FAQs

Yes! We offer same day sick visits guaranteed! Wel check-ups can often be scheduled the same day, but are not always guaranteed. We offer flexible hours to accommodate working parents needs!

Definition

Stuffy or plugged up feeling in the ear

Crackling or popping noise in the ear

Hearing is often muffled

No ear pain, except with air-travel type

Rare complaint before age 4 or 5 years

Causes of Ear Congestion

Common Cold. A viral infection of the nose is the most common cause. The nasal congestion also blocks the ear tube (eustachian tube). The ear tube normally keeps air in the middle ear.

Ear Infection. Middle ear pus can also cause muffled hearing on that side. This commonly happens with an ear infection.

Middle Ear Fluid. Fluid may remain in the middle ear after the infection is cleared up. It can last for months. The main symptoms are popping and crackling noises in the ear.

Blowing the Nose. Blowing too hard can force secretions into the ear tube.

Allergic Rhinitis. Hay fever is an allergic reaction to pollens. It causes nasal congestion, clear drainage and sneezing. It also can block the ear tube and back up secretions in the ear.

Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is ear pain. Sometimes, it just causes congestion. It usually starts when coming down for a landing. It can also occur during mountain driving.

When To Call

Call Doctor Within 24 Hours

You think your child needs to be seen

Earache

Could be a foreign object in the ear canal

Ear congestion lasts more than 48 hours

Call Doctor During Office Hours

Could be blocked with ear wax

You have other questions or concerns

Self Care at Home

Ear congestion most likely from blocked ear tube

Care Advice

What You Should Know About Ear Congestion:

Most often, this is from a blocked ear tube (eustachian tube). This tube normally drains the space behind the eardrum.

It is usually not caused by an ear infection.

Here is some care advice that should help.

Swallow and Chew More:

Swallow water or other fluid while the nose is pinched closed. Reason: Makes a vacuum in the nose that helps the ear tube open up.

After age 6, can also use chewing gum.

Decongestant Nose Spray (Age 12 years or Older):

If chewing doesn't help after 1 or 2 hours, use a long-acting decongestant nose spray. An example is Afrin.

Dose: 1 spay per side, 2 times per day as needed.

Don't use for more than 3 days. Reason: Can cause rebound swelling in the nose.

Decongestants given by mouth (such as Sudafed) are another choice. They can also open a stuffy nose and ears. Side effects: They may make a person feel nervous or dizzy. Follow the package directions.

Allergy Medicines:

Nose allergies can cause ear stuffiness.

If your child has hay fever or other allergies, give an allergy medicine. An example is Benadryl.

See the Nose Allergy care guide for other advice.

What to Expect:

The symptoms most often clear within 2 days (48 hours) with treatment.

It's safe for your child to swim or fly.

Prevention During Air or Mountain Travel:

It's safe to fly when your child has a cold.

Most symptoms happen when the airplane is coming down in altitude. This is the descent of the plane during the 15 minutes before landing.

Keep your child awake during takeoff and descent.

Swallow during descent using fluids or a pacifier.

Age over 6: Can chew gum during descent.

Yawning during descent also can open the middle ear.

Drink lots of fluids throughout the flight. This will prevent the nasal secretions from drying out.

Call Your Doctor If:

Ear pain occurs

Ear congestion lasts more than 48 hours

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.

Definition

Pimples and blackheads on the face caused by blocked oil glands

Symptoms of Acne

Whiteheads (pimples) are plugged oil glands that are closed.

Blackheads are plugged oil glands that are open. Reason: The oil turns black when it is exposed to air.

Whiteheads and blackheads are also called "zits."

Red bumps are from blocked oil glands that have leaked oil. This causes irritation in the skin around them. Larger red bumps can be quite painful.

Acne mainly appears on your face, neck, and shoulders

Causes of Acne

Acne skin changes are from plugged oil glands. Acne has several causes.

Increased levels of hormones during puberty have a part. Heredity also plays an important role.

Some skin bacteria can make it worse.

Acne is not caused by diet. You do not need to avoid eating fried foods, chocolate, or any other food.

Acne is not caused by dirt or by not washing your face often enough.

Call Doctor or Seek Care Now

Spreading red area around the acne with fever

Spreading red area or streak that's very large

Your child looks or acts very sick

Call Doctor Within 24 Hours

Spreading red area or streak around the acne, but no fever

You think your child needs to be seen

Call Doctor During Office Hours

Tender red lumps that are large occur

Yellow soft scab that drains pus or gets bigger occurs

After treating with Benzoyl Peroxide (BP) for 2 months, acne not improved

BP makes the face itchy or swollen

You have other questions or concerns

Self Care at Home

Mild acne

Care Advice

What You Should Know About Acne:

More than 90% of teenagers have some acne. Acne is a normal part of the teen years.

There is no medicine at this time that will cure acne.

However, good skin care can keep acne under control and at a mild level.

Here is some care advice that should help.

Benzoyl Peroxide Gel:

Benzoyl Peroxide (BP) is the best OTC medicine for bringing acne under control. Use a Benzoyl Peroxide 5% gel product (such as the store brand). OTC means no prescription is needed.

It helps to open pimples and to unplug blackheads. It also kills bacteria.

Apply the lotion once a day at bedtime to the area with acne. Redheads and blonds should apply it every other day for the first 2 weeks. Reason: More sensitive skin.

Use an amount of lotion the size of a pea. This should be enough to cover most of the acne.

If the skin becomes red or peels, use less of it. Other option: You can use it less often.

Caution: Avoid the corners of the eyes, nose and mouth. Reason: These areas are very sensitive.

Caution: Benzoyl Peroxide bleaches clothing, towels, blankets, etc. Apply it only at bedtime and put it on sparingly. Use a plain white pillowcase.

Antibiotics for Red Bumps:

Large red bumps mean the infection has spread beyond the oil gland. If you have several red bumps, your doctor may prescribe an antibiotic.

Antibiotics come as solutions for the skin or as pills.

The antibiotic will kill the bacteria that are causing the infection.

Give the antibiotic as directed.

Washing the Face:

Wash your skin twice a day. The most important time to wash is bedtime. Just use warm water or you can use a mild soap (such as Dove).

Shampoo your hair daily.

Avoid scrubbing your skin. Reason: Hard scrubbing of the skin irritates the openings of the oil glands. This causes them to close off even more tightly.

Pimple Opening:

Opening (popping) pimples is not advised by many doctors. But, most teens and adults do it anyway.

So, here's how to open a pimple safely without any squeezing.

Never open a pimple before it has come to a head.

Wash your face and hands first.

Use a sterile needle (cleaned with rubbing alcohol). Nick the surface of the yellow pimple with the tip of the needle. The pus should run out without squeezing.

Wipe away the pus and wash the area with soap and water.

Opening small pimples in this way will not cause skin damage.

Avoid Picking or Squeezing Acne:

Many young people pick at their acne when they are not thinking about it. Picking makes acne worse.

Try not to touch the face at all during the day.

Squeezing blackheads causes bleeding into the skin. The bleeding turns into brownish blotches on the skin. They can take 1 or 2 months to fade.

Squeezing red lumps can force bacteria into the skin. This too leaves blotches. It can also cause a serious face infection.

