Arms

Arm Injury

Definition Injuries to the arm (shoulder to fingers) Injuries to a bone, muscle, joint or ligament Excluded: Muscle pain caused by too much exercise or work (overuse). Covered in Arm Pain. Types of Arm Injuries Fractures. Fractures are broken bones. A broken collarbone is the most common broken bone in children. It's easy to notice because the collar bone is tender to touch. Also, the child cannot raise the arm upward. Dislocations. This happens when a bone is pulled out of a joint. A dislocated elbow is the most common type of this injury in kids. It's caused by an adult quickly pulling or lifting a child by the arm. Mainly seen in 1 to 4 year olds. It's also easy to spot. The child will hold his arm as if it were in a sling. He will keep the elbow bent and the palm of the hand down. Sprains. Sprains are stretches and tears of ligaments. Strains. Strains are stretches and tears of muscles (such as a pulled muscle). Muscle Overuse. Muscle pain can occur without an injury. There is no fall or direct blow. Muscle overuse is from hard work or sports (such as a sore shoulder). Muscle bruise from a direct blow Bone bruise from a direct blow Skin Injury. Examples are a cut, scratch, scrape or bruise. All are common with arm injuries. Pain Scale Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: the pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Serious injury with many broken bones Major bleeding that can't be stopped Bone is sticking through the skin You think your child has a life-threatening emergency Go to ER Now Can't move the shoulder, elbow or wrist at all Looks like a broken bone (crooked or deformed) Looks like a dislocated joint Large deep cut that will need many stitches Call Doctor or Seek Care Now Can't move the shoulder, elbow or wrist normally Can't open and close the hand normally Skin is split open or gaping and may need stitches Cut over knuckle of hand Age less than 1 year old Severe pain and not better 2 hours after taking pain medicine You think your child has a serious injury You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Very large bruise or swelling Pain not better after 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Injury limits sports or school work Dirty cut and no tetanus shot in more than 5 years Clean cut and no tetanus shot in more than 10 years Pain lasts more than 2 weeks You have other questions or concerns Self Care at Home Bruised muscle or bone from direct blow Pain in muscle from minor pulled muscle Pain around joint from minor stretched ligament Minor cut or scrape Care Advice What You Should Know About Minor Arm Injuries: During sports, muscles and bones get bruised. Muscles get stretched. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Ibuprofen works well for this type of pain. Use as needed. Small Cut or Scrape Treatment: Use direct pressure to stop any bleeding. Do this for 10 minutes or until bleeding stops. Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water. Gently scrub out any dirt with a washcloth. Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage. Change daily. Cold Pack for Pain: For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Reason: Helps the pain and helps stop any bleeding. Caution: Avoid frostbite. Use Heat After 48 Hours: If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Reason: Increase blood flow and improve healing. Caution: Avoid burns. Rest the Arm: Rest the injured arm as much as possible for 48 hours. What to Expect: Pain and swelling most often peak on day 2 or 3. Swelling should be gone by 7 days. Pain may take 2 weeks to fully go away. Call Your Doctor If: Pain becomes severe Pain is not better after 3 days Pain lasts more than 2 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Arm Pain

Definition Pain in the arm (shoulder to fingers) Includes shoulder, elbow, wrist and finger joints Includes minor muscle strains from hard work or sports (overuse) Pain is not caused by an injury Causes of Arm Pain Muscle Overuse (Strained Muscles). Arm pains are often from hard muscle work or sports. Examples are too much throwing or swimming. They are most common in the shoulder. This type of pain can last from hours up to 7 days. Muscle Cramps. Brief pains that last 1 to 15 minutes are often due to muscle cramps. These occur in the hand after too much writing or typing. Viral Illness. Mild muscle aches in both arms also occur with many viral illnesses. Septic Arthritis (Serious). This is a bacterial infection of a joint space. Main symptoms are fever and severe pain with movement of the joint. Range of motion is limited or absent (a "frozen joint"). Pain Scale Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: the pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Not moving or too weak to stand You think your child has a life-threatening emergency Call Doctor or Seek Care Now Can't use arm or hand normally Can't move the shoulder, elbow or wrist normally Swollen joint Muscles are weak (loss of strength) Numbness (loss of feeling) lasts more than 1 hour Severe pain or cries when arm is touched or moved Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Fever is present Bright red area on skin You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Cause of arm pain is not clear Arm pain lasts more than 7 days Arm pains or muscle cramps are a frequent problem You have other questions or concerns Self Care at Home Caused by overusing the muscles Cause is clear and harmless. (Examples are a sliver that's removed or a recent shot) Care Advice What You Should Know About Mild Arm Pain: Strained muscles are common after using them too much during sports. An example is throwing a ball over and over again. Weekend warriors who are out of shape get the most muscle pains. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Cold Pack for Pain: For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Caution: Avoid frostbite. Use Heat After 48 Hours: If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Reason: Increase blood flow and improve healing. Caution: Avoid burns. What to Expect: A strained muscle hurts for 2 or 3 days. The pain often peaks on day 2. After severe overuse, the pain may last a week. Call Your Doctor If: Fever or swollen joint occurs Pain caused by work or sports lasts over 7 days You think your child needs to be seen Pain gets worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Finger Injury

Definition Injuries to fingers Types of Finger Injuries Cuts, Scrapes (skinned knuckles) and Bruises. These are the most common injuries. Jammed Finger. The end of a straightened finger or thumb receives a blow. Most often, this is from a ball. The energy is absorbed by the joint surface and the injury occurs there. This is called traumatic arthritis. For jammed fingers, always check that the fingertip can be fully straightened. Crushed or Smashed Fingertip. Most often, this is from a car door or a screen door. The end of the finger may get a few cuts or a blood blister. Sometimes, the nail can be damaged. Broken bones are not common with this kind of injury. If they do occur, they are at risk for a bone infection (osteomyelitis). Fingernail Injury. If the nailbed is cut, it needs sutures to prevent a deformed fingernail. Subungual Hematoma (Blood Clot under the Nail). Most often caused by a crush injury. This can be from a door crushing the finger. It can also be from a heavy object falling on the nailbed. Many are only mildly painful. Some are severely painful and throbbing. These need the pressure under the nail released. A doctor can put a small hole through the nail. This can relieve the pain and prevent loss of the fingernail. Dislocations. The finger has been pushed out of its joint. Fractures. Finger has a broken bone. Pain Scale Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: the pain is very bad. It keeps your child from doing all normal activities. When To Call Go to ER Now Bleeding that won't stop after 10 minutes of direct pressure Looks like a broken bone or dislocated joint Call Doctor or Seek Care Now Skin is split open or gaping and may need stitches Large swelling is present Blood under a nail is causing more than mild pain Fingernail is torn off Base of nail has popped out from under the skin fold Cut over knuckle of hand Dirt in the wound is not gone after 15 minutes of scrubbing Can't open and close the hand or use the fingers normally Severe pain and not better 2 hours after taking pain medicine Age less than 1 year old You think your child has a serious injury You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Dirty cut and no tetanus shot in more than 5 years Clean cut and no tetanus shot in more than 10 years Pain not better after 3 days Not using the finger normally after 2 weeks You have other questions or concerns Self Care at Home Minor finger injury Care Advice What You Should Know About Finger Injuries: There are many ways that children can hurt their fingers. There are also many types of finger injuries. You can treat minor finger injuries at home. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Bruised/Swollen Finger: Soak in cold water for 20 minutes. Repeat as needed. Small Cuts or Scratches: For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press down firmly on the place that is bleeding for 10 minutes. This is the best way to stop bleeding. Keep using pressure until the bleeding stops. Wash the wound with soap and water for 5 minutes. For any dirt in the wound, scrub gently. For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed. Cover it with a bandage (such as Band-Aid). Change daily. Jammed Finger: Caution: Be certain range of motion is normal. Your child should be able to bend and straighten each finger. If movement is limited, your doctor must check for a broken bone. Soak the hand in cold water for 20 minutes. If the pain is more than mild, "buddy-tape" it to the next finger. Smashed or Crushed Fingertip: Wash the finger with soap and water for 5 minutes. For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed. Cover it with a bandage (such as Band-Aid). Torn Nail (from catching it on something): For a cracked nail without rough edges, leave it alone. For a large flap of nail that's almost torn through, cut it off. Use a pair of scissors that have been cleaned. Cut along the line of the tear. Reason: Pieces of nail taped in place will catch on objects. Soak the finger for 20 minutes in cold water for pain relief. Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then cover with a bandage (such as Band-Aid). Change daily. After about 7 days, the nailbed should be covered by new skin. It should no longer hurt. A new nail will grow in over 6 to 8 weeks. Call Your Doctor If: Pain becomes severe Pain not better after 3 days Finger not normal after 2 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Hand-Foot-And-Mouth Disease (HFMD)

