Animal and Human Bites

Bite wounds are very common in children. Unless your child's bite is minor, it should be checked by a professional. In general, any bite that breaks the skin requires medical attention. Infection is the most common complication for bites that have broken the skin. The germs which cause the infection differ, depending on what type of animal your child is bitten by and whether there is a foreign object that may have gotten into the wound. Any wound that looks infected, has redness or swelling at or near the site of the bite, has pus draining from the bite, or is causing severe pain or fever, needs to be treated immediately. Please contact our office at (301) 645-1133 for a same day appointment.

Appendicitis

What is acute appendicitis? Appendicitis is inflammation and infection of a pocket of small intestine called the appendix. The opening to the appendix may become blocked off, allowing congestion and infection to develop. The appendix then becomes swollen and inflamed (red and tender). Without surgery, it may burst (rupture). Rupture is a more serous problem that can lead to infection inside your child's abdomen. The only treatment for appendicitis is an operation to remove the infected appendix (appendectomy). If the doctor thinks appendicitis is possible, your child may need to go to the hospital for surgery. If the diagnosis is uncertain, tests such as computed tomography (CT scan) may be helpful.

What does it look like?

Symptoms of appendicitis vary, but main ones are:

  • Pain in the abdomen. Pain usually starts around the navel and then moves to the lower right side of the abdomen.
  • Nausea and vomiting. These usually start after the pain. Your child may vomit only a little bit or not at all.
  • Fever. Temperature may rise rapidly, usually after the start of pain.
  • It is sometimes difficult to tell appendicitis from the "stomach flu," especially in young infants. If you are sure pain started before other symptoms, this may be a sign of appendicitis.
  • Diarrhea may be present.

When should I call your office?

  • High Fever
  • Abdominal Pain
  • Swelling of the abdomen
  • Continued or worsening vomiting

After surgery, follow the surgeon's instructions for post-operative and follow-up care. Call your surgeon's office or our office if any of the following occur:

  • High fever.
  • Continued or worsening vomiting.
  • Increased pain or swelling of the abdomen.
  • Blood in bowel movements.
  • Redness around surgical incision

Asthma

Asthma is a lung disease, it affects the airways. Airways are breathing "tubes" inside your lungs. When you have Asthma, the airways swell and the muscles around the airways tighten. Swelling and tightness narrow the airways. This leads to asthma symptoms like wheezing or coughing. If you have asthma, you may often feel fine. But asthma is still there, even if you don't have symptoms. A quick relief inhaler treats symptoms, it does not control the disease though.

Millions of people in the U.S. have asthma. You don't have to let asthma stop you or your child from doing the things that you like. Work with your child's doctor. Learn to avoid triggers. Know which treatments to use and when.

For additional informaion, watch the videos below:

How to Take Care of Asthma at Home Videos
Asthma Education Videos

Bed-Wetting (Nocturnal Enuresis)

Bed-wetting can be a stressful problem for children and parents. Children generally don't wet the bed on purpose. Any child can have an occasional "accident," but medical attention may be needed if bed-wetting is a frequent problem. Behavioral and other types of treatments are available.

What are the types of bed-wetting?

  • Primary bed-wetting. Bed-wetting has always been a problem.
  • Secondary bed-wetting. Children who have been dry at night sometimes develop new problems with bed-wetting; the difficulty is often related to some stressful situation in your child's life.
  • Some children wet themselves when they are awake (diurnal). This is a different condition and so the evaluation and treatment may be different.

What causes bed-wetting?

Many different factors can contribute to bed-wetting problems, including:

  • Genetics. Bed-wetting runs in families.
  • Sleep problems. Children who wet the bed may have a different types of sleep problems.
  • Differences in kidney function. Minor differences in kidney function may interfere with your child's ability to know when he or she has to urinate.
  • Psychological issues. Sometimes bed-wetting is related to stressful or traumatic experiences.

How is bed-wetting treated?Assessment. The doctor will ask detailed questions about the bed-wetting behavior. If the problem is simply night-time bed-wetting, a urine test (urinalysis) may be done. This is mainly to check for infection or diabetes. Treatment options. The doctor may recommend one or more of the following treatments:

Home "do's and don'ts" (behavioral treatment):

  • Do try to get your child's cooperation in dealing with the problem.
  • Do have your child urinate before going to bed.
  • Do make a chart of dry nights, or help your child do so. Offer small rewards for each dry night. Increase the rewards once your child stays dry for several nights in a row.
  • Don't wake your child repeatedly to take him or her to the bathroom.
  • Don't punish or embarrass your child. Rewards are much more effective than punishment.
  • Night-time alarm. A simple "bell-and-pad" alarm system is commonly used. This type of device is a useful addition to the "do's and don'ts" listed above and can be very effective. However, the child must be willing to use it.
  • The alarm is set off by urine. The goal is to get your child to wake up and go to the bathroom or to clean up the bed.
  • After using the device for at least 3 to 4 weeks, your child will be better able to recognize the urge to urinate. For most children, bed-wetting stops after use of this device. Sometimes, however, the problem returns, and the device is needed again.
  • Medications may be tried if other treatments don't help. However, medications are less effective than the night-time alarm device. The problem may return after your child stops taking the medication.

When should I call your office? Call our office if problems with bed-wetting continue, or if they return after your child gets better.

Bug and Bee Stings

Nearly all children get stung by bees or other insects at one time or another. Most often, the sting causes only a minor skin reaction. A cold washcloth and pain reliever are the only treatment needed in this case.

The situation is different if your child is allergic to bees or other stinging insects. If your child has a large skin reaction or a more general bodily reaction to a bee sting, he or she is probably allergic. Your child may need treatment to prevent more serious reactions in the future.

What kind of reactions can occur?

Allergic reactions to bee stings range from minor skin reactions to life-threatening reactions.

  • Minor reactions. Your child will have a raised, red area around the sting. You may see the insect's stinger in the skin. Minor reactions to bee stings usually go away in a day or less. Sometimes they don't appear for a few hours.
  • Larger skin reactions. Your child may develop a larger skin reaction over several hours or a few days. The area of swelling around the sting becomes larger. The reaction goes away after a few days.
  • Non-life-threatening reactions. Your child may develop a more severe skin reaction. This usually starts within minutes after the sting. You may see red splotches spreading around the sting and sometimes on other parts of the body. Swelling and itching may be intense.
  • Life-threatening reactions. In addition to an intense skin reaction, your child may develop signs of a more serious allergic reaction, such as wheezing (high-pitched sounds coming from the lungs) and/or coughing. This is called anaphylaxis. This is an emergency. Call 911.

Bronchiolitis

What is bronchilitis?

Bronchiolitis is caused by infection and inflammation of the small airways in the lungs. It is very common in infants and toddlers and occurs most often in winter. Bronchiolitis can be a frightening illness and sometimes can become severe enough to require hospitalization of your child. Most children with bronchiolitis recover completely. Bronchiolitis is infection and inflammation (swelling and blocking) of the very smallest breathing tubes in your child's lungs. It is caused by a viral infection, most often the very common respiratory syncytial virus (RSV). As the small airways become narrowed and blocked, you may hear wheezing (high-pitched sounds coming from the lungs) as your child breaths. If bronchiolitis becomes severe, your child may have difficulty getting enough air. If this happens, he/she may need to be admitted to the hospital for oxygen and other treatments.

What does it look like?

Bronchiolitis starts off with the symptoms of a typical cold, with sneezing and a running nose. Your child may recently have been exposed to an older child with a cold. He/she may also have fever. After a few days, your child may develop more severe breathing-related problems, such as:

  • Coughing or wheezing (high-pitched sounds coming from the chest, especially when your child is breathing out)
  • Shortness of breath (as if your infant is having trouble getting enough air)
  • Fast breathing, which may make it difficult for your infant to nurse or feed
  • Dehydration (not drinking enough fluid), which may result from feeding difficulties. Symptoms of dehydration include decreased urination and dryness inside the mouth
  • Agitation or irritability may be a sign that your child is not getting enough oxygen. Get medical help as soon as possible.

What causes bronchiolitis?

Bronchiolitis is not caused by infection with bacteria, so antibiotic treatment probably won't be prescribed. Antibiotics may be recommended by your doctor if your child has another infection in addition to bronchiolitis.

How is bronchiolitis treated?

Like colds caused by RSV and other viruses, bronchiolitis goes away on its own with time. Your child's symptoms may seem to get worse for a few days but should start to get better after a week or so. Treatments for bronchiolitis generally aim to help get your child over the worst of his/her symptoms. If your child develops symptoms of respiratory distress, such as wheezing, difficulty breathing, or dehydration, he/she may have to be treated in the hospital.

When should I call your office?

Call our office if any of the following occurs:

  • Your child has signs of difficulty breathing, rapid breathing, or increased wheezing.
  • Your child seems irritable or anxious
  • Your child has signs of dehydration (decreased urination, dryness inside the month).

If your child has more severe signs of respiratory distress, especially cyanosis (blue skin color), call 911 or another emergency number. This is an emergency!

Car Seat Safety

Attached is a PDF file with the car seat safety recommendations for children through age 12. There is also a link to the National Highway Traffic Safety Administration for more information.

Associated URL: Car Seat Safety

Related Documents:

Car Seat Recommendations.pdf

Chickenpox (Varicella)

What is chickenpox?

