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Fever is confusing, and our advice varies depending on the child’s age.
If your child is less than 2 months old and has a rectal temperature higher than 100.4, you should call our main office number 324-2040. If your child is between 2 months and 6 months old and its temperature is less than 103, you can treat with Tylenol at home for up to 3 days before needing an appointment unless she has other symptoms (ear pain, dehydration, difficulty breathing). If you child is older than 6 months and her temperature is less than 104, you can treat with Tylenol or Motrin at home for up to 3 days before needing an appointment unless she has other symptoms. How do I take my child’s temperature? There are three options that we recommend: Rectal: for babies and toddlers. Older children do not appreciate having their temperatures taken rectally. Use a digital thermometer with a small amount of lubricant. Insert the thermometer .125 to .25 inch into the rectum and hold there until complete. Sometimes it’s easier to take a baby’s temperature rectally if he is lying face down across your lap with his bottom pointing up. Axillary: this is a good screening temperature for any age. Place the end of the thermometer well into the armpit and hold the child’s arm down firmly against his side. If you are checking the temperature of a baby less than 2 months old, and have an axillary temperature of 99 or higher, you need to check a rectal temperature. Oral: this will work if the child is able to hold the thermometer under his tongue with his mouth closed. Do not use a glass or mercury thermometer for this. The reading will only be accurate if the child has had nothing hot or cold to eat or drink recently. Skin temperature, passifier thermometers, and ear thermometers are not accurate and are not recommended. Don’t try to add or subtract degrees to what the thermometer reads. Just tell us what the number is and how the termperature was taken. For example: “99.5 axillary” My baby is constipated. What do I do? Again, our advice depends on your child’s age. Less than one week old: Call if your baby doesn’t have a bowel movement at least daily. 1 week to 1 year old: stools should be soft, mushy, but may be formed and the consistency of play dough. They should not be hard “rabbit pellets”, and they should never be bloody. If your child is an infant and has soft stools every 4-5 days, that is fine. If your infant has hard stools 3 times a day, you need to treat. The best way to treat constipation in an infant is by adding 1 teaspoon of karo syrup to a bottle twice daily. Using a glycerin suppository on occasion is OK as well. An older child should not have pain with pooping, and should not soil his or her underwear after he is potty trained. Even if the child poops daily, those are signs of constipation. Increasing fiber and water in the diet is the best and most natural remedy for constipation. Over the counter medicines like Miralax can be used as well for chronic problems. Constipation is the most common reason children complain of stomach pain. My child is vomiting with diarrhea. What should I do? We need to see your child if she has more than 10 episodes of vomiting a day, if she has bloody diarrhea, if she doesn’t urinate at least 3 times a day, or if her temperature is above 104. Vomiting that lasts more than 2 days without diarrhea needs to be evaluated in our office as well. Otherwise, treat vomiting at home with pedialyte. Often you will need to give your child “gut rest” and don’t feed her anything for 2-4 hours. Then start feeding half ounce of pedialyte every 15 minutes. We recommend feeding a normal diet if your child just has diarrhea, although milk and juice often make diarrhea worse, so it’s reasonable to cut those out during the course of the illness. How much Tylenol and Motrin does my baby need? Motrin is only given to children older than 6 months. Nothing should be given to treat an infant younger than 2 months old before talking to us. Besides that, Tylenol and Motrin is dosed by weight not age. It’s important to know what type of medicine you have at home, infant drops or children’s suspension because you could easily overdose if you give the wrong type. You can use the following chart to help you give the correct dose of medicine.
