General Childhood Problems
Viral Illness vs. Bacterial Infection
Bacteria are tiny living organisms that exist throughout the world, in the home, on the skin, everywhere. Some of them cause illness in people and require antibiotics to help the body’s immune system fight them off.
Viruses are even tinier organisms that also are everywhere. Some of the cause illness, too, with as much fever and discomfort as bacterial infections. However, antibiotics do not kill viruses. The body’s immune system has to fight them off on its own, and usually they resolve with little more than bed rest, fluids and patience. Viral illnesses are very contagious and many times they are passed around from family member to family member or to children at the daycare. Many of your child’s illnesses will not be due to bacterial infections but to viral illness. The doctor will recommend measures for you to take for your child to help alleviate some of the symptoms (for example, sore throat, vomiting, diarrhea, colds, runny nose and congestion) associated with viral illness.
Occasionally a child with a viral illness will be more susceptible to catching a bacterial infection such as an ear infection, bronchitis, pneumonia or sinus infection, and will then need to be treated with an antibiotic to kill the bacteria while the body fights off the virus.
Fevers
Fever alarms parents more than any other sign of illness. This is understandable since fever usually means that the child has an infection. Often it is difficult to determine the nature and seriousness of an illness at its onset. Observing a child for a short time may yield other symptoms such as rash, vomiting or sore throat.
A child’s behavior provides the best clue of how serious an illness is. Fevers drain children of energy. This makes them more cranky, clingy and sleepy than usual. When the fever is down, however, they should be able to show interest in toys and family. Most children lose their appetites when sick, but the should drink liquids well.
Normal body temperature is 98.6°F measured orally. There is normal variation in the body temperature throughout the day and it can vary between 97-100.5°F. If the temperature stays over 100.5°F for more than a few hours, a fever is present.
Measuring the temperature accurately is important. For infants, it is necessary to take it rectally; for toddlers, one can take it under the arm and in children over 4 years old, orally.
Fever is caused by the body’s immune system in preparation for fighting off viral or bacterial infection. It helps the immune system work and somewhat hinders the progress of infection; however, a higher fever (over 102°F) may produce discomfort and should be treated.
Some young children may have a seizure (convulsion) when their fever goes up rapidly. This can be frightening to witness but is usually harmless and over in a few minutes. Seizures associated with fevers are not a sign that fever has damaged the brain.
The question of when to notify the doctor of a fever depends on the age of the child. In infants less than two months old any fever should be discussed with a doctor. For older children, a temperature of 102°F, if it lasts longer than 24 hours, should be discussed with the doctor.
Don’t feel that the doctor is insensitive if he is not panicked about your child’s fever. It’s just that we know that most fever and will be interested in other symptoms such as vomiting, diarrhea, rashes, earaches, sore throat, etc.
Treatment of Fever:
In infants under 2 months old contact the doctor before deciding to treat the fever.
- Give your child plenty of fluids. This will make him feel better, help him lower the fever and prevent dehydration.
- Don’t over bundle the child or turn up the heat. A comfortable average temperature environment is best.
- Medication: Avoid using aspirin in children. Acetaminophen (Tylenol, Tempra) is the medication of choice for fever in children.
Dosing for commonly used fever/pain medications in children
| Age(use only when wt not available) | Weight | Acetaminophen Infant drops 80mg/0.8ml | Acetaminophen Children’s suspension 160mg/5ml | Acetaminophen Children’s Meltaways 80mg/tablet | Acetaminophen Junior Meltaways 160mg/tablet |
| 0-3 mo | 6-11 lbs | 0.4 ml | |||
| 4-11 mo | 12-17 lbs | 0.8 ml | ½ tsp (2.5 ml) | ||
| 12-23 mo | 18-23 lbs | 1.2 ml (0.4 + 0.8 ml) |
¾ tsp (5 ml) | ||
| 2-3 yrs | 24-35 lbs | 1.6 ml (0.8m + 0.8 ml) |
1 tsp (5 ml) | 2 tablets | |
| 4-5 yrs | 36-47 lbs | 1½ tsp (7.5 ml) | 3 tablets | ||
| 6-8 yrs | 48-59 lbs | 2 tsp (10 ml) | 4 tablets | 2 tablets | |
| 9-10 yrs | 60-71 lbs | 2½ tsp (12.5 ml) | 5 tablets | 2½ tablets | |
| 11 yrs | 72-95 lbs | 3 tsp (15 ml) | 6 tablets | 3 tablets | |
| 12 yrs | 96 lbs and over | 4 tablets |
- Acetaminophen: common brand “Tylenol”
- Dose can be given every 4 hours as needed
- Do not does more than 5 times in 24 hours
- Check labels of any other medicines you are giving for the active ingredient “acetaminophen”, especially cough/cold preparations