Until recently, chickenpox was one of the most common infectious diseases of childhood. It is caused by a widespread and highly contagious virus called varicella zoster virus. Once your child has had chickenpox, he or she usually won't be infected again. The virus can be "reacted" later in life, causing a disease called herpes zoster, but this is less common in children than adults. The virus spreads by means of respiratory secretions (such as coughing or sneezing), or by contact with fluids from the rash. In the past, nearly all children in a family caught chickenpox in childhood. An effective varicella vaccine is now available and is recommended for most children. Although vaccinated children occasionally get chickenpox, the disease is usually very mild. Chickenpox is generally mild in children, but there is a risk of serious complications. Chickenpox in pregnant women or in newborns may result in serious illness.

What does it look like?

Symptoms of chickenpox develop about 2 weeks after your child is exposed to someone with varicella zoster virus. Initial symptoms, more common in older children, include:

  • Fever, usually about 100 to 102 degrees Fahrenheit (38 to 39 degrees Celsius), but sometimes higher.
  • Loss of appetite, sometimes with abdominal pain.
  • Headache and "feeling sick".

A few days later, your child starts to develop the typical chickenpox rash: The rash starts as small red spots, which can be extremely itchy.

  • The spots develop into small raised blisters, which eventually break open and turn crusty. Meanwhile, new "crops" of rash continually develop, so that all stages are present at once.
  • The rash usually occurs on the face and trunk at first, and then spreads to the arms and legs.
  • Some children develop ulcers and blisters in other areas, such as the mouth and throat, vagina, or eyes and surrounding area.

If your child has received varicella vaccine:

  • The chances of catching chickenpox are greatly reduced.
  • If he or she does catch chickenpox, the symptoms will likely be mild. However, vaccinated children with chickenpox can still spread disease to others.

What causes chickenpox?

Chickenpox is caused by a virus called varicella zoster virus. Before the varicella vaccine was available, nearly everyone was infected with this virus sometime during childhood. The virus spreads very easily by direct contact with someone who is infected. If your child has chickenpox, any other children or adults who have not had the disease or vaccination will probably be infected as well. Chickenpox may also spread though contact with other children at school. It takes 10 to 21 days after exposure for the skin rash to begin. Chickenpox is contagious starting a day or two before the skin rash appears. It continues to be contagious until 5 days after the rash began, or as long as there are blisters.

How is chickenpox treated?

  • If your child has the typical rash and other symptoms of chickenpox, it will probably be obvious to the doctor.
  • Acyclovir, an antiviral drug, may be used in certain situations. However, for most otherwise healthy children with chickenpox, this drug doesn't make that much difference. The doctor may not recommend it.
  • Acyclovir may be recommended for other family members, such as children with skin or lung diseases, children using oral or inhaled steroid medications, or children taking aspirin regularly.
  • Otherwise, give home treatments to keep your child comfortable. Use a washcloth soaked in cool water to reduce itching, which can be quite severe. Keep your child's nails short to avoid damage to skin from scratching. Antihistamines may be prescribed to control itching. Do not give aspirin to children with chickenpox, because it may lead to a serious complication called Reye's syndrome. If needed, other pain relievers (such as acetaminophen or ibuprofen) may be used.
  • Once the rash has crusted over, chickenpox is no longer contagious. Your child can return to school or day care 5 days after the rash began, as long as there are no more blisters.
  • Your child should get better, with complete clearing of the skin rash, within 7 to 10 days. If not, or if other symptoms develop, call our office.

When should I call your office? Call our office if:

  • Your child's skin rash and other symptoms of chickenpox haven't cleared up within 7 to 20 days or if new symptoms develop.
  • Chickenpox sores show signs of infection: soreness, redness, warmth, or pus. Your child has a severe cough or difficulty breathing.
  • Your child shows unsteady walking, severe headaches, a stiff neck, or is not acting normally.
  • If your child has severe abdominal pain or bleeding from the blisters, call our office.
  • If you are pregnant, never had chickenpox, and believe you may have been exposed to someone infected with varicella, inform your doctor immediately.

Colic

What is Colic?

Colic is prolonged periods of crying for no apparent reason in an otherwise normal, healthy newborn. Doctors most often define colic as crying for 3 or more hours per day, at least three days per week, for at least three weeks. Doctors don't know exactly what causes colic or why it's a problem for certain babies. A number of factors are probably involved. Taking steps to ensure proper burping and to reduce stress and over stimulation may help to reduce crying. Nearly all infants "outgrow" colic by age three to four months.

What does it look like?

Periods of crying and fussing that last a long time. Compared with "usual" infant behavior, the crying is louder and more intense, and the baby is more difficult to comfort. Crying usually occurs around the same time each day-- often in the evening. Your baby's face may be red and flushed or sometimes pale around the lips. Your baby's belly may seem swollen and tense. He/she may pull the legs up over the belly. It may seem like nothing you can do helps stop the crying. Your baby may simply continue crying until he/she falls asleep from exhaustion. Sometimes, the crying finally stops when your baby passes gas or has a bowel movement.

How is colic treated?

  • The first step is to understand the nature o the problem. In many cases, colic seems to reflect the baby's temperament and the parents' responses. Healthy babies cry for lots of reasons; crying doesn't necessarily mean that they are in pain.
  • Improve feeding techniques:
    • Make sure to burp your baby after each feeding; hold him or her upright until you hear air coming out of the stomach. Patting the baby gently on the back may help.
    • Feed your baby in a quiet, calm environment. Feed around same time every night.
    • Avoid overstimulation, especially around feeding time. Try soothing techniques, such as rocking or quiet music.
  • Try not to get too upset yourself! High stress and emotion in the parents sometimes seem to contribute to colic attacks. It's difficult but try to keep your emotions under control. If you really need a break, there's no harm in leaving your baby in his/her crib for a few minutes or with another caretaker.
  • If the crying doesn't get better, your doctor may recommend a change in formula. (A small percentage of babies with formula intolerance may have symptoms similar to those of colic.) Remember that the condition is not serious.

Colds

Colds are a very common illness caused by viral infection. Symptoms may include a sore, scratchy throat; a stuffy, runny nose; and sometimes a cough. Young children get a lot of colds, sometimes every month or two. As your child gets older, he or she gets colds less often.

Colds are almost always harmless and go away within a week or so. If your child seems to have more than the usual cold symptoms, if the cold gets worse after 5 to 7 days, or if it doesn't start to get better within 10 days, call our office. Your child may actually have some other kind of illness.

  • Colds usually start with a sore or scratchy throat, runny or stuffy nose, or sneezing. This begins 1 to 3 days after your child is exposed to the virus causing the cold.
  • After 2 or 3 days, the sore throat gets better. The nasal drainage may change color or become thickened during the cold. This is not a sign of virus infection.
  • Your child may have coughing and fever. He or she may "feel bad" but not seem terribly ill. If other symptoms are present, or if your child looks or feels very sick, the problem may be something other than a cold, please call our office for an appointment.

How are colds treated?

Currently there is no treatment that can cure colds. Some treatments may make your child feel better by reducing the symptoms. If your child is feeling particularly bad, he or she may have to rest more and drink extra liquids.

Call our office if:

  • Your child has a cold sore accompanied by a high fever or other symptoms that might mean primary herpes simplex infection.
  • Your child's cold sores haven't cleared up within 7 to 10 days.
  • Your child has any signs of an infected cold sore (redness, pus).
  • Your child has signs of possible dehydration (not drinking enough fluids: decreased urine, decreased tears, dryness inside the mouth).

Conjunctivitis (Pinkeye)

Conjunctivitis (pinkeye) means inflammation (redness, soreness) of the white part of the eye and the inside of the eyelid. Pinkeye is caused by bacteria or viruses, which can easily spread to others.

In newborns, conjunctivitis can be caused by bacteria or viruses transmitted during birth. These infections can be more serious and require medical attention.

Symptoms of Conjunctivitis

  • The white part of one or both eyes is pink or red
  • There is a gritty or "scratchy" feeling in the eye, with little or no pain.
  • Eyelids may be swollen but not red or tender.
  • Eyes may be mildly sensitive to bright light. There may be clear, green, or yellow discharge from the eye. While your child is sleeping, a crust may develop on his/her eyelashes, causing the eyelids to stick together.

What causes conjunctivitis?

Infection with bacteria or viruses. Sometimes this happens when your child has a cold or sore throat. Other things can irritate the eye, such as allergies or dust. These are sometimes confused with pinkeye.

Can conjunctivitis be prevented?

To avoid spreading the infection, children with pinkeye may not be permitted to go to school or day care. Having your child wash his or her hands frequently may help avoid spreading the infection.

When should I call your office?

Call our office for an appointment if your child has any of the above symptoms of Pinkeye If your newborn develops redness or has fluid draining form the eyes If your child is being treated for conjunctivitis, call our office if he/she develops a fever, increased pain, increased sensitivity to light a change in vision.

Constipation

Constipation is difficult, uncomfortable, or infrequent bowel movements (BMs). Having BMs less than once daily can be perfectly normal, as long as they aren't too hard and aren't causing any discomfort. However, constipation is present if BMs are hard, difficult or painful to pass, or very infrequent.

Although there are many possible causes of constipation, it does not usually result from any medical condition. Making some simple changes in your child's diet (for example, more water, more fiber) can help a lot. The main risk is that constipation signals a medical problem in need of treatment.