Prevention - Avoid Triggers of Acne:

Avoid putting any oily or greasy substances on your face. Reason: They block oil glands and make acne worse. If you use cosmetics, use water-based cosmetics.

Avoid hair tonics or hair creams (especially greasy ones). When you sweat, they will get on the face and irritate the acne.

What to Expect:

With treatment, new whiteheads and blackheads will decrease. But, it takes 6 to 8 weeks.

Acne usually lasts until age 20 or 25.

So, you will need to continue the treatment for several years.

You don't need to worry about scarring. It is very rare for acne to leave any scars.

Call Your Doctor If:

With treatment, the acne has not improved after 2 months

It looks infected (large, red, tender bumps)

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.

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.

Definition

• A scaly rash on the scalp that starts in newborns

• Symptoms of Cradle Cap

• Yellow scales and crusts attached to the scalp

• Occurs in patches

• Scales can be greasy or dry

• Not itchy or painful

• Begins in the first 2 to 6 weeks of life

Cause of Cradle Cap

Cradle cap is probably caused by hormones from the mother. These hormones cross the placenta before birth. The hormones cause the oil glands in the skin to become overactive. They then release more oil than normal.

Dead skin cells normally fall off. The extra oil causes these cells to "stick" to the skin. These cells form yellow crusts and scales on the scalp.

When To Call

Call Doctor or Seek Care Now

• Baby under 1 month old with tiny water blisters or pimples in a cluster

• Your child looks or acts very sick

Call Doctor Within 24 Hours

• Baby under 1 month old with any water blisters or pimples

• You think your child needs to be seen

• Call Doctor During Office Hours

• Raw rash behind the ears

• Rash spreads beyond the scalp

• Cradle cap gets worse with treatment

• Cradle cap lasts longer than 12 months

• You have other questions or concerns

Self Care at Home

Mild cradle cap

Care Advice

What You Should Know About Cradle Cap:

Cradle cap is a common skin condition of newborns.

It's caused by overactive oil glands in the scalp.

It's harmless and will go away on its own. But it takes time.

Here is some care advice that should help.

• Shampoo Daily:

Wash the hair with an anti-dandruff shampoo (such as Head and Shoulders). Do this twice a week. No prescription is needed. Note: The daily use of anti-dandruff shampoo isn't approved until after 2 years old. But, using it twice a week is fine.

On the other days, wash the hair with baby shampoo.

• Scalp Massage:

While the hair is lathered, massage the scalp with a soft brush. You can also use a rough washcloth or your fingers for 5 minutes. Don't worry about hurting the soft spot.

• Baby Oil:

If the scalp has thick crusts (scales), put some baby oil on the scalp. Do this for 15 minutes before shampooing to soften the crusts.

Wash all the oil off, however, or it may worsen the cradle cap. (Reason: The oil blocks the oil glands on the baby's scalp.)

Do not use olive oil. (Reason: may increase the growth of yeast)

Cradle cap lotions for loosening up the scales are also available without a prescription. Apply the lotion 15 minutes before shampooing.

• Steroid Cream:

If the rash on the scalp is red and irritated, use 1% hydrocortisone cream. An example is Cortaid. No prescription is needed.

Put this on once a day.

After 1 hour, wash it off with soap and water.

Do this for 7 days or less.

• Expected Course:

Cradle cap will eventually go away on its own between 6 and 12 months of age. Usually, it doesn't cause any symptoms (such as pain or itching).

Therefore, treatment is optional. It is mainly done for cosmetic reasons.

Shampoos, lotions and brushing will reduce the thickness of the scales. They will usually make them go away sooner.

• Return to Child Care:

Cradle cap cannot be spread to others.

Your child does not need to miss any child care.

• Call Your Doctor If:

Gets worse with treatment

Lasts over 12 months of age

You think your child needs to be seen

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

Pain or discomfort in the upper, mid or lower back

Minor muscle strain from overuse and back injury are included

Causes of Back Pain

Strained Back Muscles. New backaches in teens are mostly from strained back muscles (muscle overuse). The pain is mostly in the lower back and near the center. There are 200 muscles in the back that allow us to stand upright.

Work Triggers. Carrying something too heavy or lifting from an awkward position can cause back pain. Bending too far backward or sideways can cause back pain. Digging in the garden for too long causes overuse of back muscles.

Exercise. New exercises or changes in an exercise routine can cause back pain. This is also called muscle overuse.

Back Packs. In school-age children, heavy backpacks have become a common cause. They also can cause shoulder and neck pains. Children who have not gone into puberty are at greater risk. Reason: They lack the muscle mass.

Kidney Infection (Serious). Pain is on one side in the middle of the back. Other symptoms are fever and pain when passing urine.

Kidney Stone (Serious). Pain is on one side of the mid-back and shoots into the lower belly. The pain is extremely severe. The urine has blood in it.

Sciatic Nerve Pain (Serious). Sciatica is pain caused by a pinched nerve in the lower back. Sciatica gives a burning pain in one buttock. The pain shoots into the back of the leg on that side. The most intense pain can be in the lower leg and foot. Leg weakness, numbness or tingling can also occur. A ruptured disk causes the pressure on the nerve. Sciatica is rare in children but common in adults.

Symptoms of Back Pain

Strained back muscles cause most of these symptoms:

The pain is in the middle or lower back

The pain is made worse by bending

The muscles near the spine are tender to the touch

The muscles may be tight (in spasm)

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

Pain starts after major injury (such as a car crash or football). Caution: do not move your child until a spine board is put on.

You think your child has a life-threatening emergency

Go to ER Now

Can't pass urine or can only pass a few drops

Can't walk or can barely walk

Call Doctor or Seek Care Now

Severe pain

Pain shoots into the buttock or back of the thigh

Tingling or numbness (loss of feeling) in the legs or feet

Blood in urine

Pain or burning when passing urine and fever

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

Pain or burning when passing urine, but no fever

Fever

Walks different than normal for more than 3 days

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Age is less than 5 years

Pain in the upper back

Cause is not clear (no history of overuse or twisting)

Cause is bending backwards (such as in gymnastics)

Back pain from overuse (exercise or work) lasts more than 2 weeks

Back pains are a frequent problem

You have other questions or concerns

Self Care at Home

Strained back muscles (from exercise or work) present less than 2 weeks

Care Advice

What You Should Know About Back Pain:

Most new lower back pain is caused by lifting heavy objects. Lifting while the back is twisted is a common cause. Muscle overuse from exercise also causes strained back muscles.

Pain is not the only symptom. Walking a little bent over or stiff may occur for a few days.

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.

Reason: Helps back pain and muscle spasms.

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 with the pain and muscle spasms.

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.

Sleep on the Side:

Sleep on the side with a pillow between the knees.

If your child only sleeps on the back, put a pillow under the knees.

Avoid sleeping on the stomach.

The mattress should be firm. Do not sleep on a waterbed.

Activity:

Avoid any sports or work that increase the pain.

Avoid lifting or jumping until well.

After 48 hours, start gentle back stretching exercises.

Complete bed rest is not needed.