- Use the enclosed dropper, measuring cup or a device used for measuring medicines, do not use a household spoon to measure the medicine
- The most accurate way to dose any medication is according to weight. Use age dosing only if weight is not available
| Age (use only when wt not available) | Weight | Ibuprofen Infant Drops 50mg/1.25ml | Ibuprofen Children’s Suspension 100mg/5ml | Ibuprofen Junior Strength Chewable Tablets 100mg/tab | Ibuprofen Junior Strength Tablets 100mg/tab (swallow) |
| 0-3 mo | 6-11 lbs | ||||
| 4-11 mo | 12-17 lbs | 1.25 ml | |||
| 12-23 mo | 18-23 lbs | 1.875 ml | |||
| 2-3 yrs | 24-35 lbs | 1 tsp (5 ml) | |||
| 4-5 yrs | 36-47 lbs | 1½ tsp (7.5 ml) | |||
| 6-8 yrs | 48-59 lbs | 2 tsp (10 ml) | 2 tablets | 2 caplets | |
| 9-10 yrs | 60-71 lbs | 2½ tsp (12.5 ml) | 2½ tablets | 2½ caplets | |
| 11 yrs | 72-95 lbs | 3 tsp (15 ml) | 3 tablets | 3 caplets | |
| 12 yrs | 96 lbs and over |
Coughs, Colds, Congestion
Most children will have 4-6 colds (viral) each year in their first few years. Colds can last up to 10 days and usually present with runny nose, stuffiness, sneezing and slight cough. Some children may have a low grade fever for a day or so with the cold.
For colds or coughs:
- Treat your child’s specific symptoms. Try to choose a medication for a symptom and avoid multi-symptom medications
- If your child’s symptoms are not interfering with sleep or daily activities, a medication is not necessary
- Many times the most effective treatments are “non-medical” like saline nasal spray, humidification and drinking plenty of fluids for hydration
Four Major Cold Medication Ingredients
Nasal Decongestant – May help clear stuff nasal passages. Does not typically cause drowsiness but may cause excitability which may interfere with sleep.
Antihistamines – Help relieve itchy, runny nose and decrease mucus production. May cause drowsiness. Usually the best for allergies.
Cough Suppressant – Helps persistent disruptive cough — suppresses cough reflex in throat and lungs.
Expectorant – May help thin and loosen thick mucus in respiratory tract.
ALL FOUR TYPES OF COUGH AND COLD MEDICATIONS ARE NO LONGER RECOMMENDED FOR CHILDREN UNDER 4 YEARS OF AGE.
For this reason there are no longer doses on labels for children under 2 years of age and manufacturers warn about their use in children under four. One reason for this restriction is that young children have been accidently overdosed by too high a dose or interactions with other medication. The second reason the FDA has made this recommendation is that there is no convincing research that these medications are safe and/or effective in children.
For these reasons we do not recommend routine use of these medications, but may from time to time based on circumstance help you choose a medication.
Nosebleeds
It is not unusual for a child to get an occasional nosebleed. This may be touched off by sneezing, coughing or by frequent blowing of the nose. Dry air makes nosebleeds more likely. Many times a nosebleed will be noted at night or in the morning by blood on the pillow.
To treat a nosebleed, hold an ice pack or a cold compress over he nose, pinch the sides of the nose squeezing it closed and hold for several minutes.
Use of a humidifier or vaporizer, especially at night, is helpful to keep the nasal lining moist making it less likely to bleed.
Repeated bleeds or a bleed that can’t be stopped in less than 15 minutes should be reported to the doctor.
Teething
Most children have their first tooth at 6-7 months old. Occasionally, a first tooth may break through as early as 3-4 months old or as late as 12 months. Most babies start drooling and putting their hands in their mouths at 3-4 months old as their gums become sensitive.
With teething many children are fussy and may not eat much, especially solids. Fevers over 101°F should not be attributed to just teething.
You can help your child with teething by giving Tylenol for the discomfort. Also, cold things to suck on are helpful, such as cold pacifiers, a cold spoon, popsicles or cold juices.
Occasionally a child will be very fussy and have trouble sleeping despite these measures. It is often helpful to use numbing medication such as Orajel, Numsit, or Ambesol.
Sore Throat
Most sore throats are caused by viruses and are associated with fever, headache, stomachache and swollen glands under the jaw. The same symptoms can be caused by strep throat (bacterial infection of the throat with streptococcus) which can and should be treated with antibiotics. To find out whether your child’s sore throat is caused by strep or a virus, a throat culture is necessary. If it is positive for strep, an antibiotic is necessary. If it is negative for strep, the sore throat and associated symptoms should be treated wo make the child more comfortable. The symptoms often last up to a week.
Whether the sore throat is from a virus or strep, Tylenol may be given for fever, aches and pains. Cold fluids, popsicles and ice cream are good to soothe the throat. In older children, gargling with warm salt water is helful.