What causes constipation?

  • Most children with constipation have "functional constipation." This means that there is no medical reason for the constipation. It often begins with a painful BM or a stressful situation when having a BM. It may also be related to diet, especially not drinking enough liquids or not eating enough high-fiber foods.
  • Other causes are possible:
    • Medications: for example, some drugs used for mental health disorders or pain.
    • Certain medical conditions, such as hypothyroidism (low thyroid hormone activity).
    • Spinal nerve problems.
    • Hirschsprung's disease (absence of normal nerves in the large intestine).
  • Make sure your child gets a balanced diet, including lots of fresh fruits and vegetables and whole grains. It's also important for your child to drink enough water and other fluids.

Call our office if:

Your child continues to have difficult, infrequent BMs despite recommended treatment. Your child has other symptoms, such as weight loss or slow growth.

What does croup look like?

Your child may have symptoms of a cold (runny nose, sore throat, or cough) for a few days before the typical symptoms begin.

  • A "barking" cough is the most common symptom.
  • It usually involves hoarseness.
  • A harsh sound when breathing in is common. This is called stridor. This stridor can be mild or severe and cause difficulty breathing.
  • If there is a lot of difficulty breathing, the ribs may stick out and the chest may get sucked in with each breath. This type of breathing is called retraction. Retraction can also occur where the neck meets the collar bone.
  • Fever may be present.

Symptoms, especially stridor, are worse when the child is upset or crying. Symptoms are usually worse at night and last a few days but should be gone within a week.

How is croup treated?

If the symptoms persist or are severe, further medical treatment may be needed. Please contact our office. Home treatment. If symptoms are mild, treatment can be done at home without seeing a doctor. The child must not have stridor (harsh sound when breathing in), retractions, or difficulty breathing. They also must not appear to be acting very sick and must be taking enough liquid.

  • For some children, cool mist with a vaporizer or moist air with a humidifier may help.
  • If vaporizer or humidifier is not available, turning on a hot shower and sitting in the bathroom with your child may help.
  • Acetaminophen (Tylenol) or ibuprofen (Advil) may be needed for fussiness or fever.
  • Fever. Fevers that accompany colds usually don't require any treatment. However, if fever seems to be making your child uncomfortable, give him or her acetaminophen.
  • Stuffy nose. Saline (saltwater) nose drops placed down each nostril will improve stuffy nose for a short time. Remember to close the opposite nostril when you are aspirating. This treatment is safe and can be repeated as often as needed. You can buy saline drops or make them at home by stirring one-half teaspoon of salt into 16 ounces of water.
  • Decongestants such as Sudafed (generic name: psedoephedrine) have not been found to be helpful. Nasal sprays can help to reduce stuffy nose but should not be used in children under 2. Don't use nasal spray for more than 2 to 3 days because they can actually make a stuffy nose worse.
  • Runny nose. Antihistamines such as Benadryl (generic name: diphenhydramine) may help to reduce a runny nose. These medications may cause drowsiness. Avoid using antihistamines and young children.
  • Sore throat. Antihistamines may help to reduce cough early in your child's cold. "Cough syrups" are usually not helpful. Drinking extra liquids makes it easier to cough up secretions.
  • Other treatments have been suggested for treatment of colds, such as vitamin C, zinc lozenges, and Echinacea. Thus far, medical studies have not found these treatments to be consistently effective.
  • In general, most medicines for colds are not very effective and may have side effects. (The exception is saline nose drops, which reduce stuffy nose with no side effects.) If your child is comfortable, it may be just as well not to give him or her any medications at all.

When should I call your office?

Call our office if the following occurs:

  • Your child's cold seems to be getting worse, not better, after 5 to 7 days.
  • Your child's cold isn't getting better after 10 days.
  • Your child develops a fever late in the illness, or fever comes back after going away for a few days.
  • Abnormal smelling or bloody fluid or severe headache.
  • Persistent or severe cough.
  • Persistent runny nose, especially in infants.

Dehydration

What is dehydration?

Dehydration occurs when the body loses fluid more rapidly than it can be replaced. The main ways the body loses water are through urination, evaporation from the skin, and breathing. Vomiting or diarrhea can cause excess fluid losses.

Although dehydration can occur in older children and adults, infants are at highest risk. Pay attention to how much your baby is drinking and urinating any time he or she is ill. Your child should drink enough liquid to replace the fluids lost form the body. Get medical help immediately any time your child has symptoms of dehydration: not urinating very often, dryness inside the mouth, crying without tears, or sunken eyes.

Any time you child has a lot of vomiting or diarrhea, keep an eye on the amount of liquids he or she is drinking and how much fluid he or she is losing. Give enough liquids to keep the mouth moist and urination normal. Even if it seems as if your child is throwing up all the liquids you give, keep giving them. You may have to give very small amounts of liquids very frequently - a teaspoon every minute or two - to keep up with fluid losses.

To prevent dehydration, in some children we may recommend it's best to give liquids containing some minerals, such as Pedialyte or Gatorade. Kool Aid and juices may make diarrhea worse because of the large amount of sugar they contain. For children of all ages (and adults too), make sure they drink enough water on hot days. Regular foods should be continued as soon as possible.

If the following symptoms of dehydration appear, seek medical care immediately:

  • Dryness inside the mouth.
  • Decreased or no tears when crying.
  • Fast heartbeat, irritability, or extreme tiredness.
  • In infants going 6 hours without wetting their diapers, may be a sign of dehydration. Sunken eyes or soft spot on the top of the infant's head (fontanelle).

Dental Injury/Trauma

Injuries causing damage to teeth and the tissues around the teeth are common in toddlers, children, and teens. Prompt action can save a lost or broken tooth. It is essential to see the dentist as soon as possible.

What does it look like?

  • Injuries to the teeth or mouth are usually obvious. Something happens to chip or break a tooth out entirely. The injury may cause a lot of pain, often with bleeding.
  • Sometimes dental injuries happen as part of more serious trauma, such as a car accident or a blow to the head.

What causes dental trauma?

The main causes of dental injuries vary with age:

  • Most injuries for toddlers occur in falls.
  • Most injuries for school-aged children occur in bicycle or playground accidents.
  • Most injuries for teenagers are frequently caused by sport injuries, car accidents, and fights.

How is dental trauma treated?

If your child has a primary (baby) tooth knocked out:

  • Call your dentist's office. Even though it's a primary tooth, the dentist may want to check for possible damage to the underlying permanent tooth. Usually, it's not necessary to replace lost primary teeth.
  • Find the tooth.
  • Rinse the tooth. Do not scrub it, and do not touch the root. After plugging the sink, hold the tooth by the crown (the biting surface) and rinse it under the running water.
  • Gently place the tooth back in the socket. Don't worry if it doesn't go all the way back in. If it isn't possible to put the tooth back in, put it in a clean container with cold milk.
  • Go to the dentist immediately. Have your child hold the tooth in place with a finger if possible.

If your child has a chipped or fractured tooth:

  • Rinse the mouth with water.
  • Go to the dentist immediately. If you can find the tooth fragment, take it with you. What will the dentist do?
  • If possible, the dentist will try to replace or repair the missing or fractured tooth. Give the dentist as much information as possible about how your child's injury occurred. Treatment decisions will depend on how much damage the injury did to the teeth, gums, and jaws.

Developmental Milestones of Early Literacy

At Cambridge Pediatrics, we are proud to support the Reach Out and Read program. Reach Out and Read makes literacy promotion a standard part of pediatric primary care, so that children grow up with books and a love of reading. When children are exposed to books at an early age, they acquire language skills at an increased rate, and learn to love and appreciate books. Children are then more likely to learn to read on schedule and become successful students.

Please click the link below for the Reach Out and Read program's ages and stages of early literacy

Related Documents:

RORmilestones_English.pdf

Diaper Rash

What is diaper rash? Diaper rash is caused by irritation of skin in the diaper area. It is sometimes called "diaper dermatitis." The skin becomes red and sore. The rash can get worse if it isn't taken care of properly, and it can become quite painful for your baby. Infection can occur, including infection with the yeast Candida. In most cases, diaper rash gets better if you keep the area as clean as possible, including frequent diaper changes, and apply an ointment to protect the skin. If diaper rash becomes large or severe, call our office.

What does it look like?

  • The skin in the diaper area looks red and scaly, some times with scattered small bumps. You may notice small cracks, rubbed areas, thickening, or raw areas of the skin.
  • The rash can be painful, causing fussiness or crying in your infant.
  • If yeast infection occurs, the rash may become very red with well-outlined boarders.
  • Scattered bumps or pimples may appear in the skin near the boarders. The rash may spread to cover the entire diaper area or beyond.

What causes diaper rash?

  • Diaper rash is caused by irritation of the skin with moisure. The most important factor is the length of time the skin stays wet and in contact with urine and stool (bowel movement).
  • Other irritants can also contribute to a rash in the diaper area, such as soaps and baby products.
  • The rash may become infected with germs, such as Candida yeast. Warmth and wetness inside the diaper encourages them to grow.
  • Every baby's skin is different; some babies just get diaper rash more often than others. Changing diapers frequently can help prevent diaper rash.

What are possible complications of diaper rash?