Prevent Backpack Pain:

Limit the weight of what is carried. It needs to less than 15% of body weight. That means a 100-pound (45 kg) child should not carry more than 15 pounds (7 kg).

A sign of carrying too much weight is having to lean forward when walking.

Buy a well-made backpack with wide, padded shoulder straps.

Never carry the pack on just one shoulder. Reason: causes shoulder and neck pain.

What to Expect:

New back pain without a reason most often goes away in a few days.

Back pain from muscle overuse (strained back muscles) goes away in 1 to 2 weeks.

Call Your Doctor If:

Pain becomes severe

Walks different than normal for more than 3 days

Pain starts to shoot into the leg

Fever occurs

Pain lasts more than 2 weeks

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.

Definition

Your child is having an asthma attack

Use this guide only if a doctor has told you your child has asthma

Symptoms of Asthma

Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.

Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out.

The diagnosis of asthma requires attacks of wheezing that recur. The diagnosis is rarely made before 1 year of age.

Causes (Triggers) of Asthma Attacks

Infections that affect breathing (like colds or the flu)

Pollens (trees, grass and weeds)

Animals (like cats or rabbits)

Tobacco smoke

Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)

Food Allergy (Serious). Asthma attacks caused by food allergy can be life-threatening (anaphylaxis). Examples are nuts or fish.

Asthma Attack Scale

Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard or mild. (Green Zone: Peak Flow Rate 80-100% of normal rate)

Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Wheezing can be heard. Retractions are present (ribs pull in with each breath). (Yellow Zone: Peak Flow Rate 50-80% of normal rate)

Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. Rarely, wheezing is absent due to poor air movement. Retractions may be severe. (Red Zone: Peak Flow Rate less than 50% of normal rate)

Peak Flow Meter: a peak flow meter measures Peak Flow Rates (PFR). It tells us how well a person can move air out of the lungs. A PFR can be used in children 6 years and older.

When To Call

Call 911 Now

Wheezing and life-threatening allergic reaction to similar substance in the past

Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food

Severe trouble breathing (struggling for each breath, can barely speak or cry)

Passed out

Lips or face are bluish when not coughing

You think your child has a life-threatening emergency

Go to ER Now

Looks like he did when hospitalized before with asthma

Trouble breathing not gone 20 minutes after neb or inhaler

Peak flow rate less than 50% of normal rate (Red Zone)

Call Doctor or Seek Care Now

Pulse oxygen level less than 90% during asthma attack

Lips or face have turned bluish during coughing

Ribs are pulling in with each breath (retractions)

PEFR is 50-80% of normal rate after using nebulizer or inhaler (Yellow Zone)

Wheezing not gone 20 minutes after using neb or inhaler

Breathing is much faster than normal

Nonstop coughing not better after using nebulizer or inhaler

Severe chest pain

Need to use asthma medicine (neb or inhaler) more often than every 4 hours

Fever over 104° F (40° C)

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

Mild wheezing lasts more than 24 hours on neb or inhaler treatments

Sinus pain (not just congestion)

Fever lasts more than 3 days

Fever returns after being gone more than 24 hours

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Don't have written asthma action plan from your doctor

Use an inhaler, but don't have a spacer

Miss more than 1 day of school per month for asthma

Asthma limits exercise or sports

Asthma attacks wake child up from sleep

Use more than 1 inhaler per month

No asthma check-up in more than 1 year

You have other questions or concerns

Self Care at Home

Mild asthma attack

Care Advice

What You Should Know About Asthma:

Over 10% of children have asthma.

Your child's asthma can flare up at any time.

When you are away from your home, always take your child's medicines with you.

The sooner you start treatment, the faster your child will feel better.

Here is some care advice that should help.

Asthma Quick-Relief Medicine:

Your child's quick-relief (rescue) medicine is albuterol or xopenex.

Start it at the first sign of any wheezing, shortness of breath or hard coughing.

Give by inhaler with a spacer (2 puffs each time) or use a neb machine.

Repeat it every 4 hours if your child is having any asthma symptoms.

Never give it more often than 4 hours without talking with your child's doctor.

Coughing. The best "cough med" for a child with asthma is always the asthma medicine. Caution: Don't use cough suppressants. If over 6 years old, cough drops may help a tickly cough.

Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.

Use the medicine until your child has not wheezed or coughed for 48 hours.

Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.

Asthma Controller Medicine:

Your child may have been told to use a controller drug. An example is an inhaled steroid.

It's for preventing attacks and must be used daily.

During asthma attacks, keep giving this medicine to your child as ordered.

Allergy Medicine for Hay Fever:

For signs of nasal allergies (hay fever), it's okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.

Fluids - Offer More:

Try to get your child to drink lots of fluids.

Goal: Keep your child well hydrated.

Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up.

Humidifier:

If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.

Avoid Tobacco Smoke:

Tobacco smoke makes asthma much worse.

Don't let anyone smoke around your child.

Avoid or Remove Triggers:

Shower to remove pollens or other allergens from the body and hair.

Avoid known causes of asthma attacks (such as smoke or cats).

During attacks, reduce exercise or sports if it makes your child's asthma worse.

What to Expect:

If treatment is started early, most asthma attacks are quickly brought under control.

All wheezing should be gone by 5 days.

Inhaler With a Spacer: How to Use

Step 1. Shake the inhaler well. Then attach it to the spacer (holding chamber).

Step 2. Breathe out completely and empty the lungs.

Step 3. Close the lips and teeth around the spacer mouthpiece.

Step 4. Press down on the inhaler. This will put one puff of the medicine in the spacer.

Step 5. Breathe in slowly until the lungs are full.

Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.

If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.

Metered Dose Inhaler (MDI): How to Use Without a Spacer (if you don't have one)

Step 1. Shake the inhaler well.

Step 2. Breathe out completely and empty the lungs.

Step 3. Close the lips and teeth around the inhaler mouthpiece.

Step 4. Press down on the inhaler to release a puff. Do this just as your child starts to breathe in.

Step 5. Breathe in slowly until the lungs are full.

Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.

If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.

Ask your doctor for a spacer if you don't have one. It will help send more medicine into the lungs.

Older children who don't like a spacer can be prescribed an albuterol dry powder device.

Home Nebulizer: How to Use:

A nebulizer machine changes a liquid medicine (med) into a fine mist. The fine mist can carry the med deep into the lungs. This is called a nebulizer (neb) treatment.

Step 1. Prepare the medicine. First, wash your hands with soap and water. For pre-mixed single dose vials, just add one vial to the neb holding cup. For multi-dose vials, you need to do the mixing. First, add the correct amount of normal saline to the neb cup. Then carefully measure and add the correct amount of medicine to the saline.

Step 2. Connect the nebulizer to the air compressor tubing. The air compressor is run by electricity. Portable ones run on a battery. Compressors make the jet of air that turns the medicine into a fine mist.

Step 3. Turn on the air compressor. It will start making the fine mist that your child needs.

Step 4 for an Older Child. Place the mouthpiece between your child's teeth and seal with the lips. Ask your child to breathe slowly and deeply. Ask your child to hold a deep breath for 10 seconds once a minute.

Step 4 for a Younger Child. If your child refuses the mouthpiece, use a face mask. It should cover the nose and mouth. It should fit snugly.