Earache
There are two kinds of ear pain problems. One is “swimmer’s hear”, usually seen in the summer when water gets into the outer ear canal and causes irritation and inflammation of the canal. The ear itself is usually painful to touch. This is usually treated with ear drops as prescribed by the doctor. Many parents have learned that if their child is prone to “swimmer’s ear” they can drain the water out of the ear after swimming and put a few drops of 1/2 vinegar and 1/2 alcohol in the ear canal. Well fitting ear plugs may help to keep the ear dry.
The other more common ear problem is the middle ear infection, which can be viral or bacterial. It is usually associated with a cold, runny nose and congestion. There does not have to be a fever. The child with ear pain should be seen by the doctor to evaluate the ears, the throat and the sinuses to decide whether antibiotics are necessary.
The pain itself can be helped with acetaminophen every four hours as well as with a heating pad or warm compress over the affected ear. This usually takes the edge off the pain enough to allow the child to sleep until he can be evaluated in the doctor’s office. After being treated for an ear infection, the doctor will want to recheck the ear drum for fluid (usually associated with infection) or further mild inflamation. Often the child will be feeling better but the ear drum is still inflamed and with fluid. A different antibiotic may be needed to prevent the fluid from becoming further infected until the body is able to remove it.
While an ear infection or fluid is present, the child’s hearing is slightly dulled in that ear, but hearing returns to normal when the fluid clears. The evaluation and treatment of ear infections are designed to avoid hearing loss which can develop if the infection and/or fluid continues for several months.
Earwax
Most parents worry about excessive earwax. Earwax is normal and is produced in the outer canal to trap dirt and small particles. It gradually works its way out of the canal and can easily be wiped away with a washcloth.
Probing inside the canal with a Q-tip is unnecessary and usually results in pushing a fair amount of wax farther in, resulting in a large block of impacted wax. This is to be avoided.
When evaluating the child for an ear infection, the doctor may need to remove some of the wax to get a good view of the eardrum. He may use a metal loop to scoop out the wax or wash it out with warm peroxide.
He may recommend an over-the-counter earwax removal system to use at home, such as Debrox or Murine, if there seems to be excessive or impacted wax.
Vomiting and Diarrhea
Nausea and vomiting are symptoms that can be caused by many different illnesses. Usually it is a stomach virus that can produce fever, stomachaches, vomiting and diarrhea. What is required, however, is that the child take in and hold down fluids. Solids are not as important.
For vomiting, we recommend:
Give nothing by mouth for 1-2 hours after the last episode of vomiting. Start with one tablespoon of clear liquid every 20 minutes for 2 hours. If tolerated, you may offer gradually increasing amounts. If there is no improvement (if the child continues to vomit even the one tablespoon of liquid several times), contact the doctor for further advice.
Clear liquids for children less than 1 year old are Pedialyte or Ricelyte (available in drug stores and supermarkets). Older children may use flat, room temperature, caffeine-free colas, ginger ale, Gatorade or Kool-Aid. Do not use milk, juice or plain water.
Continue only clear liquids for 12-24 hours; then add a bland diet of soup broth, bananas, rice, applesauce and toast and crackers.
Milk products and other foods may be introduced gradually after the third day.
For diarrhea, we recommend:
Diarrhea refers to frequent (greater than six per day) loose stools. An illness that begins with vomiting often ends with diarrhea for several days. Controlling the vomiting is the priority — diarrhea by itself rarely causes dehydration.
Once the child has tolerated clear liquids (no juice, no milk) for 8-12 hours, a simple diet like the BRATS diet (acronym for bananas, rice or rice cereal, applesauce, toast, saltines) may be introduced. Breastfed infants should continue to breastfeed through diarrhea — there is no better way to provide nourishment. Infants drinking formula may stool less by changing to a lactose-free formula (Lactofree, Prosobee, Isomil) for a few days.
When the diet is advanced, whether by the introduction of foods in the child or toddler or by advancing to a milk based formula in a formula-fed infant, increased stools are to be expected. If the child seems hungry and happy, continue to feed him. It usually takes at least seven days for the small intestine to regrow the cells that make enzymes needed to digest food. Introducing foods helps this process to occur but creates more stools initially. Milk and juice may be poorly digested, contribute to cramps and gas and should be avoided until simple foods are tolerated for a day. Anti-diarrheal medications are not recommended. If a child has a high fever, bloody diarrhea, or is not taking clear liquids well, please call the office.
Chicken Pox
With the availability of chickenpox vaccine the incidence of chickenpox has reduced significantly. This vaccine has become a required part of the immunization series in Virginia.