Definition Tiny red spots and water blisters on the hands and feet caused by a virus Rash is seen on the palms, fingers, soles and toes The diagnosis cannot be made without these Also can cause small mouth ulcers (sores) Symptoms of Hand-Foot-and-Mouth Disease (HFMD) Small red spots and tiny water blisters on the hands and feet. Seen on the palms, fingers, soles and toes. The diagnosis cannot be made without these. Small painful ulcers (sores) in the mouth. Look for them on the tongue and sides of mouth. Most children with HFMD have these, but they can be hard to see. Also, small blisters or red spots on the buttocks (30%) Low-grade fever less than 102° F (39° C) Mainly occurs in children age 6 months to 4 years Cause of HFMD Coxsackie A-16 virus and other enteroviruses Not related to any animal disease Severe Form of HFMD Since 2012, a severe form of HFMD has occurred in much of the world. It's caused by a new Coxsackie A6 virus. The rash spreads to the arms, legs and face. The rash is made up of many small blisters. Children with such a severe rash may need to be seen. Reason: to confirm the diagnosis. Exception: close contact with HFMD within the last 7 days. Treatment is the same. Drink enough fluids to prevent dehydration. Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin. Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things. Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal. When To Call Go to ER Now Stiff neck, severe headache or acts confused Weakness in the arms or legs, such as trouble walking Call Doctor or Seek Care Now Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Red, swollen and tender gums Ulcers and sores also on the outer lip Rash spreads to the arms and legs (severe form of HFMD) Fever lasts more than 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Fingernails or toenails fall off You have other questions or concerns Self Care at Home Hand-foot-mouth disease and no other problems Care Advice What You Should Know About HFM Disease: Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash. It is caused by a virus called Coxsackie. Here is some care advice that should help. Liquid Antacid for Mouth Pain (Age 1 Year and Older): For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time. Age 1 to 6 years. Put a few drops in the mouth. Can also put it on the mouth sores with a cotton swab. Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it. Caution: Do not use regular mouth washes, because they sting. Fluids and Soft Diet: Try to get your child to drink adequate fluids. Goal: Keep your child well hydrated. Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices. Solid Foods. Offer a soft diet. Good ones are mac and cheese, mashed potatoes, cereals with milk and ice cream. Also, avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids. For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain. Pain Medicine: Mouth sores are painful. Blisters also may be painful, especially on the feet. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Blisters on the Skin Blisters don't need any special treatment. You can wash them like normal skin. Blisters on the palms and soles do not open. Those on arms and elsewhere sometimes open. The fluid is contagious to other people. Open blisters do not need to be covered. They quickly dry over. Return to School: HFMD is easily spread to others. However, most often, it's a mild and harmless illness. After contact with HFMD, children come down with symptoms in 3-6 days. Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days. Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days. What to Expect: Fever lasts 2 or 3 days. Mouth sores should go away by 7 days. Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel. Call Your Doctor If: Signs of dehydration occur Fever lasts more than 3 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Weakness and Fatigue