Step 5. Continue the treatment until the med is gone. If the med sticks to the side of the cup, shake it a little. An average neb treatment takes 10 minutes.

Step 6. After each treatment, take the nebulizer apart. Rinse and clean it as directed. Reason: It can't produce mist if it becomes clogged up.

Caution: Closely follow your doctor's instructions. Use the exact amount of med your doctor ordered. Don't give a neb treatment more often than every 4 hours.

Call Your Doctor If:

Trouble breathing occurs

Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours

Wheezing lasts over 24 hours

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.

• Well child care

• Sick visits

• Injury visits

• Immunizations

• On site laboratory

• Hearing and vision testing

• Circumcisions

• Ear piercing

• Behavioral health

• Nutrition counseling

Definition

A spell that involves holding the breath, then turning blue and passing out

Breath-holding spells were diagnosed by your child's doctor

Symptoms of a Breath-Holding Spell

An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down.

The child gives out 1 or 2 long cries

Then holds his breath until the lips and face become bluish

Then passes out and falls to the floor

Then often becomes stiff. May also have a few muscle jerks.

Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes.

Only happens when child is awake, never when asleep

Cause

A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose.

This happens in 5% of healthy children. Breath-holding spells can run in families.

Starts between 6 months and 2 years of age. Goes away by age 6.

Many young children hold their breath when upset, turn blue, but don't pass out. This is common and normal.

Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn't eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test.

When To Call

Call 911 Now

Breathing stopped for more than 1 minute and hasn't returned

You think your child has a life-threatening emergency

Go to ER Now

Trouble breathing after spell ends

Call Doctor or Seek Care Now

Passed out more than 2 minutes by the clock and normal breathing now

First breath-holding spell

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent

Call Doctor During Office Hours

Never been checked by a doctor for the spells

Spells happen without a reason (no triggers)

Muscle jerks during spell

Picky eater (especially for meats)

Lots of tantrums trigger the spells

Spells happen more than once a week

You think your child needs to be seen, but the problem is not urgent

You have other questions or concerns

Self Care at Home

Normal breath-holding spell

Care Advice

What You Should Know About Breath-Holding Spells:

While breath-holding spells are scary for parents, they are harmless.

Normal breathing always returns on its own.

The spells don't lead to seizures (epilepsy).

Here is some care advice that should help.

Lie Down:

During the spell, have your child lie down.

This will increase blood flow to the brain.

Remove any food from his mouth.

Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles.

Cold Washcloth to Forehead:

Put a cold, wet washcloth on your child's forehead. Keep it on until he or she starts breathing again.

That's the only care your child needs.

Time the Length of Not Breathing:

These spells always seem to last longer than they really do.

Time the length of a few spells. Use a watch with a second hand.

Breathing almost always returns by 60 seconds.

It's hard to guess at the length of a spell and get it right.

Stay Calm:

Don't start mouth-to-mouth breathing. Don't call 911.

Don't put anything in your child's mouth. It could cause choking or vomiting.

Never shake your baby. It can cause bleeding in the brain.

Don't Give In After the Spell:

Some breath-holding spells start with a temper tantrum (Such as your child wanted something and you said "No"). Don't give in to her before or after the attack.

After spells, give your child a brief hug and go about your normal routine.

What to Expect:

Spells happen from 1 or 2 times a day to 1 or 2 times a month.

Kids outgrow them by age 6.

Call Your Doctor If:

Spells become more frequent

Spells change

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.

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.

Definition

Drainage of substance or liquid from the ear canal

Drainage through an ear tube is included

Types of Ear Discharge

Pus or Cloudy Fluid. This is the most common type of ear discharge. The main cause is an ear infection. The drainage is from a torn eardrum. The eardrum ruptures in about 10% of bacterial ear infections.

Ear Tube Fluid Release. Children with frequent ear infections may get ventilation tubes put in. These help the middle ear drain its fluids and become dry. Sometimes, the ear tube gets plugged up. Normal fluids build up in the middle ear until the ear tube opens up again. This can cause some clear fluid drainage from the ear canal for a day.

Earwax. Earwax is light brown, dark brown, or orange brown in color. If it gets wet, it can look like a discharge.

Blood. This follows an injury to the ear. Usually, it's just a minor scratch of the lining of the ear canal.

Water. Bath water or tears can get in the ear canal. Seeing a clear "discharge" that happens once is likely this.

Ear Drops. The person who sees the discharge may not know someone else put in drops.

Swimmer's Ear Discharge. Early symptoms are an itchy ear canal. Later symptoms include a whitish, watery discharge. Mainly occurs in swimmers and in the summer time.

Ear Canal Foreign Object. Young children may put small objects in their ear canal. It can cause a low grade infection and pus colored discharge. If the object was sharp, the discharge may have streaks of blood.

When To Call

Call Doctor or Seek Care Now

Pink or red swelling behind the ear

Clear or bloody fluid after a head injury

Bleeding from the ear canal. Exception: few drops and after an ear exam.

Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.

Fever over 104° F (40° C)

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

Age less than 6 months old

Ear pain or crying like in pain

Discharge is yellow or green, cloudy white or smells bad

Clear drainage (not from a head injury) lasts more than 24 hours

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

You have other questions or concerns

Self Care at Home

Normal earwax or other harmless discharge

Care Advice

Earwax:

Ear wax protects the lining of the ear canal and has germ-killing properties.

If the earwax is removed, the ear canals become itchy.

Do not use cotton swabs (Q-tips) in your child's ear.

Call Your Doctor If: Begins to look like pus (yellow or green discharge).

Clear Discharge (without head injury):

Most likely, this is from tears or water that entered the ear canal. This can happen during a bath, shower, swimming or water fight.

Don't overlook eardrops your child or someone else used without telling you.

In children with ventilation tubes, some clear or slightly cloudy fluid can occur. This happens when a tube blockage opens up and drains.

Call Your Doctor If: Clear drainage lasts for more than 24 hours.

Blood After Ear Exam:

Sometimes, ear wax needs to be removed by your doctor to see the eardrum. If ear wax was removed, it can cause a small scratch inside the ear canal. This happens about 10% of the time. The scratch oozes 1 or 2 drops of blood and then clots.

This should heal up in a few days.

It shouldn't affect the hearing.

Don't put anything in the ear canal. This may start the bleeding again.

Call Your Doctor If: Bleeding starts again.

Cloudy Discharge - Ear Infection:

Cloudy fluid or pus draining from the ear canal usually means there's an ear infection.

The pus drains because there's a small tear in the eardrum.

To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.

See Earache care guide for more advice.

Call Your Doctor If: Your child becomes worse.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

A baby less than 3 months old is crying and you don't know why

Crying is the only symptom

The type of frequent crying called colic is included

For crying with an illness or other symptom, go to that care guide

Causes of Unexplained Crying

Hungry Baby. The most common reason babies cry is because they are hungry. They stop crying at the onset of feeding. By the end of the feeding, they are happy.

Sleepy Baby. The second reason babies cry is they need sleep. They need their parent to put them in a comfortable position. It may be swaddled and on their back. Then they fuss a little and fall asleep.