  • Serious complications are rare. However, diaper rash can be painful to your baby, interfering with sleep and play time.
  • Yeast infection may occur. Though this causes a red and well-outlined rash, it is usually easy to treat.
  • Diaper rash may become severe, with very raw sores that may take a couple weeks to heal. Some babies have repeated problems with diaper rash. Even with treatment, the rash seems to keep coming back.

What increases your baby's risk of diaper rash?

  • Going too long between diaper changes.
  • Using soaps and other products that irritate the skin.

Can diaper rash be prevented?

Frequently diaper changes, careful cleaning of the area and avoiding soaps or other skin irritants may help prevent these rashes.

How is diaper rash treated?

  • Change your baby's diaper as soon as possible after it is wet or dirty. Clean the area carefully. A clean cloth or towel with fresh water is best for cleaning; avoid using diaper wipes containing perfumes or alcohol. Be sure to clean all parts of your baby's genitals. Clean inside the deep folds of the diaper area.
  • Super-absorbent disposable diapers help keep urine and stool away from the skin.
  • Apply a diaper rash ointment such as products containing zinc oxide (for example, Desitin). These products can keep moisture away from the skin. Put on a light layer right after cleaning and drying the diaper area.
  • If the rash takes a long time to heal or is severe, it may be good to visit your doctor. He or she can check to see if the rash has become infected with yeast (Candida) or other germs or if some other type of skin condition is present.
  • If yeast infection occurs, a prescription ointment will be recommended. Apply to the rash with each diaper change (four times per day) for a week or so.
  • For a more severe rash, a weak hydrocortisone cream may be recommended. Apply a few times per day for a few days.
  • Even with treatment, some babies have repeated problems with diaper rash with infection, especially with Candida. However, diaper rash rarely serious problems.
  • If your child is having frequent and/or severe diaper rash, call our office. The doctor may want to perform tests to see if there is some other problem that is causing the skin irritation.

Call our office if diaper rash doesn't improve with treatments.

Diarrhea (Gastroenteritis)

Acute diarrhea may start suddenly. Your child begins having frequent bowel movements; it may seem like he or she simply can't stop going to the bathroom.

  • Bowel movements are loose and watery.
  • Blood may be present in the bowel movements. This may be more common if bacteria are the cause of acute diarrhea. Call our office if your child has bloody stools.
  • Vomiting may be an early symptom but usually doesn't continue for more than a few days.
  • Other symptoms may include abdominal cramps and fever.

There are several possible causes, most common are:

  • Viruses. Infections caused by viruses are the most common cause of acute diarrhea. Diarrhea caused by viruses usually clear up within a few days, with no need for antibiotics.
  • Bacteria. Diarrhea can be caused by infections with bacteria, such as Salmonella, Shigella, or certain types of Escherichia coli. These germs may be spread by means of contaminated foods or water or by your child's getting germs from an infected person into his or her mouth. Some of these infections are treated with antibiotics, but others are not.
  • Parasites. Diarrhea may be caused by certain parasites. These infections are most likely if your child has recently traveled or come from an area where the parasites are common. However, outbreaks can occur in other areas as well. Specific drugs are given to kill the parasite.

Other possible causes include, allergies, food poisoning, and gastrointestinal or other diseases. If your child's diarrhea doesn't clear up as expected, the physician may recommend tests to help pinpoint the cause.

Dehydration is the main complication of diarrhea in children. It occurs when your child doesn't drink enough liquids to replace the fluids his or her body is losing because of diarrhea. Your child may become dehydrated even if he or she doesn't feel thirsty. Dehydration can develop quickly, especially in infants. Your child must be watched carefully to avoid dehydration, especially infants.

Discipline - The Basics

Generally, discipline should be regarded as the provision of consistent structure. Effective discipline is based on a positive, supportive relationship between parents and children. Strategies based on praising and rewarding desired behaviors and removing privileges are generally better than strategies based on punishment. For young children, "time outs" are a useful strategy. Most pediatricians don't recommend spanking because other approaches seem to work better.

How should I discipline my children?

There's no "right" way to discipline children; every family must find an approach that works for them. However, some key concepts can help you develop an effective approach to teaching children proper behavior.

The approach to discipline should be consistent for all children in your family, with limits set and enforced for all. Both parents, as well as other care providers, should be consistent in disciplining children.

It's important to consider your child's developmental level in setting expectations and responding to behavior problems. For example, it would be normal for a one-year-old to play with the family stereo, possible causing damage. An appropriate response would be to distract the child and put the stereo out of reach.

The family atmosphere should be a safe, loving and supportive one for your child. It is also very important for parents to be good role models. Show the kind of behavior you would like your child to follow. Children learn from their parents.

What are the principles of discipline?

"Positive reinforcement" means praising and rewarding desired behaviors. This is more effective than" negative re-enforcement" - yelling or punishment for undesired behaviors.

When punishment is necessary, "time outs" are a good tool to use with young children. By age 5, children are old enough to understand the consequences of their behavior. Strategies based on removing privileges are recommended for this age group.

  • Time outs. For toddlers and preschoolers, the idea behind time-outs is to remove the child from playtime or other desired activities as a direct consequence of undesired behavior.
  • Tell your child you are giving him or her time-out. During the time-out, your child must sit by himself or herself away from play or other activities.
  • Especially for toddlers, the time-out should happen immediately after the undesired behavior. Two-year-olds can't make the connection between misbehaving earlier in the day and the time-out they are getting later.
  • Time-outs shouldn't last too long: 1 minute per year of age is a good guideline. Stay calm and don't argue or bargain with your child.
  • Time-outs only work when they are used consistently. If you are just starting to use time-outs, at first your toddler may respond by having a tantrum. When tantrums happen, ignore them if possible, and remove the child from the situation if necessary. Don't give in to tantrums, or you will reinforce that behavior. Your child will learn that he will get what he wants eventually. Parents who stick with it usually find time-outs effective in reducing undesired behaviors.
  • Removing Privileges. After age 4 or 5, children are old enough to understand why they are being disciplined.
  • Taking away some privilege or activity that your child really wants provides consequences for misbehavior. For younger children, this may mean taking away TV or video game privileges. Older children may be "grounded" (not allowed to go out with friends). Teens may have their driving privileges taken away.
  • Be clear, direct, and consistent each time the undesired behavior occurs. Be calm when discussing the misbehavior with your child. If you can't stay calm, it may be best to discuss the problem later.

What discipline strategies are less effective?

  • Negative verbal statements. If used infrequently, negative verbal statements can be helpful in pointing out misbehavior. However, if used often, negative comments and criticisms become less effective; they can actually be a way of giving the child attention. Negative statements should refer to the behavior ("what you did was wrong because…"), not the child's character ("You're a bad boy.")
  • Spanking. Most pediatricians think other strategies are more effective. Discipline must be non-violent. Spanking is defined as hitting a child with an open hand on the buttocks, arm, or leg without causing physical harm. Spanking is not as effective as the other methods discussed.
  • Any other type of physical punishment is not spanking. This includes hitting a child in anger; hitting hard; hitting with a fist or object; kicking; hitting hard enough to leave a mark; or pulling hair, jerking arms, or shaking a child. They also show him or her that aggressive, angry behavior is a way to solve problems.

NOTE:

If you ever feel so angry that you might hurt a child, remove yourself from the situation. Leave the room and try to clam down, or call your spouse or a friend.

When should I call the office?

  • The methods of discipline you are using do not seem to be working.
  • You are getting very frustrated with your child and feel like you might harm him or her.

Ear Infections

Ear infections are common in young children. Most kids get at least one before they are 3 years old. They're often related to a cold or other illness. Ear infections cause redness, swelling, or fluid in in your child's middle ear and are often painful. That can make it hard for your child to eat and sleep. Sometimes they cause fever. Pain relievers, like acetaminophen or ibuprofen, should be used to relieve ear pain whether or not an antibiotic is also prescribed. Many ear infections don't need an antibiotic. They often get better on their own - just as quickly- without the use of antibiotics. The doctor will look inside your child's ear to help decide the best way to treat it. The doctor may ask you to wait a day or two to see if your child gets better gets better without an antibiotic. If an antibiotic is prescribed, make sure to follow the doctors's instructions.

So Some Helpful Tips to Avoid Ear Infections:

  • Keeping children away from cigarette smoke.
  • Protecting children from cold and flu viruses.
  • Breastfeeding babies if possible, or making sure children don't drink from bottles while lying down.
  • Eliminating or cutting back on use of pacifiers, since sucking can pull germs into the middle ear.
  • Staying up to date on immunizations. The infant pneumococcal and HIB vaccines help lower the risk for ear infections. An annual flu shot for children older than 6 months also helps.

Fainting (syncope)

Syncope is the medical term for fainting. Fainting occurs fairly commonly in children and teens and is usually not serious. In a small percentage of cases, fainting can be caused by heart rhythm problems (abnormal heartbeats) or other uncommon causes. Tests may be needed to determine the origin of the problem.

Fainting during physical activity can be more serious and always requires medical evaluation. Contact our office immediately if this happens.

Symptoms of Syncope:

  • Your child suddenly collapses, losing consciousness.
  • He/she may have various symptoms before passing out, such as:
    • Dizziness (lightheadedness).
    • Fast breathing (hyperventilation).
    • Flushing: feeling warm, sweating.
    • Vision changes.
    • Nausea.
  • Many other symptoms are possible.
  • Sometimes after fainting, muscle twitching occurs. This can make it difficult to tell simple fainting from a seizure (involuntary, uncontrollable muscle movements).
  • Your child regains consciousness a minute or two after fainting. He/she should be alert and aware of what's going on. (If not, a seizure may be more likely to have occurred.)