Definition Weakness means decreased muscle strength. Paralysis means severe loss of strength. The child can't move a part of the body. Fatigue means feeling very tired and needing extra rest. Muscle strength is normal. Symptoms of Weakness (loss of strength) True weakness always interferes with function. Once a child is walking, weakness is seen more in the legs than the arms. Reason: muscle strength is needed for normal walking. Leg Weakness. This is what you will see. Examples: trouble standing, walking, climbing stairs, getting off the floor, running and jumping. If severe, the child can't stand or walk. Arm Weakness. This is what you will see. Examples: trouble feeding one's self, writing/drawing/typing, combing or washing the hair. Other children have trouble lifting objects above the head, turning door knobs or buttoning shirts. If the weakness is severe, the child starts dropping objects. Face Weakness. Weak face muscles cause droopy eyelids or trouble moving the eyes. A droopy face or crooked smile may also occur. You might notice trouble sucking, swallowing or speaking. Weakness in Babies. In infants not yet walking, you will see the loss of motor milestones (loss of normal development). These include new trouble turning over, sitting, crawling, and pulling up. In the early months, you will see the loss of head support, reaching or kicking. A weak cry or suck also may be seen. Causes of New Onset Muscle Weakness Most causes of new onset muscle weakness are serious. True weakness points to diseases of the spinal cord or its nerves. Nerves carry messages from the spinal cord to the muscles in the arms and legs. Diseases that cause muscle weakness are very rare. Most children with new onset weakness need special tests to make the right diagnosis. If the weakness gets worse, most children need to be admitted to the hospital. Specific Causes of New Onset Muscle Weakness Polio. A severe spinal cord disease that causes paralysis. It is prevented by the polio virus vaccine. Polio is almost wiped out in the entire world. There have been no cases in the US since 1979. Now, it only occurs in 2 countries. Acute Flaccid Myelitis (AFM). A rare infection of the spinal cord. It acts like polio did. It causes sudden onset of arm or leg weakness in one or more places. The main cause has been an enterovirus. There has been a rise in cases since 2014. West Nile Virus myelitis. See the Mosquito Bite care guide for details. Also acts like polio did. Guillain-Barre syndrome. A severe nerve weakness that starts in the feet and moves up the body over several days. It affects the same parts on both sides of the body. It can follow some viral infections. Tick paralysis. A rare problem from a tick that has been attached for 5 or more days. Often it is hidden in the hair. Once the tick is removed, the weakness clears. It takes a few hours to a day. Poisoning. Some types of poisoning can cause weakness, often with confusion. Viral myositis. Muscle pain in the leg muscles is seen with some viral infections, such as influenza. The pain can make some children not want to walk. This is different than weakness. The muscle pain lasts a few days to a week. When To Call Call 911 Now Hard to wake up or to keep awake. Exception: child needs normal sleep. Awake but can't move Trouble breathing or slow, weak breathing Followed a head or neck injury You think your child has a life-threatening emergency Go to ER Now Can't stand or walk Confused or not alert when awake Doesn't make eye contact or respond when awake Crooked smile (weakness of 1 side of the face) Not able to pass urine Stiff neck (can't touch chin to chest) Severe headache Call Doctor or Seek Care Now All other children with new onset of weakness New onset of unsteady walking Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Weakness is a chronic problem and getting worse Fever present more than 3 days with fatigue (tires easily but no weakness) You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Weakness is a chronic problem and not getting worse Fatigue (tires easily but no weakness) lasts more than 2 weeks Delays in motor development (sitting, crawling, walking) You have other questions or concerns Self Care at Home Normal fatigue during a short-term illness (tires easily and needs more rest, but no true weakness) Normal fatigue after hard work or sports Care Advice What You Should Know About Normal Fatigue (feeling very tired) When Sick: Children who are sick are often less active. They become easily tired and need extra rest. They take extra naps and sleep longer hours for many days. As long as your child is alert when awake, extra sleeping is normal. This is different than the normal fatigue from exercise. Examples are a soccer game, manual labor or a long hike. This type of fatigue does not last long. It responds to a good night's sleep. Sick children also are less hungry for meals but like to drink fluids. As long as they stay hydrated, this is normal. Here is some care advice that should help. Trust Your Child to Choose the Right Activity Level: When they are awake, most sick kids want to watch TV. Some want to play with their toys. A few may want to play outside. That's also fine. If they are feeling badly, they may just want to rest. They may prefer to stay in bed or on the sofa for a day or two. As long as they are alert and able to walk normally, this is normal. Avoid Trying to Force Bed Rest When Awake: Most children sleep extra hours when they are sick with any infection. Their body tells them how much sleep they need. Getting enough sleep helps them fight the infection. Let them choose the amount. Trying to force extra bed rest is not helpful for common childhood illness. It doesn't reduce symptoms. It doesn't help the body heal faster. It doesn't shorten how long the illness lasts. It doesn't prevent complications. Bed rest also can't be enforced in children who don't want it. An old myth was that sick children must stay in bed until their fever is gone. This is not true. Return to School: Your child can go back to school after the fever is gone and the fatigue is mild. Your child should also feel well enough to join in normal activities. What to Expect: Being very tired during the first 2 or 3 days of an infection is normal. Energy is often back to normal within 7 days. After a major sickness like mono, it may take 2 weeks. Call Your Doctor If: Weakness (loss of muscle strength) occurs Fever lasts more than 3 days Extra sleepiness lasts more than 1 week Fatigue (very tired) lasts more than 2 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Legs