My baby just chewed on a mushroom from the yard or ate the dog’s flea collar or poured Ajax in her eye or put the Raid ant trap in her mouth. What should I do? Call Poison Control at 1-800-222-1222. They no longer recommend giving Syrup of Ipecac, but sometimes milk or charcoal is recommended, so those are reasonable things to keep in your medicine chest. My child has a diaper rash. What can I use? Diaper rashes usually respond to frequent airings and Zinc Oxide creams like Desitin or Balmex. If you have done that for several days without improvement, call for an appointment. Diaper rashes with pus, open sores, or bruising and broken blood vessels need to be seen. My baby is spitting up. What do I do? It’s important to know that what comes out of a baby’s mouth can be anything so long as it isn’t clear/fluorescent green or yellow or bloody. It can be chunky, undigested, seedy, curdled and slimy. Normal baby spit up can pour out of a baby’s nose or mouth like a miniature Old Faithful, but it only rarely shoots out of the mouth with enough force to travel more than a few inches. The real issue is determining if your baby is a “happy spitter”. A happy spitter is just that. She drinks, eats, then regurgitates, usually with a smile on her face. She gains weight well, and if she does cry when she spits up it is very short-lived. A baby with GERD, or gastroesophageal reflux disease often is very fussy, screams when he spits up, and sometimes is not able to gain weight well. He will often need medicine for treatment. A baby who spit ups is often helped by frequent burping during feeds, being held upright for 20 minutes after a feed, and elevating the crib mattress for sleeping so his head is higher than his feet. My baby is crying. Can you help? First of all, babies are supposed to cry. Until they are several months old, the same cry is used to tell you many things. The problem is sometimes it’s hard to tell what the baby is saying. Normal fussing will go away within a half hour to hour. You should try to feed your baby, rock her, change her diaper, and put her on your shoulder and rock her. A baby with gas will sometimes feel better if there is some pressure on her belly, so sitting her up and leaning her over your hand may help. If your baby screams and nothing makes her happy, call our office so we can help you decide what needs to be done next. If you feel extremely stressed by your baby’s crying, take a break, call our office or put your baby down in her crib and walk away for a minute. What kind of car seat do I need and when do I change to a booster seat? Car seats vary quite a bit as far as what size baby can use the seat. Be sure to check the label on the side of your child’s car seat to make sure he fits by both height and weight limits. Typically children are in an infant car seat until between 6-9 months old, then they transition to a convertible car seat. The child should continue to face backwards until he reaches 20 pounds and one year old old. After 40 pounds and 4 years old, you can transition your child to a booster seat, and after that your child under 12 should use a car seat belt while in the back seat. You can find more information regarding New York State Laws here. My child has a runny nose and is coughing. What medicine can I use? We don’t recommend any cough or cold medicines for children less than 2 years old. If your child is between 2 and 6 years old, the benefit of cough and cold medicines is questionable and you should only use it if it seems to help. Plain Benadryl (diphenhydramine) is safe for all ages, but may not help with runny nose due to a cold. The most effective treatments for a child are saline drops in the nose to loosen secretions, a humidifier at bedtime, and elevating the head of the child’s bed as he sleeps. Runny noses from viral infections last up to 14 days, and children in daycare often get one viral infection after another and so they “always” have a runny nose. Antibiotics don’t help children with viral infections get better. My baby won’t sleep through the night. What do I do? Well, first of all, if your child is between 18 months and 5 years old, you need to read this for future offspring, because there is very little that will help you now. Babies need to be trained to sleep in their own bed through the night before they are 15 months old, or you are up the proverbial creek. If you are in that unlucky time frame, the only thing you can do is camp outside your child’s room and every time the little footed pajamas hit the floor you open the door and physically tuck your child back into bed. I promise they don’t need another drink, another hug, another trip to the bathroom. They don’t need to tell the goldfish goodnight again. If your child is older than 18 months old, if you sleep outside the door to his bedroom for about 3 months, you will fix the problem. So, let’s say you are lucky and are dealing with a 10 month old who awakens in the night. The important thing to know is that what you do is a family decision. Some families sleep all together in a giant family bed. Some families have 2 day old babies in a crib in their own room on a different floor from the parents. Whatever you