold outside
* Take along an extra blanket just in case
* Avoid taking baby out in extreme weather conditions
* Strangers like to peer in a stroller, ask them not to touch the baby

Traveling by car:

* Most babies do fine in the car - they sleep through most of the journey You will need to make more frequent stops than before for diaper changes, feedings, and just to hold baby
* Toddlers and young children need to stretch their legs, use the "potty", and have a snack at frequent intervals

Traveling by airplane:

* Most babies and young children travel by plane without many problems
* Avoid airplane travel for at least the first month of life
* Avoid contact with strangers on the plane when flying with a young infant
* Breastfeed or offer a bottle to baby during take off and landing
* Bring snacks and drinks for toddlers and young children
* After 2 months of age, you may give baby a dose of acetaminophen (Tylenol) shortly before the flight to relieve possible discomfort in the ears


My baby has very dry, sensitive skin, could it be eczema?

Dry skin and eczema are closely related problems in children. The causes of both problems do differ, but the treatment plans often overlap. Dry skin is caused by overbathing with harsh soaps, thereby removing the skins protective oils and natural defenses. Dry, indoor air during the winter months tend to make dry skin worse and even more itchy. Most babies do have sensitive skin, and parents should use care when choosing skin care products for them. Eczema is also a condition of dry skin, but the skin often gets red, rashy, weepy, and raw, that is worsened by the "itch-scratch" cycle. However, eczema is an inherited disorder. It is commonly seen in babies with a family history of allergies and asthma. Eczema tends to flare up when the skin is exposed to an irritant. Treatment is aimed at keeping skin well-hydrated and avoiding known irritants. Most children grow out of eczema, but some go on to develop allergies or asthma later in life.

Signs and symptoms of eczema:

* Dry skin over most of body
* Patches of red, rough, sometimes raw and weepy rash, commonly seen in the creases of the elbows, wrists and knees, and face and neck
* Age of onset is usually between 2 and 6 months

Home Treatment:

Bathing

* Less frequent bathing is not usually necessary -plain water baths can help with itching and keeps skin clean, reducing the likelihood of infection from scratching
* Avoid bubble bath and harsh soaps, use a mild soap like Dove on the dirty parts only - avoid those baby skin care products
* Limit bath time to 10 minutes
* If child likes to play in bath, allow for play in plain water first, then shampoo hair and clean body , rinse thoroughly and get out of tub - do not allow child to soak in soapy water

Skin Care

* Once your child is out of the bath, do not dry the skin with a towel
* Use the water droplets on the skin to your advantage by applying an emollient directly to the damp skin to seal in this extra moisture
* The best and least expensive emollient is petroleum jelly, but it can be greasy, Eucerin and Cetaphil creams are also very good and not as greasy - lotions do not work for extremely dry skin
* Apply the emollient at least twice a day
* If your child has been prescribed a steroid cream, apply it to the skin before the emollient

Prevention and Other Hints:

* Use Dreft for your child's laundry and double rinse if possible
* Avoid use of fabric softeners
* Use caution with your perfumes on your clothing
* Dress your child in soft, natural fibers such as cotton
* Use a humidifier during the winter months
* Avoid known irritants
* Continue to use mild soap and emollient even when child's skin looks good
* Keep child's nails well groomed

Call our office if:

* The rash appears infected, scabbed, bleeding, or blistered
* The rash has not improved in 1 week of diligent skin care
* The itching interferes with sleep
* You have other questions or concerns

My baby was so easy, but now at 6 weeks old, he cries every night, is this colic?
All babies cry and most babies cry a lot during the first few months of life. Crying is the baby's form of communicating needs. Crying is not harmful itself but it could be a signal of distress that you would not want to ignore. If your baby is not sick, hungry or in pain, then the following suggestions may help you get through this time period with some sanity still intact. "Colic" is used to describe the crying episodes that can go on for up to 3 hours. It is not well understood, and there are several theories about colic and young infants. Parents do not cause colic. Babies that tend to have a more sensitive temperament are more likely to have crying episodes.