Athlete's Foot

Definition An itchy rash of the feet and between the toes Skin infection caused by a fungus Age over 10 years Symptoms of Athlete's Foot Red, scaly, cracked rash between the toes The rash itches and burns With itching, the rash becomes raw and weepy Often also involves the insteps of the feet Unpleasant foot odor Mainly in teens. Before age 10, it's usually something else. Cause of Athlete's Foot A fungus infection that grows best on warm, damp skin Other health problems of Athlete's Foot Jock Itch. A fungus infection of the groin and inner, upper thighs. Caused by the same fungus that causes athlete's foot. Transferred by a towel used to dry the feet and then the groin. Impetigo. A local bacterial infection that starts in the cracks between the toes. Gives sores, soft scabs and pus. Cellulitis. The bacterial infection spreads into the skin. Gives redness spreading into the back of the foot. The red area is painful to the touch. Lymphangitis. The bacterial infection spreads up the lymph channels. Gives a red line that goes up the leg. More serious because the infection can get into the bloodstream. This is called sepsis. When To Call Call Doctor or Seek Care Now Fever and looks infected (spreading redness) Call Doctor Within 24 Hours Looks infected and no fever Pus drains from the rash Foot is very painful Call Doctor During Office Hours You think your child needs to be seen Rash has spread to the top of the foot Age less than 10 years Rash is not better after 1 week on treatment Rash not gone after 2 weeks on treatment You have other questions or concerns Self Care at Home Mild athlete's foot Care Advice What You Should Know About Athlete's Foot: Athlete's foot is common in teens. It's caused by a fungus that grows best on warm, damp skin. Here is some care advice that should help. Anti-Fungal Cream: Use an anti-fungal cream (such as Lotrimin). No prescription is needed. Use 2 times per day. Put it on the rash and 1 inch (25 mm) beyond its borders. Continue the cream for at least 7 days after the rash is gone. Keep the Feet Dry: Rinse the feet 2 times per day before using the cream. Go barefoot or wear sandals as much as possible. Wear socks made of man-made fibers. They will keep the feet drier and cooler than cotton. Change them twice daily. Do Not Scratch: Scratching infected feet will delay a cure. Rinse the itchy feet in cool water for relief. Return to School: Athlete's foot is not easily spread to others. The fungus can't grow on dry, normal skin. Children with athlete's foot do not need to miss any school. Your child may take gym and play sports. The socks can be washed with the normal laundry. They don't need to be boiled. Jock Itch Prevention: The athlete's foot fungus can spread to the groin area. This is called jock itch. The fungus can be spread by a towel or washcloth. Therefore, after bathing, dry the groin area before the feet. You can also use a different towel for the feet. Do this until the athlete's foot is cured. What to Expect: With proper treatment, athlete's foot goes away within 2 weeks. Call Your Doctor If: It looks infected Rash is not better after 1 week on treatment Rash is not gone after 2 weeks on treatment You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Hand-Foot-And-Mouth Disease (HFMD)

Definition Tiny red spots and water blisters on the hands and feet caused by a virus Rash is seen on the palms, fingers, soles and toes The diagnosis cannot be made without these Also can cause small mouth ulcers (sores) Symptoms of Hand-Foot-and-Mouth Disease (HFMD) Small red spots and tiny water blisters on the hands and feet. Seen on the palms, fingers, soles and toes. The diagnosis cannot be made without these. Small painful ulcers (sores) in the mouth. Look for them on the tongue and sides of mouth. Most children with HFMD have these, but they can be hard to see. Also, small blisters or red spots on the buttocks (30%) Low-grade fever less than 102° F (39° C) Mainly occurs in children age 6 months to 4 years Cause of HFMD Coxsackie A-16 virus and other enteroviruses Not related to any animal disease Severe Form of HFMD Since 2012, a severe form of HFMD has occurred in much of the world. It's caused by a new Coxsackie A6 virus. The rash spreads to the arms, legs and face. The rash is made up of many small blisters. Children with such a severe rash may need to be seen. Reason: to confirm the diagnosis. Exception: close contact with HFMD within the last 7 days. Treatment is the same. Drink enough fluids to prevent dehydration. Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin. Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things. Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal. When To Call Go to ER Now Stiff neck, severe headache or acts confused Weakness in the arms or legs, such as trouble walking Call Doctor or Seek Care Now Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Red, swollen and tender gums Ulcers and sores also on the outer lip Rash spreads to the arms and legs (severe form of HFMD) Fever lasts more than 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Fingernails or toenails fall off You have other questions or concerns Self Care at Home Hand-foot-mouth disease and no other problems Care Advice What You Should Know About HFM Disease: Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash. It is caused by a virus called Coxsackie. Here is some care advice that should help. Liquid Antacid for Mouth Pain (Age 1 Year and Older): For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time. Age 1 to 6 years. Put a few drops in the mouth. Can also put it on the mouth sores with a cotton swab. Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it. Caution: Do not use regular mouth washes, because they sting. Fluids and Soft Diet: Try to get your child to drink adequate fluids. Goal: Keep your child well hydrated. Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices. Solid Foods. Offer a soft diet. Good ones are mac and cheese, mashed potatoes, cereals with milk and ice cream. Also, avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids. For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain. Pain Medicine: Mouth sores are painful. Blisters also may be painful, especially on the feet. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Blisters on the Skin Blisters don't need any special treatment. You can wash them like normal skin. Blisters on the palms and soles do not open. Those on arms and elsewhere sometimes open. The fluid is contagious to other people. Open blisters do not need to be covered. They quickly dry over. Return to School: HFMD is easily spread to others. However, most often, it's a mild and harmless illness. After contact with HFMD, children come down with symptoms in 3-6 days. Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days. Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days. What to Expect: Fever lasts 2 or 3 days. Mouth sores should go away by 7 days. Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel. Call Your Doctor If: Signs of dehydration occur Fever lasts more than 3 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Leg Injury

Definition Injuries to the leg (hip to foot) Injuries to a bone, muscle, joint or ligament Muscle pain caused by too much exercise or work (overuse). Overuse is covered in Leg Pain. Types of Leg Injuries Fracture. This is the medical name for a broken bone. The most common broken bone in the leg is the tibia. The tibia is the largest bone in the lower part of the leg. Children with a fracture are not able to bear weight or walk. Dislocation. This happens when a bone is pulled out of its joint. The most common one in the leg is a dislocated kneecap (patella). Sprains. Sprains are stretches and tears of ligaments. A sprained ankle is the most common ligament injury of the leg. It's usually caused by turning the ankle inward. Also, called a "twisted ankle." The main symptoms are pain and swelling of the outside of the ankle. Strains. Strains are stretches and tears of muscles (a pulled muscle) Muscle Overuse. Muscle pain can occur without an injury. There is no fall or direct blow. Muscle overuse injuries are from sports or exercise. Shin splints of the lower leg are often from running up hills. Muscle Bruise from a direct blow. Bleeding into the quad (thigh muscles) is very painful. Bone Bruise from a direct blow (like on the hip). Called a "hip pointer." Skin Injury. Examples are a cut, scratch, scrape or bruise. All are common with leg injuries. Pain Scale Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: The pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Major bleeding that can't be stopped Serious injury with many broken bones Bone is sticking through the skin Looks like a dislocated joint (hip, knee or ankle) You think your child has a life-threatening emergency Go to ER Now Looks like a broken bone (crooked or deformed) Can't stand or walk Large deep cut that will need many stitches Call Doctor or Seek Care Now Skin is split open or gaping and may need stitches Age less than 1 year old Severe pain and not better 2 hours after taking pain medicine Can't move hip, knee or ankle normally Knee injury with a "snap" or "pop" felt at the time of impact You think your child has a serious injury You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Has a limp when walking Very large bruise Large swelling is present Pain not better after 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Injury limits sports or school work Dirty cut and no tetanus shot in more than 5 years Clean cut and no tetanus shot in more than 10 years Pain lasts more than 2 weeks You have other questions or concerns Self Care at Home Bruised muscle or bone from direct blow Pain in muscle from minor pulled muscle Pain around joint from minor stretched ligament Minor cut or scrape Care Advice What You Should Know About Minor Leg Injuries: During sports, muscles and bones get bruised. Muscles get stretched. These injuries can be treated at home. Here is some care advice that should help. Pulled Muscle, Bruised Muscle or Bruised Bone Treatment: Pain Medicine. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Ibuprofen works better for this type of pain. Cold Pack. For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Reason: Helps with the pain and helps stop any bleeding. Caution: Avoid frostbite. Heat Pack. If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Caution: Avoid burns. For stiffness all over, use a hot bath instead. Move the sore leg muscles under the warm water. Rest. Rest the injured part as much as possible for 48 hours. Stretching. For pulled muscles, teach your youngster about stretching and strength training. Mild Sprains (stretched ligaments) of Ankle or Knee Treatment: First Aid: Apply ice now to reduce bleeding, swelling, and pain. The more bleeding and swelling there is, the longer it will take to get better. Wrap with an elastic bandage. Treat with R.I.C.E. (rest, ice, compression, and elevation) for the first 24 to 48 hours. Apply compression with a snug, elastic bandage for 48 hours. Numbness, tingling, or increased pain means the bandage is too tight. Cold Pack: For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the ankle or knee for 20 minutes. Repeat 4 times on the first day, then as needed. Reason: Helps with the pain and helps stop any bleeding. Caution: Avoid frostbite. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Continue for at least 48 hours. Keep the injured ankle or knee elevated and at rest for 24 hours. After 24 hours, allow any activity that doesn't cause pain. Small Cut or Scrape Treatment Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops. Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water. Gently scrub out any dirt with a washcloth. Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover with a bandage. Change daily. What to Expect: Pain and swelling usually peak on day 2 or 3. Most often, swelling is gone in 7 days. Pain may take 2 weeks to fully go away. Call Your Doctor If: Pain becomes severe Pain is not better after 3 days Pain lasts more than 2 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Leg Pain

Definition Pain in the legs (hip to foot) Includes hip, knee, ankle and toe joints Includes minor muscle strain from overuse Muscle cramps are also covered The pain is not caused by an injury Causes Main Causes. Muscle spasms (cramps) and strained muscles (overuse) account for most leg pain. Muscle Cramps. Brief pains (1 to 15 minutes) are often due to muscle spasms (cramps). Foot or calf muscles are especially prone to cramps that occur during sports. Foot or leg cramps may also awaken your child from sleep. Muscle cramps that occur during hard work or sports are called heat cramps. They often respond to extra fluids and salt. Muscle Overuse (Strained Muscles). Constant leg pains are often from hard work or sports. Examples are running or jumping too much. This type of pain can last several hours or up to 7 days. Muscle pain can also be from a forgotten injury that occurred the day before. Growing Pains. 10% of healthy children have harmless leg pains that come and go. These are often called growing pains (although they have nothing to do with growth). Growing pains usually occur in the calf or thigh muscles. They usually occur on both sides, not one side. They occur late in the day. Most likely, they are due to running or playing hard. They usually last 10 to 30 minutes. Low Calcium Level. Low calcium and vitamin D levels can cause minor bone pains. Pain is mainly in the legs and ribs. Children on a milk-free diet are at risk. Osgood Schlatter Disease. Pain, swelling and tenderness of the bone (tibia) just below the kneecap. The patellar tendon attaches to this bone. Caused by excessive jumping or running. Peak age is young teens. Harmless and goes away in 1 - 2 years. Viral Infections. Muscle aches in both legs are common with viral illness, especially influenza. Serious Causes. Fractures, deep vein thrombosis (blood clot in leg). Also, neuritis (a nerve infection) and arthritis (a joint infection). Septic Arthritis (Serious). A bacterial infection of any joint space is a medical emergency. The symptoms are severe joint pain, joint stiffness and a high fever. Toxic Synovitis of the hip is a harmless condition. It can imitate a septic arthritis of the hip. The symptoms are a limp, moderate pain and usually no fever. Toxic synovitis tends to occur in toddlers after jumping too much. Pain Scale Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: The pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Not moving or too weak to stand You think your child has a life-threatening emergency