There will be times your child shows signs and symptoms of illness. The following is general information about common childhood illnesses. If you have further questions you may call and leave a message for the nurse to call you back or make an appointment for your child. Nurses can give general advice over the phone, but cannot diagnose your child’s illness; therefore, an appointment will sometimes be necessary for your child.
FEVER
Sometimes children will feel hot, but may not have fever. If you suspect that your child has fever, TAKE A TEMPERATURE USING A THERMOMETER. Digital thermometers are recommended. Ear thermometers as well as forehead strips and pacifier thermometers may not be accurate. Fever is expected after certain immunizations and does not need to be reported to the physician. Mild fevers can be caused by too much clothing, increased activity or ingestion of hot foods. Fever is a positive sign that the body is fighting infection. Your child will feel uncomfortable with fever and his heart and respiratory rate will increase. Fever is not cause for concern by itself; however, when accompanied by other signs and symptoms, it needs to be evaluated. There is no “magic number” when we are concerned about fever. We are concerned about how your child is acting when he is running fever.
Call our office IMMEDIATELY if your child has fever associated with the following:
Under 2 months of age with a rectal temperature of 100.4 or greater
Constant crying (as if in pain)
Stiff neck
Difficulty breathing
Difficult to arouse
Appears extremely ill
If your child has fever associated with a sore throat, ear pain, persistent cough and/or difficulty urinating, please call our office for an appointment. Fever that makes your child uncomfortable may be treated with acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). Ibuprofen should only be used in children over 6 months of age. DO NOT give your child aspirin for fever. Please refer to the dosage chart. Dose is based on weight, not age.
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COLDS
Colds (or URIs) are caused by a viral infection of the nose and throat. Germs are spread from person to person by coughing, sneezing, and hand contact. Colds are not caused by drafts or cold air. Since there are about 200 cold viruses, children will get up to 6 colds per year, more if they are in daycare. Symptoms of colds may include runny and/or stuffy nose, cough, sore throat, hoarseness, red eyes and fever. The fever usually lasts about 3 days, the nose and throat symptoms about 1 week and the cough may last 2-3 weeks. Secondary infections may develop such as ear infections, sinus infections, conjunctivitis and pneumonia. There is no treatment for colds other than symptomatic treatment which includes plenty of fluids, rest, fever control measures, humidifiers or vaporizers and over the counter cold medications. The cold medicines will not shorten the duration of the cold, but may help alleviate the symptoms. Some of these medications have side effects such as excitability, irritability and sedation. For young infants with congestion, we recommend using saline nose drops and suctioning with a bulb syringe. Saline nose drops can be purchased over the counter (Ayr, Ocean). Place 2-3 drops into each nostril then suction with a bulb syringe. This is most effective when done prior to feedings and at bedtime.
Antibiotics do NOT cure colds, but if cold symptoms last more than 10-14 days and/or the following occur, your child needs to be evaluated:
Fever lasting more than 3 days
Eyes matting
Ear pain
Difficulty breathing
Your child acts sick
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CONJUNCTIVITIS
Conjunctivitis or “pinkeye” is an inflammation of the white part of the eye. Red eyes without yellow drainage are most often viral or due to irritation. If the red eyes are accompanied by yellow drainage, it is probably bacterial. First, remove any drainage from the eye area with warm water and cotton balls or a clean cloth. You may also use tear-free shampoo. Often prescription eye drops are required to treat conjunctivitis. An office visit may be required depending on other symptoms your child exhibits.
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CONSTIPATION
Constipation is the painful passage of stools, an inability to pass stools after straining and pushing and/or infrequent, hard stools. What is normal for one child may not be normal for another. Babies less than 6 months of age may grunt, strain, become flushed and draw up their legs while passing stools. These behaviors are normal and are no cause for concern (see section that discusses stools in “Normal Newborn Care”). If you believe your infant is constipated, please call our office during regular hours for instructions. In older children, constipation is most often caused by a lack of fiber in the diet, eating large quantities of constipating foods (milk, cheese, peanut butter, etc.) and not getting enough fluids; therefore, dietary changes are often helpful. Be sure to include fruit juices, high fiber foods (bran muffins, graham crackers, oatmeal, brown rice, whole wheat bread, popcorn, etc.), fruits and vegetables in your child’s diet. Encourage regular bowel patterns by having your child sit on the toilet for 10 minutes after meals. Stool softeners may be required if dietary changes do not produce results. Call our office during regular hours to discuss treatment recommendations.
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COUGHS
Coughs are usually due to viral infections of the trachea (windpipe) and bronchi (large air passages). Coughing is a protective mechanism that keeps the lungs clear of mucous and protects them from pneumonia. Coughs may last for 2-3 weeks. Some children have coughing spasms which can last 5 minutes. Measures to make your child more comfortable include:
Using a humidifier-dry air tends to make coughs worse.
Plenty of fluids
Avoiding cigarette smoke-even if you are not smoking around your child, the smoke settles in clothing, hair and air spaces and can aggravate your child’s cough. Multiple studies have shown that passive smoke aggravates asthma, ear infections and respiratory infections.
Medications-cough suppressants reduce the cough reflex. They are only recommended for coughs that interfere with sleep, school attendance and other activities. Dextromethorphan is a common over the counter cough suppressant. Prior to prescribing a stronger medication, your child will need to be examined.