Signs and symptoms of colic:

* Unexplained crying episodes - not related to hunger, pain, discomfort, or illness - occurring 1 -2 times a day, usually at the same time of day
* Crying episodes usually last 1-3 hours
* Infant is inconsolable even when held
* Occurs at 1 month age and resolves by 3 months of age
* Healthy, thriving baby that is happy between crying episodes

Home Treatment:

Bathing

* Pick up and soothe your young infant when he cries - you can not spoil a young infant by holding him too much
* Use a swing, sling or carrier, vibrating seat, stroller
* Offer a pacifier if your baby takes one
* Give your baby a bath
* Run the vacuum cleaner or radio with a poor signal, babies like white noise. Avoid taking baby for a ride in the car - nothing is more dangerous than a sleep-deprived parent behind the wheel with a crying baby in the car
* As a last resort or if you are at your wit's end, place your baby in the crib where it is dark, quiet, and soothing - your baby may calm himself or fall asleep - if crying continues for 10 minutes pick baby up and try to comfort him again
* Understand that this is a very trying time as a parent, but it is short-lived and it is not your fault, don't be afraid to ask for help
* Rest when your baby does

Call our office if:

* You think your baby is sick or in pain
* Crying episode lasts more than 3 hours
* Crying episodes occur frequently throughout the day
* Your baby is younger than 1 month or older than 3 months
* You are afraid you might hurt your baby
* You have other questions or concerns

What is croup?

Croup is an acute viral infection which causes narrowing of the airway below the vocal cords and the trachea. In its early stages, the virus can produce an inspiratory sound called stridor or a tight, low pitched barking cough (like a seal or a goose). After a few days the tight cough is often replaced by a more productive loose cough. For little known reason, children’s symptoms are worse at night. Sometimes, the first indication of the illness is the child awakening at night with a very harsh loud cough. The cough is usually accompanied by crying which may exacerbate the symptoms. Croup can be frightening for parents but it is usually a mild illness lasting from 1-5 nights and the cold symptoms that follow may last as long as 10 days. Symptoms may also be severe enough to require emergent evaluation. Other symptoms that may accompany the diagnosis of croup include a hoarse voice, nasal congestion, fever (usually 104° or lower) and a sore throat.

What causes croup?

Croup may be caused by many viral agents. The parainfluenza viruses are quite common, as well as respiratory syncytial virus (RSV), and influenza viruses (both A and B).

What are the peak ages of croup?

Croup occurs primarily in children between the ages of 3 months and 3 years of age with the peak incidence in the 2nd year of life. Older children and adults usually present with just a raspy hoarse voice or laryngitis with sore throat.

How is croup spread from person to person?

Infection with croup usually occurs with contact from respiratory fluids (mucus or saliva) and spreads from fingers to mouth to respiratory tract. From there, the virus multiplies and spreads to the large airways and causes inflammation or swelling of the larynx and trachea. Because smaller children have smaller (the width of your pinky finger) and typically more pliable airways, this population is usually more at risk of having more severe symptoms.

How do the symptoms start and when will they go away?

The child will awaken on the first night with a spasmodic cough and respiratory distress. The child’s symptoms are most noticeable at each inspiration or air coming in. There may be some retracting (sucking in) of the muscles around the rib cage so that the edge of the ribs and the clavicles are more prominent. This occurs because the child is experiencing a harder time getting air into the lungs. You may notice that your child looks like he/she is running a race. Sometimes the symptoms may stop for awhile- (like all next day) and then restart again (possibly after a nap or later in the evening). This respiratory distress cycle may repeat over 1-3 days and possibly be accompanied by fever and then “turn into” a regular cold over 7-10 days.

How do I treat croup?

Treatments for croup are directed at decreasing the swelling of the airway. Appropriate dosing of ibuprofen (Motrin/Advil) may help decrease the swelling and help lower fever if present. Please see the dosing chart. Turn on the hot water in the shower and sink and make a “steam shower”. Sit in there with your child to relieve the inflammation which is causing the cough. Try to calm your child as best as possible- singing, reading, any other distraction. Crying makes the symptoms worse. Bundling your child up and going outside to breathe cold night air may also help relieve the stridor. If after the steam shower and the trip outside your child is still very noisy with every inspiration and still working hard to breathe, you may need to go to the emergency room for immediate care. Therapies in the ER include a breathing treatment with racemic epinephrine and/or the administration of steroids. Steroids can also be prescribed in the office by the doctor. Some children may be more susceptible to recurrent episodes of croup. If steroids are prescribed for your child once, they may be recommended if croup recurs. Please call your doctor.

Call the office if:

The coughing spasms are getting worse

The attacks of stridor are occurring with more frequency

Your child is not drinking much and has not had urine output in 8 hours

You have other concerns or questions

Please call the doctor immediately if:

The stridor or raspy breathing at rest is occurring during the day

Your child develops retractions (tugging or sucking in around the ribs)

The warm mist in the steam shower or a trip out in the cold night air does not help

You feel your child is getting worse.