Chickenpox is caused by a virus. Usually the child will have a low grade fever (101-102°F) for several days and an itchy rash that starts on the chest and spreads to the face, back, arms and legs. The rash itself starts as a reddish mark that quickly becomes a little clear blister. Each blister then pops and scabs and crusts over. New blisters form as the old ones crust over. The child is contagious from one to two days before the rash appears and until every blister is crusted over. He may then return to daycare or school. Incubation period is 2-3 weeks from exposure.
Treatment is directed toward making the child more comfortable: Acetaminophen (Tylenol or Tempra — never asprin) to control the fever. Control the itching with Aveeno (oatmeal) baths, several times a day and use Benadryl Elixir every 4 hours as needed.
Most children with chicken pox are miserable and do not want to eat. However they do need to drink lots of fluids to remain well-hydrated.
Old chickenpox sores may discolor the skin temporarily, but normal skin color will return in several months.
Humidifiers and Vaporizers
Wintertime is often a particularly dry time in our area of the country. No matter what heating system your home has, the air in the house is very dry and can be irritating to the nose and throat. Many children will, therefore, cough, complain of soreness in the throat and have increased nasal stuffiness.
In many cases it is helpful to humidify the air. There are three kinds of systems: the cool mist vaporizer, the steam humidifier and ultrasonic humidifiers. Steam or hot air humidifers are not recommended because of the danger of scalds. It is important to clean the system regularly to avoid buildup of mold and germs in the water that will be sprayed up in the air.
Dental Care
Flouride is essentially for the proper growth of teeth. Flouride toothpastes are recommended when a child will not swallow large amounts of toothpaste. The water in the Richmond, Henrico and Chesterfield area is flouridated. The only children who need supplemental flouride are those drinking water from private wells and breastfed babies, as flouride is not passed in breast milk.
Brushing the teeth daily is important. Establishing a routine that the child enjoys is crucial and should be started as early as possible. At first, the parent should clean the teeth with a washcloth. Later, use a soft brush and then teach the child how to do it on his own with supervision.
Teeth can become brownish and decayed in children who are continuously sucking and drinking liquids, especially juices. This is most often seen in the child who regularly goes to bed with his bottle. This is to be discouraged. Using other security objects, such as a stuffed animal or blanket is much better.
Children should start seeing a dentist at about 3 years of age. Make sure your dentist is comfortable caring for young dental patients.
Safety
Just as important as watching your child for illness is watching your child for accidents and injuries. A young child or baby does not know all the potential dangers that exist in every home in every situation and requires the parents’ constant vigilance.
Using carseats and restraints is always important and should be an absolute routine for every adult and child for every car ride, no matter how short. (See Carseat discussion in the Newborn Care section.)
Cribs can cause injury, too. Make sure the crib is sturdy and the rails are not loose. The slats should be less than 2&fra12; inches apart. The mattress must fit tightly so that your baby can’t get caught. Hanging objects and mobiles must be placed so that your baby won’t get tangled. Make sure your crib is not too close to any potential danger. And don’t leave your infant unattended on any elevated surface such as a bed or changing table.
Smoke detectors are important for the safety of the family. They should be checked regularly to make sure they work and the batteries are fresh.
Hot water, hot drinks and stoves are common causes of injury in children. Do not drink hot drinks with an infant in your lap. If your child is burned, immediately put the burned area into cold water for 10-15 minutes and call the doctor. Blisters that appear on the burned area should not be opened.
Electrical outlets must always be covered or out of reach. Remove extension cords from areas available to your baby.
Stairs are a common place where falls occur. A young toddler just learning how to climb the stairs may go up okay but will have more trouble balancing to come down. Gates are useful to prevent children from going up or down stairs or from entering an un-baby-proofed room.
Walkers are used by many parents to help their children learn to get around earlier. However, walkers are often dangerous for young children, causing falls and tangling the child up in them. THEY ARE NOT RECOMMENDED.
Plants are often forgotten as a potential problem for children. Many children will grab at them and try to eat the leaves and flowers, some of which may be poisonous. They can also pull down large plants on top of themselves, causing injury.
Use only unbreakable toys with no sharp edges or small detachable parts. Educate older children not to hand the baby small objects such as toys or candies. Do not place coins on low tables.
Water is a natural attraction for babies. They must be closely supervised around any body of water — this includes commodes, pools, gulleys, ponds, etc.
Choking is common in toddlers. We advise that you not offer nuts, hard candy, raw carrots, whole grapes, popcorn, chunks of hot dog or whole kernel corn to children less than 5 years old.
Poisoning. For all households with children old enough to crawl, it is important to babyproof the house. Children get into all kinds of bottles and containers and will drink or eat pills, liquids, small objects and plants. It is important to have all cleaning fluids, detergents, plants, car products, bathroom liquids and, of course, all medicines out of reach and locked away. No matter how careful you are, however, there is always the chance the child can get into something poisonous.
Be certain that grandparents and babysitters use the same childproofing techniques in their homes that you have used in your home.