Go to ER Now Can't stand or walk Call Doctor or Seek Care Now Fever and pain in one leg only Can't move a hip, knee or ankle normally Swollen joint Calf pain on 1 side lasts more than 12 hours Numbness (loss of feeling) lasts more than 1 hour Severe pain or cries when leg is touched or moved Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Walking is not normal (has a limp) Fever and pain in both legs Bright red area on skin You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Cause of leg pain is not clear Leg pain lasts more than 7 days Leg pains or muscle cramps are a frequent problem You have other questions or concerns Self Care at Home Muscle cramps in the calf or foot Strained muscles caused by overuse (exercise or work) Growing pains suspected Cause is clear and harmless. (Examples are tight new shoes or a recent shot) Care Advice What You Should Know About Leg Pain: Strained muscles are common after too much exercise or hard sports. Examples are hiking or running. Weekend warriors who are out of shape get the most muscle pains. Here is some care advice that should help. Muscle Cramps Treatment: Muscle cramps in the feet or calf muscles occur in a third of children. Stretching. During attacks, stretch the painful muscle by pulling the foot and toes upward. Stretch as far as they will go to break the spasm. Stretch in the opposite direction to how it is being pulled by the cramp. Cold Pack. Use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscle for 20 minutes. Water. Heat cramps can occur with hard sports on a hot day. If you suspect heat cramps, have your child drink lots of fluids. Water or sports drinks are good choices. Continue with stretching and using a cold pack. Prevention. Future attacks may be prevented by daily stretching exercises of the heel cords. Stand with the knees straight. Then, stretch the ankles by leaning forward against a wall. Place a pillow under the covers at the foot of the bed at night. This gives the feet more room to move at night. Also, be sure your child gets enough calcium in the diet. Daily vitamin D3 may also help. Strained Muscles from Overuse - Treatment: Pain Medicine. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Cold Pack. For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Caution: Avoid frostbite. Heat Pack. If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Caution: Avoid burns. For stiffness all over, use a hot bath instead. Move the sore leg muscles under the warm water. Growing Pains Treatment: Most often, the pains are mild and don't last long. No treatment is needed. Massage. Rub the sore muscles to help the pain go away. Pain Medicine. If the pain lasts more than 30 minutes, give a pain medicine. You can use either acetaminophen (such as Tylenol) or ibuprofen (such as Advil). Use as needed. Prevention. Research has shown that daily stretching can prevent most growing pains. Stretch the quads, hamstrings and calf muscles. Also, be sure your child gets enough calcium and vitamin D in their diet. What to Expect: Muscle cramps usually last 5 to 30 minutes. Once they go away, the muscle returns to normal quickly. A strained muscle hurts for 3 to 7 days. The pain often peaks on day 2. Following severe overuse, the pain may last a week. Call Your Doctor If: Muscle cramps occur often Fever, limp, or a swollen joint occurs Pain caused by work or sports lasts more than 7 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Lymph Nodes - Swollen

Definition Increased size of one or more lymph nodes. Most are in the neck. Also, includes swollen lymph nodes in the armpit or groin It's larger than the same node on the other side of the body Normal nodes are usually less than ½ inch (12 mm) across. This is the size of a pea or baked bean. Causes of Swollen Lymph Nodes Neck Nodes. The cervical (neck) nodes are most commonly involved. This is because of the many respiratory infections that occur during childhood. Viral Throat Infection. This is the most common cause of swollen nodes in the neck. The swollen nodes are usually ½ to 1 inch (12 -25 mm) across. They are the same on each side. Bacterial Throat Infection. A swollen node with a bacterial throat infection is usually just on one side. It can be quite large; over 1 inch (25 mm) across. This is about the size of a quarter. Most often, it's the node that drains the tonsil. Tooth Decay or Abscess. This causes a swollen, tender node under the jawbone. Only one node is involved. The lower face may also be swollen on that side. Armpit Swollen Nodes. Causes include skin infections (such as impetigo). A rash (such as poison ivy) can do the same. Groin Swollen Nodes. Causes include skin infections (such as athlete's foot). A retained foreign object (such as a sliver) can be the cause. Shaving. Teen girls can cause low-grade infections when shaving the legs. Widespread Swollen Nodes. Swollen nodes everywhere suggest an infection spread in the blood. An example is infectious mono. Widespread rashes such as eczema can also cause all the nodes to enlarge. Normal Nodes. Lymph nodes can always be felt in the neck and groin. They are about the size of a bean. They never go away.