Fed Too Much. Some babies cry because of a bloated stomach from overfeeding. Unlike gas, too much milk can cause discomfort that lasts a short time.

Caffeine. Caffeine is a stimulant that can cause increased crying and trouble falling asleep. Breastfeeding mothers need to limit their caffeine intake.

Clothing. Being too hot or too cold can make a baby cry. So can clothing that is too tight.

Dirty Diaper. Stool is very irritating to the skin. If not cleaned off, it can cause pain and burning.

Colic. Colic is the main cause of recurrent crying during the early months. All babies have some normal fussy crying every day. When this occurs over 3 hours per day, it's called colic. When they are not crying, they are happy.

Pain (Serious). Painful causes include an earache, mouth ulcers, or a raw diaper rash. An ulcer on tip of penis may also cause pain and crying. These babies cry a lot and are not happy when they are not crying. They need to see a doctor to make a diagnosis. Fever in this age group is serious until proven otherwise. Shaken baby syndrome is a concern.

Myths About Causes of Crying

Not Due to Gas. Gas passing through normal intestines does not cause pain or crying. All crying babies pass lots of gas. Their stomachs also make lots of gassy noises. The gas comes from swallowed air. The gas is normal. It does not become trapped nor cause any pains. That's why burping a baby doesn't help the crying. Blaming gas is a myth.

Definition of Colic

A lot of crying once or twice per day

Usually consolable when held and comforted

Acts normal (happy, contented) between bouts of crying

The baby is getting enough to eat and is not hungry

The baby is not sick

Onset most often before 2 weeks of age

Usually goes away by 3 months of age (sometimes up to 4 months)

When To Call

Call 911 Now

Not moving or very weak

You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Age less than 1 month old and looks or acts abnormal in any way

Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.

Bulging or swollen soft spot

Swollen scrotum or groin

Vomiting

Cries when you touch, move or hold your baby

Could be an injury

Nonstop crying lasts more than 2 hours. (Your baby can't be consoled using this Care Advice).

Will not drink or drinks very little for more than 8 hours

Not alert when awake ("out of it")

You are afraid someone might hurt or shake your baby

High-risk child (such as with heart or brain disease)

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

Not gaining weight or seems hungry

New crying but your baby can be consoled. (Your baby will stop crying, but cause of crying not clear)

You are worn out from all the crying

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Your baby has never been checked for excessive crying

Crying started after 1 month of age

Crying occurs 3 or more times per day

You have other questions or concerns

Self Care at Home

Normal crying in all babies

Colic (Excessive crying in a well baby who can be consoled)

Care Advice

What You Should Know About Crying:

Normal Crying: All babies cry when they are hungry. Also, the normal baby has 1 to 2 hours of unexplained crying each day. It is scattered throughout the day. As long as they are happy and content when they are not crying, this is normal.

Colic: Some babies are very hard to comfort. Some babies also cry a lot (over 3 hours per day). If growing normally and have a normal medical exam, the crying is called colic. Remind yourself that colic is due to your baby's temperament. It has nothing to do with your parenting or any medical disease.

Here is some care advice that should help both types of crying.

Feedings:

For formula-fed babies, feed if more than 2 hours since the last feeding. For breast-fed babies, feed if more than 1½ hours since the last feeding.

Be careful not to feed your baby every time she cries. Some babies cry because of a bloated stomach from overfeeding. Let your baby decide when she's had enough milk. (For example, she turns her head away.) Don't encourage your baby to finish what's in the bottle.

Caffeine. If breastfeeding, decrease your caffeine intake. Limit your coffee, tea and energy drinks to 2 servings per day. That's 2 cups or 16 ounces (480 mL).

Hold and Comfort for Crying:

Hold and try to calm your baby whenever he cries without a reason. Hold your baby flat to help them relax and go to sleep.

Rock your child in a rocking chair, in a cradle or while standing. Many babies calm best with rapid tiny movements like vibrations.

Place in a windup swing or vibrating chair.

Take for a stroller ride, outdoors or indoors.

Do anything else you think may be comforting. Examples are using a pacifier, massage, or warm bath.

Swaddle your Baby in a Blanket for Crying:

Swaddling is the most helpful technique for calming crying babies. It also keeps your baby from waking up with a startle reflex.

Use a big square blanket and the "burrito-wrap" technique:

Step 1: Have the arms inside and straight at the sides.

Step 2: Pull the left side of the blanket over the upper body and tuck.

Step 3: Fold the bottom up with the knees a little flexed. Safe swaddling keeps the legs in a straddle position.

Step 4: Pull the right side over the upper body and tuck.

Caution: Don't cover your baby's head or overheat your baby.

Caution: Stop swaddling when your baby shows signs of rolling over. Age limit: 4 months.

Read the book (or view the DVD),"The Happiest Baby on the Block". Both products are authored by Dr. Harvey Karp. It is the best resource on how to calm fussy babies.

White Noise for Crying:

Swaddling works even better when paired with a low-pitched white noise. Examples are a CD, vacuum cleaner, fan or other constant sound.

Caution: Avoid making white noise too loud. Reason: risk of hearing damage.

Keep the white noise on any time your baby is crying.

When your baby is awake and not crying, keep your baby unwrapped. Turn off the white noise. Reason: So she can get used to the normal sounds of your home. (For details, view Dr. Karp's DVD.)

Falling Asleep on their Own:

Often babies cry because they need to sleep. If over 2 hours have passed since the last nap, this probably is the reason.

You have tried different ways to comfort your baby. You fed him recently. Nothing you do seems to help your baby relax. So, now, it's time to get out of the way.

Swaddle your baby. Place him on his back in his crib. Turn on some white noise or soothing music. Then, leave the room.

Let your baby fuss until he falls asleep.

For some overtired babies, this is the only answer.

Encourage Nighttime Sleep (Rather Than Daytime Sleep):

Try to keep your child from sleeping too much during the daytime.

If your baby has napped 2 hours or longer, gently wake him up. Play with or feed your baby, depending on his needs. This will lessen the amount of time your baby is awake at night.

Warning: Never Shake a Baby

It can cause bleeding on the brain. Severe brain damage can happen in a few seconds.

Never leave your baby with someone who is immature or has a bad temper.

If you are frustrated, put your baby down in a safe place.

Call or ask a friend or relative for help.

Take a break until you calm down.

What to Expect:

The right technique should start to reduce the crying. You may have to try several things before finding the best method.

The crying should start to decrease to about 1 hour per day.

Colic gets better after 2 months of age. Most often, it is gone by 3 months.

Call Your Doctor If:

Your baby starts to look or act abnormal

Cries nonstop for more than 2 hours

Your child can't be consoled using this advice

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.

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.

Lymph Nodes: What They Drain

The lymph nodes are filled with white blood cells. They filter the lymph fluid coming from certain parts of the body. They fight infections.

Neck Nodes in Front. These drain the nose, throat and lower face.

Neck Nodes in Back. These drain the scalp.

Armpit Nodes. These drain the arms and upper chest wall.

Groin Nodes. These drain the legs and lower stomach wall.