Call 911 or go to the ER immediately if:

Breathing is very difficult

Your child is drooling excessively and can’t or won’t swallow easily

The lips turn blue or your child is dusky around the mouth

Can my toddler survive on goldfish crackers and milk?

The first year of life is a period of tremendous physical growth. Babies often gain 15 pounds in that year. Between ages 1 and 5 years, children only gain about 4 to 5 pounds a year. For this reason, toddlers and preschoolers have a normal appetite slump. This slowed growth and decreased appetite are very worrisome to parents, often causing battles at meals and forced feedings. Children have a natural instinct to know how much food they need. It is a parent's responsibility to provide a variety of nutritious foods at regular intervals during the day, but it is the child's responsibility to eat (or not) those foods given to him. Forced feedings will only take away the pleasure associated with eating. The struggle over meals can be worsened by a strong-willed toddler/preschooler trying to develop his autonomy (normal behavior at this developmental stage).

Signs of a normal appetite slump:

* Child never seems hungry and eats only if spoon-fed by parent
* Child is between 1 and 5 years of age
* Child is healthy and growing along expected course
* Child still has lots of energy
* Child only wants a particular food for every meal "Food Jags"
* Eats one "good" meal a day

Home Treatment:

* Allow your child to self-feed by spoon or fingers - Do not feed him!
* Limit milk to 16 ounces a day
* Juice is not recommended but if you give juice to your child limit it to 4-6 ounces a day
* Offer water in between snacks and meals if thirsty
* Limit snacks to 2 a day
* Allow child to skip a meal if not hungry
* Serve small portions of food, if more is wanted the child will ask
* Give a vitamin (usually unnecessary), if it makes you feel better
* Make meal times enjoyable - do not focus on eating
* Eat as a family as often as possible
* Eliminate the "Clean Plate Club" mentality you may have experienced

Call our office if:

* Think your child is losing weight from a decreased appetite
* Observe any symptoms of illness
* You have other questions or concerns

How can I prevent dehydration in my child with the "stomach flu"?

Vomiting and diarrhea are almost always the result of a viral infection. The most serious side effect from vomiting and diarrhea is dehydration because of the loss of fluid and salt from the gastrointestinal tract. Younger children tend to be less tolerant of this fluid loss and may become dehydrated sooner than older children. Dehydration can be avoided in many cases by following the treatment plan outlined below. This plan may seem labor-intensive. Intravenous fluids are rarely part of the treatment plan if your child is tolerating any fluid. This method of management is reserved only for the seriously ill child who cannot tolerate any fluid for an extended amount of time - usually more then 6-8 hours.

Initially your child will start with repetitive vomiting for 3-6 hours then progress to diarrhea and intermittent vomiting.

This illness is almost always a virus which means there is NO TREATMENT but TIME, FLUIDS, and PATIENCE. Do not panic!

Here is the plan for rehydration….

1. Do not give any food or liquid for 2 hours after the last episode of vomiting
2. Start with 1 tablespoon of a water every 20 minutes for 2 hours. If the child vomits at any time, wait 1 hour and start over
3. After 2 hours if the child has not vomited then you may start giving 1-2 oz of any cold, clear liquid
4. Slowly increase the volume of fluids as tolerated.
5. If vomiting occurs during this time period, restart at step 1
6. Do not offer any solids until the child can tolerate at least 4 oz of fluid at a time.

Additional treatment and helpful hints:

* You must get the clear liquids in - use a spoon, dropper, cup, bottle or play a game if needed
* Your child will be thirsty and want to gulp - Do not let him!
* You may give acetaminophen if your child has a fever
* Do not give your child any Pepto Bismol, Imodium or other similar products for diarrhea

Clear Liquid Diet:

Best options (try these first):

* Oral electrolyte solution - Pedialyte, Gerber Liquilytes, other oral rehydrating solution
* Oral electrolyte popsicles - Pedialyte Popsicles
* Breast milk is good for nursing babies
* Make your own electrolyte solution…1/3 cup Sprite, 1/3 cup bottled (if traveling internationally) water, ½ tsp salt, and ½ tsp baking soda!



Other alternatives to oral electrolyte solutions:

* Gatorade
* Clear soup broth
* Half strength Jello water (1 pkg/1 Qt water)
* Seven-Up, Sprite or ginger ale with the bubbles stirred out
* Half strength white grape juice
* Popsicles

Good First Foods with Stomach Flu: (Always offer age appropriate foods)

Infants

* Full strength baby formula
* Strained bananas, applesauce
* Rice, rice or barley cereal, oatmeal, Cheerios
* Strained carrots, squash, potatoes

Children

* Bananas, applesauce, apples
* Rice, potatoes, unsweetened cereal, crackers, pretzels, toast
* Cooked lean meats
* Reintroduce milk and dairy only after the diarrhea has resolved

Avoid giving….