What causes syncope?

  • The most common cause of simple fainting in children is "vasovagal" syncope, sometimes called "neurocardiogenic" syncope.
  • An abnormal response of the parasympathetic nervous system (which controls automatic activities such as heartbeat) results in a drop in blood pressure and heart rate. This reduces blood flow returns to normal when your child falls or lies down.
  • This type of fainting is uncommon before ages six to ten years. Fainting can be a sign of low blood sugar in people with diabetes (sometimes even in those without diabetes).
  • Rarely, fainting in children can result from some potentially serious heart conditions, including heart rhythm problems called arrythmias. With arrythmias, the heart beats too fast or, less often, too slowly. This sometimes doesn't allow enough blood to be pumped to the brain and causes fainting. The child may feel his/her heart beating faster.

When should I call your office?

Although fainting spells are usually not a sign of serious disease, it's good idea to get medical evaluation if your child faints.

  • In general, you should call or see the doctor the first time your child faints. The doctor will advise you what to do if fainting occurs again.
  • If your child is being evaluated for fainting and the episode appears different than usual, call our office or go to the emergency room. For example:
    • If your child loses control over urination or bowel movements.
    • If your child is unconscious for more than a minute or two, or if he/she is confused after waking up.
  • If your child faints during activity or exercise, call our office or go to the emergency room.

Fever Management

Most doctors define a fever as a temperature of 100.4°F or 38.0°C when taken rectally. Mnay different illnesses can cause fevers. The most common cause is some type of infection - usually with a virus or bacteria. Fever may help your child's body fight the infection.

Never give aspirin for fever in young children. This can increase the chances of developing a serious illness called Reye's syndrome.

When should fevers be checked by the doctor?

Call our office or see a doctor if any of the following occurs:

  • Fever in a child who is acting very ill: not easily soothed, crying a lot, very tired or sleepy - more than expected than for just "being sick."
  • Fever lasting 3 or more days.
  • Very high temperature: 104°F (40°C) or higher.
  • Fever in an infant less than 2 to 3 months old.
  • Fever developing later in an illness; for example, your child has a cold for 4 to 5 days and then gets a fever.
  • Seizures related to a fever.

Which fevers should be treated with medications?

Treatment with fever-reducing drugs does not affect how long your child will be sick. However, lowering your child's temperature may help to make him or her feel better.

  • If your child is uncomfortable or in pain. Fevers higher than 102°F (39°C) often make children uncomfortable, so it's reasonable to give drugs to bring the fever down.
  • If your child is at risk of becoming dehydrated (not drinking enough liquids or losing fluids through vomiting or diarrhea). Fevers cause increased loss of water from the body (through evaporation).
  • Children with certain diseases, such as heart disease or febrile seizures, may benefit from treatment to control fever.

What medications should I use?

If giving medications to lower your child's fever, use acetaminophen or ibuprofen. Both drugs can help reduce fever and make your child feel better. They are available in liquid, chewable, or pill form.

Occasionally, lukewarm sponge baths can be helpful if your child's fever is hard to control, but these usually aren't necessary. There is never a reason to use rubbing alcohol to bring the fever down. If the fever is still present after 2 to 3 days of treatment, see the doctor.

Foreskin Problems

Most uncircumcised boys have no problems that relate to the intact foreskin - the skin covering the tip of the penis. In infants and toddlers, it is normal for the foreskin not to slide back over the end of the penis. In older boys, the foreskin may be too tight to slide back (phimosis), but this is usually not a serious problem. If the tight foreskin is forced over the head of the penis and cannot be pulled back, this may cause a serious condition called paraphimosis.

What kinds of foreskin problems may occur?

Phimosis means tight foreskin. In this condition, the foreskin cannot easily be pulled over the head of the penis. This is normal in toddlers and infants. Usually, the foreskin becomes loose enough to be pulled back as your child gets older. In older boys, phimosis can make if difficult to clean the head of the penis. Occasionally it causes problems with urination.

Balanoposthitis refers to inflammation to the head of the penis and foreskin that result from irritation or infection. Infection can be either bacterial or yeast. Poor hygiene can be part of the problem.

Paraphimosis is a problem in which the foreskin gets pulled over the head of the penis and cannot be pulled back. This can cause problems with blood flow in the head of the penis and there is a risk of permanent damage.

Paraphimosis can be an emergency requiring immediate treatment.

What Do they Look Like?

  • Phimosis
    • "Tight" foreskin that cannot easily be pulled back over the head of the penis.
    • This is normal in infants and young boys. Usually by age 3, the foreskin becomes loose enough to be pulled back easily.
    • Never force the foreskin back over head of the penis. This actually increases the risk of problems the risk of problems with tight foreskin/phimosis.
    • Phimosis sometimes causes problems during problems during urination. The foreskin may fill up like a balloon before the urine finally comes out. If this occurs call our office for an appointment.
    • In older boys, phimosis may cause when the penis is erect.
  • Balanoposthitis.
    • Redness, tenderness or swelling of the foreskin or head of the penis.
    • Pus of other fluid draining from the tip of the penis.
    • May be pain with urination.
    • Antibiotics may be needed if infection is present. The antibiotic used on the cause of infection.
    • The doctor may recommend antibiotic pills or cream. Steroid cream or ointment may also be used for the inflammation.
    • Circumcision is sometimes recommended if the problem occurs repeatedly.
  • Paraphimos
    • Tight foreskin pulled back over the of the penis.
    • Head of the penis becomes swollen and very painful.
    • Paraphimosis requires immediate treatment to avoid damage to the head of the penis caused by problems with insufficient blood supply. Contact our office immediately

When should I contact your office?

Call our office whenever symptoms related to the foreskin develop, especially pain, tenderness, or swelling of the foreskin or head of the penis.

Frequent Infections

Average Frequencies of Infections

Some children seem to have the constant sniffles. They get one cold after another. Many a parent wonder, "Isn't my child having too many colds?" Children start to get colds after about 6 months of age. During infancy and the preschool years they average seven or eight colds each year. During adolescence they finally reach an adult level of approximately four colds per year. Colds account for more than 50 % of all acute illnesses with fever. In addition, children can have diarrheal illnesses (with or without vomiting) two or three times per year.

Similar Condition: Allergies

If your child is over 3 years of age, sneezes a lot, has a clear nasal discharge that lasts for over 1 month, doesn't have a fever, and especially if these symptoms occur during pollen season, your child probably has a nasal allergy. Allergies are much easier to treat than frequent colds because medicines are effective at controlling symptoms.

Causes

The main reason your child is getting all these infections is that he/she is being exposed to new viruses. There are at least 200 cold viruses. The younger the child, the less the exposure and subsequent protection. Your child has more indirect exposures if she has older siblings in school. Therefore, colds are more common in large families. The rate of colds triples in the winter when people spend more time crowded together indoors breathing recirculated air. In addition, smoking in the home increases your child's susceptibility to colds, coughs, ear infections, sinus infections, croup, wheezing, and asthma.

What doesn't cause frequent infections?

Most parents are worried that their repeatedly ill child has some serious underlying disease. A child with immune system disease (inadequate antibody or white blood cell production) doesn't experience any more colds than the average child. Instead, the child has two or more bouts per year of pneumonia, sinus infection, draining lymph nodes, or boils, and heals slowly from these infections. In addition, a child with serious isease does not gain weight adequately nor appear well between bouts of infection.

Dealing With Frequent Infections

Look at Your Child's General Health. If your child is vigorous and gaining weight, you don't have to worry about his/her basic health. Your child is no sicker than the average child of his/her age. Children get over colds by themselves. Although you can reduce the symptoms, you can't shorten the course of each child. Your child will muddle through like every other child. The long-term outlook is good. The number of colds will decrease over the years as your child's body builds up a good antibody supply to the various viruses. For perspective, note the findings of a recent survey: on any given day 10% of children have colds, 8% have fevers, 5% have diarrhea, and 3% have ear infections. Young children have an average of 6-8 colds per year. The incidence of illness decreases with age, with 2 to 3 illnesses per year by adulthood. Children in out-of-home daycare centers during the 1st year of life have 50% more colds than children cared for only at home.

Send your child back to school as soon as possible. The main requirement for returning your child to day care or school is that the fever must be gone and the symptoms are not excessively noisy or distracting to classmates. It doesn't make sense to keep a child home until we can guarantee that he/she is no longer shedding any viruses because this could take two or three weeks. If isolation for respiratory infections were taken seriously, insufficient days would remain to educate children. Also, the "germ warfare" that normally occurs in schools is fairly uncontrollable. Most children shred germs during the first days of their illness before they even look sick or have symptoms. In other words, contact with respiratory infections in unavoidable in group settings such as schools or day care. Also, as long as your child's fever has cleared, there is no reason why he/she cannot attend parties, play with friends after school, and go on scheduled trips. Gym and team sports may need to be postponed for a few days.

Try Not To Miss Work

When both parents work, these repeated colds are extremely inconvenient and costly. Since the complication rate is low and the improvement rate is slow, don't hesitate to leave your child with someone else at these times. Perhaps you have a babysitter who is willing to care for a child with a fever.