Common Objects Used to Guess the Size

Pea or pencil eraser: ¼ inch or 6 mm

Dime: ¾ inch or 1.8 cm

Quarter: 1 inch or 2.5 cm

Golf ball: 1 ½ inches or 3.8 cm

Tennis Ball: 2 ½ inches or 6.4 cm

When To Call

Call Doctor or Seek Care Now

Node in the neck causes trouble with breathing, swallowing or drinking

Fever over 104° F (40° C)

Skin over the node is red

Node gets much bigger over 6 hours or less

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

1 or more inches (2.5 cm or more) in size by measurement

Very tender to the touch

Age less than 1 month old

Node limits moving the neck, arm or leg

Toothache with a swollen node under the jawbone

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

In the neck and also has a sore throat

Large nodes at 2 or more parts of the body

Cause of the swollen node is not clear

Large node lasts more than 1 month

You have other questions or concerns

Self Care at Home

Mildly swollen lymph node

Care Advice

What You Should Know About Normal Nodes:

If you have found a pea-sized or bean-sized node, this is normal. Normal lymph nodes are smaller than ½ inch or 12 mm.

Don't look for lymph nodes, because you can always find some. They are easy to find in the neck and groin.

What You Should Know About Swollen Nodes from a Viral Infection:

Viral throat infections and colds can cause lymph nodes in the neck to get bigger. They may double in size. They may also become tender.

This reaction is normal. It means the lymph node is fighting the infection and doing a good job.

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.

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.

Do Not Squeeze:

Don't squeeze lymph nodes.

Reason: This may keep them from shrinking back to normal size.

Return to School:

Swollen lymph nodes alone cannot be spread to others.

If the swollen nodes are with a viral illness, your child can return to school. Wait until after the fever is gone. Your child should feel well enough to participate in normal activities.

What to Expect:

After the infection is gone, the nodes slowly return to normal size.

This may take 2 to 4 weeks.

However, they won't ever completely go away.

Call Your Doctor If:

Node gets 1 inch (2.5 cm) or larger in size

Big node lasts more than 1 month

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.

Definition

Bite from a pet, wild animal or human

Types of Wounds

Bruise. There is no break in the skin. No risk of infection.

Scrape (Abrasion) or Scratch. A wound that doesn't go all the way through the skin. Low chance of infection. Antibiotic drugs are not needed.

Cut (Laceration). A wound that goes through the skin to the fat or muscle tissue. Some chance of infection. Most need to be seen. Cleaning the wound can help prevent this. Antibiotic drugs may be needed.

Puncture Wound. These wounds break through the skin. Greater risk of infection. Puncture wounds from cat bites are more likely to get infected. Antibiotic drugs may be needed.

Wound Infection. This is the main risk of an animal bite. The main finding is redness around the bite and pain. It starts 8 hours to 3 days after the bite. It can often be prevented by early, careful cleaning of the bite. This is why most animal bites need to be seen.

Types of Animal Bites

Large Wild Animal Bites. Rabies is a disease that can kill people. Bites or scratches from any large wild animal can pass on rabies. Animals at highest risk are bats, skunks, raccoons, foxes, or coyotes. These animals may spread rabies even if they have no symptoms.

Small Wild Animal Bites. Small animals such as mice, rats, moles, or gophers do not carry rabies. Chipmunks, prairie dogs, squirrels and rabbits also do not carry rabies. Exception: one of these small animals actually attacks a human (an unprovoked bite). Sometimes, their bites can get infected.

Large Pet Animal Bites. Most bites from pets are from dogs or cats. Bites from other pets such as horses can be handled using this guide. Dogs and cats are free of rabies in most U.S. and Canadian cities. Stray animals are always at risk for rabies until proven otherwise. Cats and dogs that always stay indoors should be safe. The main risk in pet bites is wound infection, not rabies. Cat bites become infected more often than dog bites. Cat scratches can get infected just like a bite because cats lick their claws.

Small Indoor Pet Animal Bites. Small indoor pets are not at risk for rabies. Examples of these pets are gerbils, hamsters, guinea pigs, or mice. Tiny puncture wounds from these small animals also don't need to be seen. They carry a small risk for wound infections.

Human Bites. Most human bites occur during fights, especially in teenagers. Sometimes a fist is cut when it strikes a tooth. Human bites are more likely to become infected than animal bites. Bites on the hands are at higher risk. Many toddler bites are safe because they don't break the skin.

Bat Bites and Rabies. In the U.S., 90% of cases of rabies in humans are caused by bats. Bats have spread rabies without a visible bite mark.

Animals at Risk for Rabies

Bat, skunk, raccoon, fox, or coyote

Other large wild animals

Pets that have never had rabies shots and spend time outdoors

In the U.S., rabies occurs 4 times more in cats than in dogs.

Outdoor animals who are sick or stray

Dogs or cats in countries that do not require rabies shots

In the U.S. and Canada, bites from city dogs and cats are safe.

In the U.S., there are 2 - 3 deaths from rabies per year in humans.

When To Call

Call 911 Now

Major bleeding that can't be stopped

Not moving or too weak to stand

You think your child has a life-threatening emergency

Go to ER Now

Bleeding that won't stop after 10 minutes of direct pressure

Any scratch or cut from an animal at risk for Rabies

Call Doctor or Seek Care Now

Wild animal bite that breaks the skin

Pet animal (such as dog or cat) bite that breaks the skin. Exception: minor scratches that don't go through the skin.

Puncture wound (holes through skin) from a Cat's teeth or claws

Puncture wound (holes through skin) of hand or face

Human bite that breaks the skin

Bite looks infected (redness or red streaks) or has a fever

Bat contact or exposure, even without a bite mark

Contact with a rabies-prone animal, even without a bite mark

Minor cut or scrape and no past tetanus shots

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

Last tetanus shot more than 5 years ago

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

You have other questions or concerns

Self Care at Home

Bite did not break the skin or is only a bruise

Minor scratches that don't go through the skin from a pet

Tiny puncture wound from small pet, such as a hamster or puppy. Exception: cat puncture wound.

Care Advice

What You Should Know About Bites:

Bites that don't break the skin can't become infected.

Cuts and punctures always are at risk for infection.

Here is some care advice that should help.

Clean the Bite:

Wash all wounds right now with soap and water for 5 minutes.

Also, flush well under running water for a few minutes. Reason: Can prevent many wound infections.

Bleeding - How to Stop:

For any bleeding, put pressure on the wound.

Use a gauze pad or clean cloth.

Press for 10 minutes or until the bleeding has stopped.

Antibiotic Ointment:

For small cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.

Put it on the cut 3 times a day.

Do this for 3 days.

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 bruising, use a cold pack. You can also use ice wrapped in a wet cloth. Apply it to the bruise once for 20 minutes. Reason: Helps with bleeding, pain and swelling.

What to Expect:

Most scratches, scrapes and other minor bites heal up fine in 5 to 7 days.

Call Your Doctor If:

Bite starts to look infected (pus, redness, red streaks)

Fever occurs

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.

Definition

Pain in or around the ear

The older child complains about ear pain

Younger child acts like he did with last ear infection or cries a lot

Not caused by an ear injury

Causes of Earaches

Ear Infection. An infection of the middle ear (space behind the eardrum) is the most common cause. Ear infections can be caused by viruses or bacteria. Usually, a doctor can tell the difference by looking at the eardrum.