* Eggs, butter, bacon, pork
* Peanut butter
* Spicy or seasoned foods

Call our office if your child:

* Has a fever over 104 degrees
* Has a seizure or convulsion
* Has blood in diarrhea or vomit
* Urine output is decreased; no urine in 6-8 hours
* Mouth seems dry of saliva/extreme thirst
* No tears are produced when crying
* Unusually drowsy or fussy
* Shows no improvement in 24 hours or is getting worse
* Vomits longer than 24 hours
* Continues having diarrhea for more than 6-8 times a day for more than 3-5 days
* Seems particularly cranky or quiet

My child gets nosebleeds lately, is something seriously wrong?

Many children get nosebleeds throughout childhood, and most often it is nothing serious. Possible causes of common nosebleeds (epistaxis) in children are dry air, frequent nose blowing, nose picking, nasal injury, and allergies. Some diseases can cause nosebleeds, but luckily they are rare.

Home Treatment:

* Firmly pinch the nostrils closed together and hold continuously for 10 minutes, holding over the bony part won't stop the bleeding
* Have child lean forward and spit out any blood in the mouth
* Release the nose after 10 minutes, if still bleeding then squeeze the nostrils again for another 10 minutes

Prevention:

* Use a humidifier during the dry, winter months and during a "cold"
* Nasal saline sprays keep nasal membranes moist
* Apply petroleum jelly inside the nose twice a day
* Use positive reinforcement to discourage child from nose picking
* Treat nasal allergies as directed by health care provider
* Avoid frequent use of Ibuprofen (Advil, Motrin)

Call our office if:

* The nose bleed does not stop after 20 minutes
* The nosebleed is a result of a traumatic injury
* You see a foreign body in the nose
* Your child feels lightheaded or dizzy
* Nosebleeds are occurring daily despite preventative measures
* Nosebleeds are accompanied by other unusual bleeding or excessive bruising

The school nurse found head lice on my child, what do I do?

Head lice is very common in the schools and summer camps. Any adult or child can get lice. It has nothing to do with cleanliness or good health habits. Head lice is spread from person to person by hats, combs or brushes, bedding and close contact.

Signs and symptoms of lice include:

* Itchy scalp, usually with a rash
* Nits - white eggs "glued" onto the hair shaft, favoring the neckline and behind the ears (dandruff and other hair debris will pull out easily)
* Lice - small, gray, wingless insect moving quickly on scalp

DO NOT send your child to school or camp until treated

Home Treatment:

* Use the over-the-counter shampoo containing permethrin (NIX) and follow directions on the box carefully
* Use the special nit comb after the treatment to pick out all the nits
* DO NOT use vinegar in hair to help loosen nits, this may deactivate the treatment and possibly cause reinfestation
* Soak combs, brushes, and hair accessories in the treatment solution for 1 hour
* Thoroughly vacuum your floors and furniture
* Wash your child's recently worn clothing, linens and towels in hot water
* Non-washable items such as stuffed animals your child sleeps with can be sealed in a plastic bag for 3 weeks (nits cannot survive any longer)
* Check all the family members for lice, nits or itchy scalp and treat immediately if any signs of infestation are seen
* It is not necessary to fumigate or shave hair to treat lice at home

Prevention:

* Encourage child not to share personal items such as combs, brushes, hair accessories, hats, and clothing
* For widespread outbreaks at your child's school, the lice treatment containing permethrin (NIX) is indicated for prevention of infestation with one application providing protection up to 2 weeks

Call our office if:

* Rash on scalp looks infected or not resolved in 1 week
* New nits are found after treatment
* Itching interferes with you child's sleep
* Have other concerns or questions

My child was just stung by a bee, what should I do?

From Spring until Fall, bee (wasp, hornet, or yellow jacket) stings are quite common for children. Most common stings only cause temporary pain and swelling, but some individuals can have a more severe reaction that require special attention.