If your child goes to day care or preschool, he/she can go back once the fever is gone. There is no reason to prolong the recovery at home if you need to return to work. Early return of a child with a respiratory illness won't increase the complication rate for your child or the exposure rate for other children. Consider switching to a small home-based day care if your child is less than 2 years old. Also, find another day care if someone on the day care staff smokes on site.

There are no instant cures for recurrent colds and other viral illnesses. Cough and cold medications that contain expectorants, antihistamines, nasal decongestants and cough suppressants are commonly used to treat symptoms of upper respiratory infection. However, studies have shown that use of cough and cold medications in children younger than 2 years is not effective and could lead to potential adverse effects. Antibiotics are not helpful unless your child develops complications such as an ear infection, sinus infection, or pneumonia. Having your child's tonsils removed is not helpful because colds are not caused by bad tonsils. Colds are not caused by poor diet or lack of vitamins. Again, the best time to have these infections and develop immunity is during childhood. Colds are the one infection we can't prevent yet. From a medical standpoint, colds are an unavoidable educational experience for your child's immune system.

Growing Pains

Growing pains are episodes of pain in your child's legs. They are most common in preschool and preteen children. Although the pain is real, the cause of growing pains in children is unknown. One explanation is that the pains may result from muscle contractions or spasms, usually at the end of the day of active play.

What do they look like?

  • Pains often occur at night or when your child is resting.
  • Pain usually occurs in the lower legs.
  • Pain does not occur in the joints (hips or ankles).
  • Rubbing the legs lessens the pain.

What are some possible complications of growing pains?

None. Unless there is another explanation for your child's leg pain, the pains will go away completely with no harmful effects.

Can growing pains be prevented?

Since the cause is unknown, there is no clear way to prevent growing pains. Stretching the muscles before exercise or activity may be helpful.

How are growing pains treated?

  • Rubbing your child's legs may make the pain lessen.
  • Pain medication (acetaminophen or ibuprofen) may be helpful.

When should I call the doctor?

  • Your child has leg pain after an accident or injury.
  • Your child had pain in the leg joints, not just the muscles.
  • Your child has severe leg pain or tenderness.

Occasional episodes of growing pains are harmless and can be safely treated at home.

Hay Fever (Allergic Rhinitis)

Like adults, children can sniffle and sneeze because of allergies. Effective treatment includes medications and steps to avoid allergens. Hay fever and eczema (atopic dermatitis) in young children are risk factors for asthma.

What does it look like?

  • Stuffy, running nose.
  • Itchy nose and eyes (allergic conjunctivitis).
  • Sneezing.
  • Headaches.
  • Instead of blowing his/her nose, your child may sniff and snort.
  • Young children may rub their noses upward with the palm of the hand. This habit—sometimes called the "allergic salute"—may cause a crease over the bridge of the nose.
  • Your child may breathe with his/her mouth open and have dark circles under the eyes.

What causes hay fever?

Some of the most important allergens to which your child has become allergic are:

  • Pollens. If your child is allergic to tree pollen, symptoms will appear or worsen in the spring. Grass pollen levels are high in early summer, while weed pollen levels peak in late summer. Symptoms of pollen allergy may disappear in the fall, after the first frost occurs.
  • Molds, outdoor or indoor.
  • Pets, especially cats and dogs. Because pet fur is carried on clothing, it may be found even in pet free areas, such as at school and day care.
  • Household pests, especially house dust mites and cockroaches.

The doctor may prescribe medication to reduce symptoms of hay fever

Call our office if:

  • Your child's allergic symptoms don't get better with treatment, or if they get worse Your child develops signs of asthma, such as wheezing (high- pitched sounds coming from the lungs) or coughing.
  • Your child develops signs if sinusitis (such as fever, headache) or if he/she simply isn't feeling well.

Head Injury

Most head injuries in children are not serious. Confusion, unsteadiness, and headache usually mean a concussion is present, and your child should see the doctor. Medical attention is also needed if your child has lost consciousness, even for a short time. Imaging tests may be needed to make sure there is no bleeding inside the skull.

Children may suffer head injuries in many ways, some of which include sports injuries, bicycle accidents, and motor vehicle accidents. Medical evaluation is needed for all but the most mild "closed" head injuries, that is, injuries in which nothing penetrated the head or skull.

The main concern in whether your child has suffered swelling or bleeding in or around the brain. Concussions are mild brain injuries producing no damage that can be detected by the usual imaging tests. If your child loses consciousness for even a short time or has any behavior change after a head injury, get medical care as soon as possible.

Contact our office if your child has any of the following symptoms:

  • For any head injury that causes unconsciousness, grogginess, or confusion, vomiting, or severe headache.
  • Any time your child has a hard injury to the head, even if there are no symptoms. Worsening or severe headache
  • Weakness, dizziness.
  • Vomiting.
  • Difficulty walking.
  • Different-sized pupils, or pupils that don't change much in response to light.
  • Seizures (involuntary body movements).
  • Confusion or irritability; won't stop crying.

Laryngitis

Laryngitis is a viral infection of the larynx, or voice box. Older children with laryngitis may become hoarse or lose their voices completely. However, the illness is rarely severe and usually gets better within a few days. In younger children, infections of the larynx and trachea ("windpipe") may cause a barking cough, called croup. Laryngitis is generally mild and starts to clear up within 4 to 7 days.

What does it look like?

  • Your child's voice becomes hoarse or disappears completely.
  • Sore throat and cough may also be present, but hoarseness is the main symptom.
  • Your child may "sound sicker" than he or she feels.
  • Other symptoms, such as noisy or difficult breathing, are uncommon.
  • In younger children, especially under age 3, an infection of larynx and trachea is called croup and may cause a distinctive, "barking" cough.

What are some possible complications of laryngitis?

Laryngitis in older children has few complications. Your child should start to feel better in 4 to 7 days. Sometimes, laryngitis is a symptom of a more severe infection. If your child has other symptoms, such as a high fever or difficulty breathing, call our office.

Can laryngitis be prevented?

Have your child wash his or her hands frequently and try to avoid contact with people who have coughs and cold.

How is laryngitis treated?

  • Just as for colds, there is no specific treatment for laryngitis. Antibiotics are usually unnecessary.
  • Your child should rest his or her voice as much as possible for a few days.
  • If your child is feeling particularly ill, he or she may have to rest more and drink extra liquids.
  • Pain relievers (such as acetaminophen or ibuprofen) may help reduce sore throat. Drinking plenty of liquids may also help your child's throat feel better. Have your child avoid exposure to anything that may irritate the throat, especially cigarette smoke.

When should I call your office?

Laryngitis should start to feel better within a few days. If your child's hoarseness doesn't get better within 1 week, or if symptoms get worse, call our office. Call our office if your child develops a high fever or difficulty breathing or wheezing (high-pitch sounds coming from the lungs).

Nose Bleeds

Most nosebleeds stop on their own in a few minutes. The following steps may be helpful:

  • Put gentle pressure on the nostrils. It may help to hold a cold washcloth to the nose.
  • Have your child sit quietly. Keep the head tilted forward; this helps the blood from trickling back into the throat.
  • If the nosebleed doesn't stop within several minutes, try a nasal spray such as Afrin or Neo-Synephrine.
  • If there is a lot of blood coming from your child's nose or if the nosebleed doesn't stop within 5 to 10 minutes, please contact our office please.

At the doctor's office or emergency room:

The doctor may place a small gauze pack inside the nostril to control the bleeding. Once the bleeding is under control, the doctor may need to locate the blood vessel that is causing the bleeding. A medication called silver nitrate can be placed to seal off the bleeding vessel.

Pinworm Infection

What is pinworm infection?

Pinworm infection is infection with tiny worms. Pinworm infection is very common and spreads easily, especially among young children. The infection is not serious, but it can be uncomfortable. Simple treatments can get rid of the worms.

What does it look like?

  • Pinworm infection may produce only mild symptoms or no symptoms at all.
  • The main symptom is itching around the anus.
  • Itching often occurs at night and may interfere with your child's sleep.
  • In girls, itching may occur around the vagina.
  • Your child may be irritable or restless.

What causes pinworm infection?

  • Pinworms are common parasites their scientific name is Enterobius vermicularis; pinworm infection is sometimes called enterobiasis.
  • Infection occurs when your child gets pinworm eggs into his/her mouth (ingestion) Pinworm infection spreads easily.

Can pinworm infection be prevented?

  • Because pinworm infection is so common, it very difficult to prevent.
  • Try to keep children from putting unwashed hands into their mouths. Keep their nails short, because pinworm eggs get underneath the nails.
  • Your child's treatment will include recommendations to avoid spreading the infection to others and to prevent your child from becoming infected with pinworms again.

When should I call your office?

Your child has symptoms of anal itching or symptoms return after treatment of a pinworm infection.

Poison Ivy

What is poison ivy? Poison ivy is a plant that causes an intense, sometimes severe skin rash with, itching. The rash develops after the skin comes into contact with chemical found in the plant's resin. It is a type of allergic reaction called "contact dermatitis." In addition to direct contact with the plant, the resin can be spread over other parts of the body by scratching or rubbing, or from contact with clothing or animal fur. If one has had poison ivy before ("sensitized"), the rash usually develops within a few days after coming in contact with the resin. If not, it may take longer – up to a few weeks. Poison ivy is found in most parts of the United States and can grow as either a shrub or vine. The leaves are notched and grow in threes on a stem. Poison oak and poison sumac are less widespread plants that cause similar allergic contact dermatitis reactions. Poison oak is a shrubby plant with three leaves that look like oak leaves. Poison sumac is a woody plant with paired leaves on either side of a long stem.