decide is fine, but there is a point of no return (at least for a few years) if you let your baby sleep in your bed with you. So the key to sleeping through the night is this: Between 4-9 months old is the best time to teach your infant to sleep through the night. Teaching is a euphemism for listening to your baby cry, and the younger your baby, the less crying he will do. A 4 month old may be able to cry for a little more than half an hour. A 9 month old can shake the bars of the crib and sob for 90 minutes or more. Pretty much add a “0” onto the end of the number of months, and you have a maximum cry time. But teaching is simple. It’s a two step process. Put the baby down in the same place, the same time of night while he’s awake. Pick the baby up in the morning. There will be crying involved, usually the parents cry more than the child. There are probably a thousand books that you can buy on the subject. They all include those two steps although some books make you feel better about yourself when you implement them. Bug spray recommendations: To protect against things like West Nile Virus, Lyme Disease, and Rocky Mountain Spotted Fever, infants and children older than 2 months should use bug spray. Make sure to use sprays with a concentration of DEET less than 10 percent, and don’t get the insecticide in your child’s mouth or eyes. Sunscreen recommendations: Children older than 6 months should use sunscreen. Less than 6 months old, use hats and long sleeves and keep the baby in the shade. Don’t use a sunscreen that is a combination product of bug spray and sunscreen as you will need to reapply the sunscreen often and should not reapply the bug spray that frequently There is a tick on my child! What should I do? First don’t panic. Ticks aren’t removed easily if you flap your hands fast and yell “ohmygodohmygod that’s sooo grosssss!” Next a list of things NOT to do. Don’t burn the tick off, don’t drown it in alcohol. Don’t smother it in Vaseline. The correct way to remove a tick is to take tweezers and grab the tick as close to your child’s skin as possible. Pull it out. Make sure you have the tick’s “head” and there is nothing left in your child. Lyme disease, Rocky Mountain Spotted Fever and Tularemia are all possible infections, but they are unlikely if the tick has not been on your child for at least 24 hours. If you bring the tick into our office, we can send if off for identification and lab testing to determine if it might carry Lyme disease. During the summer time, line your children up and do “tick checks” before bedtime. When they are outside have them wear light colored clothing so it is easier to see if the little creatures are crawling on the kids. Head lice: While this is extremely stressful to parents and children, it does not warrant a phone call at 2AM to the doctor’s office. You can treat this yourself. Go to the drug store or grocery store and get NIX and follow the package instructions. The most important part of lice treatment is nit removal. Take a nit comb and get every egg off your child’s hair or the lice will return. This takes hours and hours of combing. Be sure to follow instructions regarding washing bedding or the little creepy crawly things will be back in your child’s hair in no time. If your child has been exposed to lice, but you don’t see any bugs, just wash your child’s hair, clothes and bedding well and keep a close eye out for things that are crawling. Lice are found first behind a child’s ears. They look like grey or white bugs. Nits are hard white egg sacs that are on the hair shaft. They are hard to remove and don’t shake or wash out, but have to be removed with a comb or with fingernails. When will my child get shots? The recommended shot schedule changes almost yearly for children and teenagers with new vaccines and recommendations occurring on a regular basis. So even as this is written, someone somewhere is probably recommending something new. Our office follows the recommendations of the American Academy of Pediatrics. And that organization closely follows the Advisory Committee for Immunization Practices (ACIP). Some vaccines are required for school entry, some are recommended by not required. Unless you have a religious objection to vaccines, your child will need the following as a minimum before entry into school: polio, mumps, measles, diphtheria, rubella, varicella, haemophilus influenzae b, pertussins, tetanus, hepatits B. Most babies receive their first vaccine just hours after birth, and then there are shots at almost every well child check between 2 months old and 4 years old. There are more vaccines available now to protect adolescents as well. Because the recommendations change often, please talk to your provider at the check up to clarify any questions. Some parents have concerns about vaccine safety and your child’s pediatrician can spend time addressing those concerns as well. If your child receives shots, he may have fever that lasts 3 days and goes up to 103 degrees F. If he receives a live viral vaccine, he may develop a rash that can last up to a week, and the rash may occur up to 2 weeks after getting the shot. |
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