Swimmer's Ear. An infection or irritation of the skin that lines the ear canal. Main symptom is itchy ear canal. If the canal becomes infected, it also becomes painful. Mainly occurs in swimmers and in the summer time.

Ear Canal Injury. A cotton swab or fingernail can cause a scrape in the canal.

Ear Canal Abscess. An infection of a hair follicle in the ear canal can be very painful. It looks like a small red bump. Sometimes, it turns into a pimple. It needs to be drained.

Earwax. A big piece of hard earwax can cause mild ear pain. If the wax has been pushed in by cotton swabs, the ear canal can become blocked. This pain will be worse.

Ear Canal Foreign Object. Young children may put small objects in their ear canal. It will cause pain if object is sharp or pushed in very far.

Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is severe ear pain. It usually starts when coming down for a landing. It can also occur during mountain driving.

Pierced Ear Infections. These are common. If not treated early, they can become very painful.

Referred Pain. Ear pain can also be referred from diseases not in the ear. Tonsil infections are a common example. Tooth decay in a back molar can seem like ear pain. Mumps can be reported as ear pain. Reason: the mumps parotid gland is in front of the ear. Jaw pain (TMJ syndrome) can masquerade as ear pain.

Ear Infections: Most Common Cause

Definition. An infection of the middle ear (the space behind the eardrum). Viral ear infections are more common that bacterial ones.

Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.

Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.

Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.

Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.

Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.

Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.

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

Severe earache and not improved 2 hours after taking ibuprofen

Pink or red swelling behind the ear

Outer ear is red, swollen and painful

Stiff neck (can't touch chin to the chest)

Walking is not steady

Pointed object was put into the ear canal (such as a pencil, stick, or wire)

Not alert when awake ("out of it")

Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.

Fever over 104° F (40° C)

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

Earache, but none of the symptoms above. Reason: could be an ear infection.

Pus or cloudy discharge from ear canal

Care Advice

What You Should Know About Earaches:

Your child may have an ear infection. The only way to be sure is to look at the eardrum.

It is safe to wait until your doctor's office is open to call. It is not harmful to wait if the pain starts at night.

Ear pain can usually be controlled with pain medicine.

Many earaches are caused by a virus and don't need an antibiotic.

Here is some care advice that should help until you talk with your doctor.

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:

Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.

Note: Some children prefer heat for 20 minutes.

Caution: Heat or cold kept on too long could cause a burn or frostbite.

Ear Infection Discharge:

If pus is draining from the ear, the eardrum probably has a small tear. Usually, this is from an ear infection. Discharge can also occur if your child has ear tubes.

The pus may be blood-tinged.

Most often, this heals well after the ear infection is treated.

Wipe the discharge away as you see it.

Do not plug the ear canal with cotton. (Reason: Retained pus can cause an infection of the lining of the ear canal)

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.

Return to School:

Ear infections cannot be spread to others.

Can return to school or child care when the fever is gone.

Call Your Doctor If:

Pain becomes severe

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.

On average, our overall time in office (for 1 child) is 30 minutes or less. If it's a particularly busy day with a lot of sick visits or emergencies, you may wait longer. We value your time and strive to get you in and out of your appointment as quickly as possible. If you are not committed to any particular provider you can request the first available time slot with any provider. Please note that the best time to schedule your visit is first thing in the morning or first thing after lunch.

Definition

Your child has been diagnosed with bronchiolitis

It's an infection of the smallest airways in the lungs

Caused by a virus called RSV

Wheezing during the first 2 years of life is often caused by bronchiolitis

You wonder if your child needs to be seen again

Symptoms of Bronchiolitis

Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound.

You can hear it best when your child is breathing out.

Rapid breathing at a rate of over 40 breaths per minute.

Tight breathing (having to work hard to push air out).

Coughing (may cough up very sticky mucus).

Fever and a runny nose often start before the breathing problems.

The average age for getting bronchiolitis is 6 months (range: birth to 2 years).

Symptoms are like asthma.

About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times.

Cause of Bronchiolitis

A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus.

The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter.

People do not develop life-long immunity to the RSV virus. This means they can be infected many times.

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

Struggling for each breath or short of breath.

Tight breathing so that your child can barely speak or cry.

Ribs are pulling in with each breath (called retractions).

Breathing has become noisy (such as wheezes).

Breathing is much faster than normal.

Lips or face turn a blue color.

Diagnosis of Bronchiolitis

A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope.

Prevention of Spread to Others

Cover the nose and mouth with a tissue when coughing or sneezing.

Wash hands often. After coughing or sneezing are important times.

When To Call

Call 911 Now

Severe trouble breathing (struggling for each breath, can barely speak or cry)

Passed out or stopped breathing

Lips or face are bluish when not coughing

You think your child has a life-threatening emergency

Go to ER Now

Your child looks like they did when hospitalized before with bronchiolitis

Call Doctor or Seek Care Now

Trouble breathing. Exception: if it happens only when coughing.

Lips or face have turned bluish, but only during coughing

Ribs are pulling in with each breath (retractions)

New harsh sound with breathing in (called stridor)

Wheezing (purring or whistling sound) is worse than when seen

Breathing is much faster than when seen

Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, no tears.

Not alert when awake ("out of it")

High-risk child (such as chronic lung disease) and getting worse

Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.

Age less than 6 months old and worse in any way

Fever over 104° F (40° C)

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

Nonstop coughing spells

Trouble feeding worse than when seen

Earache or ear drainage

Fever lasts more than 3 days

Fever returns after being gone more than 24 hours

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Coughing causes vomiting 3 or more times

Mild wheezing sounds lasts more than 7 days

Cough lasts more than 3 weeks

You have other questions or concerns

Self Care at Home

Bronchiolitis same or better than when last seen

Care Advice

What You Should Know About Bronchiolitis:

Bronchiolitis is common during the first 2 years of life.

Most children just have coughing and fast breathing.

Some develop wheezing. This means the lower airway is getting tight.

If you were given a follow-up appointment, be sure to keep it.

Here is some care advice that should help.

Asthma Medicines:

Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines.

If one has been prescribed for your child, give it as instructed.

Keep giving the medicine until your child's wheezing is gone for 24 hours.

Coughing Fits or Spells:

Breathe warm mist (such as with shower running in a closed bathroom).

Give warm clear fluids to drink. Examples are apple juice and lemonade.

Amount. If 3 - 12 months of age, give 1 ounce (30 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.

Reason: Both relax the airway and loosen up any phlegm.

Homemade Cough Medicine:

Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips:

Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.

Age 1 year and older: Use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don't have any honey, you can use corn syrup.

Nasal Saline To Open a Blocked Nose:

Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus.

Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water.

Step 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop).

Step 2: Suction each nostril out while closing off the other nostril. Then, do the other side.

Step 3: Repeat nose drops and suctioning until the discharge is clear.

How often: Do nasal saline when your child can't breathe through the nose. Limit: No more than 4 times per day.

Saline nose drops or spray can be bought in any drugstore. No prescription is needed.

Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction.

Humidifier:

If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.

Smaller Feedings:

Use small, frequent feedings whenever your child has the energy to drink.