What does it look like?

A red rash develops in areas of the skin that have come into contact with the poison ivy resin.

  • Red bumps appear, often with blisters of different sizes.
  • The skin may become crusted, scabbed, and oozing.
  • The rash can appear in streaks where the skin brushed up against the plant. However, other patterns are possible, depending on how the resin got into contact with the skin. For example, if a dog has been in poison ivy and your child pets or hugs it, the rash will appear in those areas that touched the pet.
  • The rash may be mild or severe, depending on whether you've had poison ivy before and how your particular skin reacts to it.
  • If the rash is severe, especially when it's on the face, lots of swelling can occur.
  • The rash and itching often get worse for a few days before they start to get better. It may often take a few weeks for the rash to go away.

Can poison ivy be prevented?

  • The best prevention is to recognize poison ivy and stay away from it.
  • Another good preventative step is to wear long sleeves and pants while walking in wooded areas. (This also lowers the risk of tick bites.) However, the resin can still get on your clothes if you come into contact with poison ivy. Wash your clothes as clothes as soon as possible.
  • If you come into contact with poison ivy, wash the skin as soon as possible - preferably within 30 minutes. Wash thoroughly, including under the fingernails.
  • If trying to eliminate the poison ivy plant, don't burn it because smoke can carry the resin onto the skin, particularly the face.

How is poison ivy treated?

Once the rash of poison ivy has appeared, treatments can help control itching and inflammation.

  • Mild cases are treated with lotions that reduce itching, such as calamine lotion, or a weak steroid cream, such as 1% hydrocortisone. Both can be bought over the counter.
  • A cool compress (washcloth soaked in cool water) can be helpful, especially if the rash is crusty or oozy.
  • For more severe cases, please contact our office to schedule an appointment.
  • The doctor may also recommend oral antihistamines to help control itching.

Removing poison ivy - if you have the poison ivy plant on your property, it can be difficult to eliminate. Herbicides may work but can kill other plants as well. You can eliminate the plant by pulling it up by hand, but make sure to wear appropriate gloves and other protective clothing. Never burn poison ivy! (For more removal tips, see the internet resource listed at the end of this article.)

When should I call your office?

Call our office if any of the following occurs:

  • Medications aren't helping after a few days.
  • The rash becomes more severe or starts to involve the face or genital area.
  • Signs of bacterial infection develop, especially pus oozing from skin blisters.

Poisoning

Poisoning is a common and often serious emergency in children. Poisoning most often occurs when toddlers and preschools find poisons in the home and eat or drink them. If you have an infant or toddler, you need to "poison-proof" your home and make a plan for what to do if poisoning occurs.

What types of poisoning occur in children?

The average home contains many products that could cause poisoning in a young child, even in small doses. Many common medications can be harmful when taken in large doses. Infants and toddlers are at risk of poisoning because they love to explore their environment and will put almost anything in their mouths.

If you have an infant or a toddler, it is essential to "poison-proof" your home so that your child cannot find and eat or drink anything harmful. All potential poisons must be locked up!

Some common and dangerous household poisons include medicines, cleaning and chemical products, and auto antifreeze.

Always get medical advice before attempting any treatment for poisoning! For some types of poisons - especially caustic substances such as drain openers - you should not induce vomiting. If your child eats, drinks, or inhales something that may be poisonous, call 911 or another emergency number. Get medical help as soon as possible. Call our office or the Poison Help Line (1-800-222-1222). Don't make your child vomit, unless you are told to do so by a doctor or the poison control center. Some poisons may cause more damage if your child vomits.

What does it look like?

Poisoning symptoms depend on what type of poison your child has taken. Often, there are no symptoms - the parent just discovers that a child has drunken or eaten a possible poison substance.

Possible symptoms include:

  • Nausea and vomiting.
  • Very fast or very slow breathing.
  • Confusion, behavior changes.
  • Changes in the pupils (black part of eye); they become dilated (large) or constricted (small).
  • Extreme sleepiness or unconsciousness.
  • Burns around the mouth.
  • Coughing or choking.

How can poisoning be prevented?

Poison-proof your home by putting away all medicines, household cleaners, and other possible poisons. All of these products should be locked up or put away where your child cannot see or find them. (Remember, toddlers love to climb!). Teach your child never to but anything food or drink into his or her mouth. Never tell your child that medicine is "candy." Buy medicines with childproof caps. (Remember, grandparents may have medicine bottles without safety caps.) Ladies purses are a favorite place for toddlers to explore. Keep medicines in their original containers. Have a plan in case poisoning occurs!

How is poisoning treated?

If you think your child may have been poisoned, get medical help immediately. Call your regional poison control center (1-800-222-1222), or call 911. Don't wait for symptoms to occur. Be prepared to provide as much information as possible about the substance your child was exposed to.

For swallowed poisons, do not give syrup of ipecac or anything else to induce vomiting unless instructed to do so by the poison control center or doctor.

For inhaled poisons, get the child to fresh air as soon as possible.

If the poison has gotten on to the skin or in the eyes, rinse with lots of freshwater for several minutes.

When should I call your office?

Call the regional poison control center (1-800-222-1222) any time you think your child may have drunk or swallowed any type of poison.

Skin Abscesses

What do they look like?

An area of swelling on or under the skin. Abscesses are usually small at first outset but may gradually get bigger. Abscesses may occur anywhere on the body; the buttocks are a common location. The skin over the abscess may be inflamed (red, warm, and tender). Abscesses can be quite painful, depending on their size and location. Some abscesses may drain fluid on their own.

What causes abscesses?

Abscesses are caused when a minor wound (such as a cut or scratch) becomes infected with bacteria (such as the common "staph" [Staphylococcus] bacteria).The infection becomes walled off or enclosed as the body attempts to fight the germs. Abscesses may go unnoticed for some time, especially if they are located below the skin.

What puts your child at risk of abscesses?

Without proper wound care, any cut, scratch, or other wound may lead to an abscess.

Can abscesses be prevented?

  • Wash all wounds thoroughly as soon as possible.
  • Keep wounds covered with bandages until the skin closes over them.
  • Teach children to keep their fingers away from wounds and scabs, since fingers may carry germs that can lead to abscesses.
  • How are abscesses treated? Although most skin abscesses are not serious, they require medical care. The doctor can provide proper treatment to relieve discomfort and prevent the infection from spreading.

When should I call your office?

Call our office for any wound that looks infected and any sign of an abscess. After treatment for an abscess, call our office if there is any sign that the infection is returning (recurrence of swelling, pain, warmth). If your child develops fever, chills, or any other signs of spreading infection, seek medical care as soon as possible.

Skin Wounds (Lacerations, Punctures, and Abrasions)

What are skin wounds?

A wound is any type of injury that causes a break in the skin.

Lacerations (cuts or incisions). Wounds caused by something sharp, such as a knife or broken glass. Cuts may cause a lot of bleeding.

Punctures. Wounds caused by a pointed object stuck deep into the skin, such as a nail. If the puncture wound is deep and difficult to clean or if the object was contaminated, there is an increased risk of infection.

Abrasions (scrapes). Wounds caused by rubbing against something rough, such as a sidewalk. Abrasions are often contaminated by dirt or grit.

What kinds of wounds require a doctor's visit?

Children with the following types of wounds should be taken to the doctor's office or the emergency room if it is a severe wound:

  • Deep puncture wounds.
  • Wounds in which edges won't stay together.
  • Wounds with deep layers (fat or muscle) visible inside.
  • Wounds with jagged edges.
  • Wounds that don't stop bleeding after a few minutes or that spurt blood.
  • Lacerations or puncture wounds with visible contamination, such as dirt or grit.
  • Wounds that are very painful.
  • Wounds on the face, unless they are very minor.

What puts your child at risk of skin wounds?

Obviously, children get a lot of cuts and scrapes. Most are minor and heal without problems. Provide age-appropriate supervision when children play. Make sure that play areas such as backyards are free of hazards that could cause injuries.

How are wounds treated?

Minor wounds can be treated at home:

  • Wash your hands with soap and water before cleaning the wound.
  • Wash the area gently with soap and water, then rinse with lots of clean water. All dirt, sand, and debris need to be removed.
  • To stop bleeding, put gentle pressure on the wound.
  • Putting a thin layer of antibiotic ointment on the wound may help reduce pain and promote healing. However, to prevent infection, cleaning the wound is more important than using an antibiotic.
  • After applying antibiotic ointment, place a bandage over the wound. This will help it heal more quickly.
  • When a scab forms, be sure your child leaves it alone. Scabs serve the same purpose as bandages, sealing the wound of the germs. Picking at scabs increases the risk of infection.
  • Other wounds should be evaluated and treated by a health professional, including large wounds, wounds with jagged edges, deep puncture wounds, "dirty" wounds, and certain other types.
  • Don't wait to see the doctor! Cleanse the wound immediately, as described for minor wounds.
  • Stitches (sutures). If the wound is large or deep or if the edges do not line up properly, the doctor may decide to place stitches, also known as sutures. This is done to promote proper healing while reducing the chances of scarring.