A serious sting:

* If your child is having difficulty in breathing, speaking, or swallowing, call 911 immediately - do not waste time by calling our office first!
* If your child has a sting in the mouth, hives, or multiple stings, call our office immediately

A common sting will have:

* Immediate pain at the sting site, usually lasting 2 hours
* Immediate redness and a small "bump" which will continue to swell for about 24 hours
* The stinger may still be in the skin

Home Treatment:

* Remove the stinger by scraping it off, DO NOT squeeze it
* Make a paste with meat tenderizer and water and apply to sting to relieve pain by neutralizing the toxin from the stinger
* Apply ice pack until meat tenderizer is available
* Ice packs can help swelling for the next 24 hours
* Use of over-the-counter antihistamine (Benadryl) may help swelling, but call our office for directions on use

Prevention:

* Encourage children to wear shoes when outside, especially in the grass. Avoid drinking beverages from cans while outside
* Instruct children not to antagonize bees or other stinging insects

Call our office if:

* Swelling or redness continues to worsen after 24 hours after sting
* You cannot remove the stinger
* You have other concerns or questions

How do I comfort my child who has the chickenpox?

Chickenpox (varicella) is a highly contagious viral illness. Few people escape chickenpox as a child. With the varicella vaccine (Varivax), hopefully more children will reach adulthood without ever getting chickenpox. The vaccine prevents the disease 94-96% of the time. Chickenpox is caused by an exposure to the virus 10-21 days prior to the first sore appearing on the skin. The disease progresses in a very distinctive way, with new sores appearing every day for about 5 days. On average a child will have 300-500 sores. Once a child has chickenpox, he will have lifelong immunity with a few exceptions. Most cases of chickenpox do little but cause discomfort and inconvenience. However, serious complications can arise from chickenpox, especially in children with underlying medical conditions. The best method of prevention is vaccination.

Signs and Symptoms of Chickenpox:

* Rash starts on head and trunk, then spreads all over the body
* Sores start as small, red bumps (like pimples) and progress to water blisters (like dew drops on a rose petal) to cloudy blisters to oozy sores that get crusty (all within a 24 hours period)
* New crops emerge daily for about 5 days
* Possible fever

Home Treatment:

* Call us on the first day of rash to see if a medication might be prescribed to possibly lessen the severity of the illness
* Tepid baths every few hours with an oatmeal bath product(Aveeno)
* Application of Calamine lotion (not Caladryl) after the bath
* For severe itching, give an antihistamine (Benadryl)
* For fever and discomfort, give acetaminophen (Tylenol)
* Offer soft, bland foods and cool drinks to ease mouth sores
* Trim and clean fingernails
* Encourage not to scratch to prevent secondary infection and scars
* Keep your child at home until all sores have dried up, usually 7-10 days

Call our office if:

* Has a patch of red, tender skin or a fine, red, sandpaper-like rash
* Becomes lethargic, difficult to awaken, or confused
* Complains of a stiff neck
* Has difficulty breathing
* Has a fever over 104 or lasts more than 3 days
* Has scabs that ooze pus or look infected
* Has sores on the eyeballs
* Has trouble urinating because of sores around the genitals
* You have other questions or concerns

My teenager is starting to get acne, what should we do?

Most teenagers will have some degree of acne during the period of adolescence. Hormones made during puberty stimulate oil glands on the face, back, and chest. The oils from these glands and the cells lining the oil ducts mix to form plugs. These plugs encourage the growth of skin bacteria, causing the red bumpy appearance of acne. Additionally, acne can be an inherited trait. Since hormones and heredity cannot be changed, keeping oil ducts clean and clear is important to controlling acne.

Signs of acne:

* Red, inflamed bumps on the face, chest, and/or back
* Blackheads and whiteheads
* Possibly scars from picking previous pimples

Home Treatment:

* DO NOT squeeze or try to "pop" pimples - may cause scarring
* DO NOT scrub skin harshly
* DO NOT use makeup, lotions, or hair products containing oils
* Avoid stress and tension
* Keep skin clean by gently cleansing with a mild soap twice daily
* Try an over-the-counter benzoyl peroxide lotion or gel

1. Start with 5% strength, apply once daily to affected skin, not just current pimples and avoid use around eyes and mouth

2. In one week, if skin is not too red or scaly, apply twice daily

3. In three weeks, increase to 10% strength applied once daily

4. In one more week, if skin is not too red or scaly, apply twice daily

5. After six weeks of consistent use, the redness and scaliness should be gone and skin should be clearer

Prevention:

* Keep hands, hair, sweat bands, and hats off face
* If the treatment is working, DO NOT stop using it

Call our office if:

* Using benzoyl peroxide treatment does not improve skin in six weeks
* Acne is widespread on the chest and back
* You have other questions or concerns