Call our office for an appointment if your child:
Runs fever for more than 3 days
Has a cough that lasts for more than 3 weeks
Has difficulty breathing or shortness of breath
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CROUP
Croup is a viral infection of the vocal cords, voice box (larynx) and windpipe (trachea). It is characterized by a distinct, barky cough along with stridor. Stridor is a raspy sound that is heard on inhalation. As croup worsens, stridor is also heard during sleep or at rest. Generally croup lasts for 5-6 days. It is typically worse at night. Warm, moist air seems to relax the vocal cords and break stridor. At home, you can turn on the warm water in the shower and shut the bathroom door. After the room is steamed up, go in and sit with your child for about 30-45 minutes. Your child should be able to rest more quietly after this.
Call our office for the following:
Stridor is not relieved after sitting in warm, moist air
Breathing becomes difficult
Your child develops drooling, spitting or great difficulty swallowing
Your child develops retractions (tugging in between the ribs) when he breathes
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DIARRHEA
Diarrhea is defined as the sudden increase in the frequency and looseness of bowel movements caused by viral infections and occasionally bacterial infections. Sometimes loose stools can be caused by food allergies or something unusual that was eaten. The main complication of diarrhea is dehydration from the excessive loss of body fluids.
Symptoms of dehydration include:
Dry mouth
Absence of tears
Decreased urine production (no urine output for 6-8 hours)
Acting listless
Regardless of treatment, diarrhea will usually last from several days to a week. Treatment of diarrhea is mainly dietary changes. Medications that slow diarrhea typically just prolong the illness. Your child’s age will determine what dietary changes are necessary. Keep in mind that if your child is also vomiting, additional measures may be required.
Bottle Fed Infants: Use an oral rehydration solution such as Pedialyte for 6-24 hours then resume formula. If your baby is on solid foods also, these may be resumed. Start with more starchy foods such as cereals, applesauce, bananas and other high fiber foods.
Breast Fed Infants: It is much more difficult to tell when these babies are experiencing diarrhea due to the wide range of normal stools they may have. If there is any mucous or blood in the stool, or if it has a foul odor it should be considered diarrhea. Other signs would be if the baby acts sick or feeds poorly. Continue breastfeeding and offer Pedialyte in between feedings.
Children Over 1 Year Old: Starchy foods are absorbed best-cereals, breads, noodles, mashed potatoes, applesauce, bananas, crackers, etc. Encourage a high fluid intake, but avoid fruit juices so as not to make the diarrhea worse.
Diarrhea is contagious so good hand washing is crucial. Due to the high acidity of the stools, your child’s rectal area may be “burned”. To help with this, change diapers soon after stools occur then apply petroleum jelly to act as a barrier.
Call our office for an appointment if the following occur:
Bloody diarrhea
Signs of dehydration
Diarrhea lasts more than 2 weeks
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EAR INFECTION (OTITIS MEDIA)
This is a bacterial infection of the middle ear (space behind the eardrum) that usually results from a cold. The cold blocks off the eustachian tube (passage connecting the middle ear to the back of the throat). Main symptoms are ear pain and muffled hearing. Younger children may just cry and fuss. A fever is present with about ½ of all ear infections. Ear pain is the result of pressure and bulging of the eardrum trapped, infected fluid. A physician MUST diagnose an ear infection. Antibiotics are not called in for ear pain. The majority of children (75%) will have more than one ear infection and over 25% will have repeated ear infections. Sometimes the pressure in the middle ear causes the eardrum to rupture and drain yellow, cloudy fluid. This most often heals within a week. Antibiotics are prescribed for ear infections AFTER an exam by the physician. It is important to take the antibiotic exactly as prescribed to avoid recurrence and antibiotic resistance. Most any antibiotic can cause loose stools. Call our office for recommendations if this occurs. It is not recommended to use antibiotics you have at home from a previous illness. Doing so may partially treat a different and/or worse infection. Acetaminophen or ibuprofen may be used for ear pain. On occasion, numbing drops may be prescribed by the physician. These drops should not be used if there is drainage from the ear.
Call our office for the following:
Fever and/or pain is not gone after 48 hours of starting the antibiotic
Your child seems to be getting worse
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VOMITING
Vomiting is mainly caused by a viral infection of the stomach. It may also be caused by eating something that disagrees with your child’s stomach or it may go along with other illnesses. Vomiting usually resolves after 6-24 hours. If your child has vomited, do not immediately give him something to eat or drink. Wait 1-2 hours. The stomach needs to rest and will not tolerate more fluid or food. Offer your child small amounts (1 teaspoon) of clear fluids every 10 minutes. Gradually increase the amount of fluids after 4 hours without vomiting. After 8 hours you may add bland, starchy foods. A normal diet may be resumed after 24 hours. A common mistake is to give your child as much fluid as he wants. This will lead to continued vomiting. There are no effective medications for vomiting. Suppositories may help with nausea, but have a sedative effect. Persistent vomiting may cause dehydration.
Call our office if your child develops the following:
Signs of dehydration-no urine output for 6-8 hours, dry mouth, absence of tears
Blood in the vomited material
Abdominal pain that persists
Vomiting persists for more than 24 hours
More difficult to arouse
Any other symptoms that cause concern
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POISONING
Poisoning is one of the most common medical emergencies. Most, if not all are preventable. Children are by nature curious and will open drawers, doors and anything else to find out what’s inside. Anything potentially dangerous should be locked up out of the reach of children. Be careful about medications and other items that are in purses which are left within children’s reach. If you find that your child has ingested anything potentially dangerous, please call ALABAMA’S POISON CONTROL at 1-800-222-1222. Please keep this number by the telephone in case of any emergency. The poison control centers are the experts when it comes to poisoning. Please follow any directions they give you.
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