When should I call your office?

Call our office your child has a wound and your are not sure whether medical attention is needed or if the wound shows any of the following signs of not healing properly:

  • Wound edges are coming apart.
  • Signs of infection (redness, soreness, tenderness, fever).
  • For new or old wounds, call our office if your child is experiencing a lot of pain or is having difficulty moving the injured part.

Sore throat

Most sore throats (pharyngitis) in children are caused by viruses, like those responsible for the common cold. Unless a specific cause such as infection with "strep" (streptococcal pharyngitis) bacteria is identified, sore throats usually clear up without treatment. Infection of the tonsils is common in children with sore throats. Surgery to remove the tonsils (tonsillectomy) is performed only if infections become very frequent or for other specific reasons.

Sore throats are very common in children. They are one of the main reasons for the visits to the doctor's office. Symptoms include:

  • Throat pain, ranging from mild to severe.
  • Difficulty swallowing, sometimes with the feeling of a "lump" in the throat.
  • Fever.
  • Additional cold symptoms, such as fever, runny nose, sneezing, achiness.
  • At times, swollen glands in the neck.

What causes pharyngitis and tonsillitis?

Sore throats are a common symptom of respiratory infections, including the same viruses which are likely to begin gradually and to occur along with typical symptoms of a cold, such as runny nose and cough. Some sore throats are strep throat, which is infectious with a specific type of bacteria. Some of the features of strep throat include:

  • Sore throat comes on suddenly.
  • Few symptoms of cough or cold.
  • Swollen and tender glands in the neck.
  • Headache and abdominal pain.
  • Tonsils appear swollen and red, sometimes with visible pus.
  • Distinct rash of scarlet fever. This fine, red, rough-feeling rash, like sandpaper. Just because your child has scarlet fever doesn't necessarily mean the strep throat is more severe.

How are pharyngitis and tonsillitis treated?

  • Unless your child has strep throat, controlling pain and drinking enough liquids to prevent dehydration are all the treatment needed. Your child's sore throat should start to get better within a few days.
  • We probably will not prescribe an antibiotic for your child because antibiotics are not effective against viruses, the most common cause of pharyngitis. If the doctor suspects infection with strep bacteria and office tests are positive, your child will be given antibiotics.
  • Make sure your child drinks plenty of liquids. Avoid orange juice or other acidic drinks, which may irritate the throat.
  • Use pain relievers (such acetaminophen or ibuprophen) to reduce the discomfort of sore throat, headache, or muscle aches.
  • For older children, gargling with warm salt water may help the throat feel better. Anesthetic sprays and lozenges may also be helpful.
  • Tonsillectomy is usually considered only if tonsillitis becomes a frequent or chronic problem.

When should I call your office?

Call our office if your child's sore throat doesn't get better in 4 or 5 days, if your child's sore throat gets worse, or if he or she develops new symptoms, such as:

  • Difficulty opening his or her mouth.
  • Drooling.
  • Large swelling or redness of the glands (lymph nodes) in the neck.
  • Difficulty breathing
  • A very muffled voice.

The Vaccine Controversy

Click on the link below to read an article entitled "Why So Many Parents Are Delaying Vaccines"

Why So Many Parents Are Delayed or Skipping Vaccines

The following link is a slide show about "5 Myths About Vaccines"

5 Myths About Vaccines Slide Show

Sprains and Strains

Sprains and strains are common injuries in active children. A sprain is an injury to the ligaments in and around joints. A strain is an overstretched or "pulled" muscle. Any time your child has an injury causing a lot of tenderness, swelling, or difficulty moving a limb or joint, you should seek medical advice.

What are sprains and strains?

Sprains are most common athletic injuries in children. The ankle is the most commonly sprained joint, but wrist, finger, and knee sprains may occur as well. Sometimes it's difficult to tell a sprain from fracture. You should always seek medical attention if your child has more than a mild sprain. Strains, sometimes called "pulled muscles," are also every common. Strains happen away from the joint. The upper leg is a common site for strains, as are the chest, groin, and shoulders.

What do they look like?

Ankle or knee sprains. Ankle and knee sprains are common sports injuries. Ankle sprains most often result from a fall with the foot turned inward. Knee sprains may result from various causes, such as a direct hit or jumping and landing off-balance. The joint is painful, especially when your child tries to move it. If there is a lot of pain or swelling around the injury or if your child cannot walk on the injured leg, seek medical attention.

Wrist or finger sprains. Sprains of the wrist and hand joints may also occur. For example, your child's finger may get jammed in ball game. If your child has significant pain or swelling, get medical attention.

Muscle Strains. Strains can occur in almost any muscle. Strains of the thigh muscles are common, especially in active or athletic children. Muscle strains may be seen when the muscle is overstretched during the sports or other activities, from a direct hit, or for other reasons. Symptoms include pain, tenderness, and occasionally swelling.

How are strains and sprains treated?

  • For mild muscle strains or sprains, the usual recommended treatment is rest, ice, compression, and elevation.
  • Rest. Use the injured area as little as possible for the first day or two after the injury. Passive movement, which does not produce pain, will keep the joint from becoming stiff. Try to keep your child off an injured leg, especially if the knee or ankle is injured.
  • Ice. Put an ice pack on the injured area. This will help to control swelling and pain. Don't put the ice directly on your child's skin because the cold may cause skin damage. Instead, put the ice in a plastic bag and wrap it in a cloth. For muscle strains, heat (for example, a heating pad) is sometimes recommended instead of or in addition to cold.
  • Compression. Wrapping the injured area in an elastic bandage may help to reduce swelling.
  • Elevation. If possible, have your child raise the injured muscle or joint while he or she is resting.
  • Medications such as acetaminophen or ibuprofen may help to control pain. In mild strains and sprains, the injured joint or muscle should start to feel better in a day or two.

When should I call your office? Call our office if:

  • Your child has a joint or muscle injury producing swelling, significant pain, or difficulty moving the joint.
  • Your child is limping or is unable to move the injured joint without pain.
  • Your child's sprain or strain doesn't seem to get better after a day or two of "RICE" or other home treatments.

Temper Tantrums

Temper tantrums are common in toddlers, especially between 18 months and 3 years. Tantrums may be triggered by a number of things, most often anger or frustration at not getting something your child wants. They may also be influenced by overtiredness, hunger, or attention seeking.

What do they look like?

A tantrum includes any kind of inappropriate behavior that your child uses to express anger or frustration. When upset, your child may cry, scram, or hold his or her breath. The behavior may seem way out of proportion to your child's disappointment.

What causes temper tantrums?

As toddlers grow, they want to be more independent, but they're too young to really make many decisions for themselves. They're also not intellectually mature enough to understand the reason for things, or why they have to wait for some things. They lack the language skills to express their frustration in words. It's also hard for them to control powerful emotions, especially if they are feeling tired or hungry.

All of these factors contribute to temper tantrums as a way for young children to express frustration and anger. Handling tantrums in a "calm, cool, and collected" way helps to prevent them from turning into a regular habit.

What's the best way to handle tantrums?

  • Handling tantrums in a "calm, cool, and collected" way is the best way to shorten and reduce the number of tantrums.
  • Turn away for a minute or two. This gives your child time to recover, while allowing him or her to see that the tantrum isn't getting the desired response.
  • Try not to get angry. Don't hit or spank your child. If you react with anger, your child will get the message that out-of-control emotions are an acceptable way to respond to frustrating situations. If you're having trouble staying calm, leave the room for a few minutes. The most important thing is to show your child the ways of controlling anger that you want him or her to use.
  • Don't give your child what he or she wants to make the tantrum stop. If you do, your child will get the message that tantrums work.
  • If tantrums are relatively minor, you can often just ignore them. You may be able to distract your child with a toy or by making funny faces. Saying positives things and giving your child a chance to calm down may be helpful. If that doesn't work, then turn away until the tantrum has passed.
  • If your toddler is holding his or her breath, you can usually just ignore it. Even if he or she passes out, there is rarely any harm done. But be sure to mention this behavior to the doctor.
  • For more severe tantrums, you may need to take steps to ensure that your child doesn't hurt him self or others or doesn't destroy property. If the tantrum is happening in a public place, take your child somewhere more private (for example, to a car or restroom) until he or she calms down. If it seems like there is a danger of physical harm, you may have to hold or restrain your child until he or she calms down.
  • After the tantrum has passed, don't punish your child. However, when your child is calm, you should explain that his or her frustrations are understandable, but that tantrums and other kinds of out-of-control behavior are not acceptable. If hunger or sleepiness seems to have contributed to your child's tantrum, give him or her a snack or a nap. Fortunately, temper tantrums usually become less frequent after age 3. The tantrums should stop by age 4. By this time, your child will have more control over his or her day and more ability to communicate his or her feelings.

When should I call your office?

Call our office if:

  • Your child is still having temper tantrums at age 4 or older. A more in-depth discussion of parenting may be needed.
  • Your child is having severe temper tantrums that pose a risk of harm to himself or herself or others, or if he or she is having destructive tantrums.
  • Your child is holding her breath during tantrums, particularly is she passes out.
  • Your child's tantrums are accompanied by head banging, physical symptoms such as headaches, or other changes in behavior.