Reason: Children with wheezing don't have enough energy for long feedings.

Offer enough fluids to prevent dehydration.

Avoid Tobacco Smoke:

Tobacco smoke makes coughs and wheezing much worse.

Don't let anyone smoke around your child.

What to Expect:

Wheezing and rapid breathing most often improve over 2 or 3 days.

Mild wheezing sounds can last up to 1 week.

Coughing may last 3 weeks.

Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.

Return to Child Care:

Your child can return to child care after the wheezing and fever are gone.

Call Your Doctor If:

Trouble breathing occurs

Wheezing gets worse (becomes tight)

Trouble feeding occurs

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.

Definition

Pain or discomfort in the back, side or front of the neck

Minor muscle strain from overuse and neck injury are included

Pain in the front of the neck often is from a sore throat. It can also be from a swollen lymph node.

Causes of Neck Pain

Strained Neck Muscles. In teens, new neck pain is mostly from stretched neck muscles (muscle overuse). The most common modern cause is working with the head flexed down. Such head bending occurs with texting or looking at smartphones and mobile devices. Reading lying in bed or working on a computer for hours can trigger neck pain. The neck likes to keep the head in a neutral position. This is because the head is heavy (12 pounds or 5.4 kilograms). Other triggers are sleeping in an awkward position or fixing something on the ceiling.

Infected Lymph Node. At all ages, it can be from a swollen lymph node. That can irritate and cause spasm of the neck muscle it lies against.

Whiplash Injury. Caused by sudden movement of the head and neck. The head snaps back and forth. Neck muscles, nerves and ligaments are stretched. Can occur with a rear-end auto collision. Can also be from a sports injury. Needs to be examined.

Major Neck Injury (Serious). The neck protects the spinal cord. A fracture or other injury of the neck can damage the cord. Therefore, all neck injuries need to on a spine board until they are cleared.

Meningitis (Very Serious). A bacterial infection of the membrane that covers the spinal cord and brain. The main symptoms are a stiff neck, headache, confusion and fever. A stiff neck means your child can't touch the chin to the chest. Younger children are lethargic or so irritable that they can't be consoled. If not treated early, child can suffer brain damage.

Symptoms

Neck pains due to strained muscles cause these symptoms:

The head is often cocked to one side

Can't bend the head backward or put the chin to each shoulder. Often, can still bend the neck forward (touch the chin to the chest).

The neck muscles are often sore to the touch

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

Pain starts after a major injury such as with contact sports or car crash

Not moving or too weak to stand

You think your child has a life-threatening emergency

Go to ER Now

Stiff neck (can't touch chin to chest) with fever

Headache with fever

Numbness, tingling or pain in arms, upper back or legs

Muscles in the arms or legs are weak (loss of strength)

Call Doctor or Seek Care Now

Pain started after a minor injury

Can't move neck normally with fever

Severe pain

Not alert when awake ("out of it")

Acts or talks confused

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

Can't move neck normally

Headache without fever

Fever lasts more than 24 hours

Age less than 5 years old

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Cause of neck pain is not clear (no history of overuse)

Neck pain (from lots of turning) lasts more than 2 weeks

Neck pains are a frequent problem

You have other questions or concerns

Self Care at Home

Strained neck muscles (from turning or overuse) present less than 2 weeks

Care Advice

What You Should Know About Neck Pain:

Most new neck pain is from stretching and turning the neck muscles too much. Muscle overuse causes strained neck muscles.

Long periods of looking down is a common cause of neck pain. Seen mainly with texting or looking down at other mobile devices.

When muscle pain starts without reason, it can be from sleeping in an awkward position.

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:

During the first 2 days, use a cold pack or 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: Reduces pain and any spasm.

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.

Sleep Position:

Sleep on the back or side, not the stomach.

Sleeping with a neck collar helps some people.

Use a foam neck collar (from a drug store). If don't have one, wrap a small towel around the neck.

Reason: Keep the head from moving too much during sleep.

Activity:

Protect the neck. Avoid any activity that increases the pain.

Avoid any sports or work that increase the pain.

After 48 hours, start a gentle stretching program.

Stretching Exercises:

Do 3 minutes of gentle stretching exercises each day. Reason: improve the tone of the neck muscles.

Touch the chin to each shoulder. Touch the ear to each shoulder. Move the head forward and backward.

Don't apply any resistance during these stretching exercises.

What to Expect:

New neck pain without a reason most often goes away in a few days.

Neck pain from muscle overuse (strained neck muscles) goes away in 1 to 2 weeks.

Call Your Doctor If:

Neck pain becomes severe

Stiff neck occurs

Pain starts to shoot into the arms, upper back or legs

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.

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.

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.

Definition

A child more than 3 months old is crying and you don't know why

Your child is too young to tell you why

Age: Most of these children are younger than 2 years old

Crying is the only symptom

For crying with an illness or other symptom, go to that care guide

Causes of Unexplained Crying

New Illness. Coming down with an illness is the main physical cause. Young children cry about being sick, even if they don't have any pain.

Physical Pain. Painful causes include earache, sore throat, mouth ulcers, or a raw diaper rash. A sore on the penis or constipation may also cause pain or crying.

Behavioral Causes. Most crying means the child is upset about something. Crying can occur when a young child is separated from his parents. Other examples are crying with tantrums or when overtired. This guide detects many babies with sleep problems. Crying always occurs during re-training programs for bad sleep habits. Some preverbal children cry any time they want something.

Hunger. After the early months, most parents can recognize hunger and feed their child. If they don't, the child may cry.

Cold Medicines. Drugs like Sudafed can also cause crying. Note: FDA does not advise cough and cold medicines for children under 4 years.

Myths About Causes of Crying

Not Due to Teething. Teething may cause some babies to be fussy. But, in general, it does not cause crying.

Not Due to Gas. Gas passing through normal intestines does not cause pain or crying.

When To Call

Call 911 Now

Not moving or very weak

You think your child has a life-threatening emergency

Go to ER Now

Stiff neck (can't touch chin to the chest)

Bulging or swollen soft spot

Swollen scrotum or groin

Won't move an arm or leg normally

Cries when you touch or move your child

Screaming child and can't be consoled

Call Doctor or Seek Care Now

Could be an injury

Nonstop crying lasts more than 2 hours. (Your child can't be consoled using this Care Advice)

You are afraid someone might hurt or shake your child

Will not drink or drinks very little for more than 8 hours

Not alert when awake ("out of it")

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

You think pain (such as an earache) is causing the crying

New crying but your child can be consoled. Cause of crying is not clear.

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Mild, off-and-on fussiness without a cause lasts more than 2 days

Crying is a frequent problem

You have other questions or concerns

Self Care at Home

Mild fussiness without a cause is present less than 2 days

Normal protest crying

Temper tantrum crying

Sleep problem crying

Care Advice

Mild Fussiness of Unknown Cause

What You Should Know:

Your child is crying and fussing more than normal. But, if acting normal when not crying, the cause is probably not serious.

He could be coming down with an illness. Most often, that will become clear in a day or so.

He could be reacting to some changes in your home or child care setting. See if you can come up with some ideas.

At times, children can also go through a "clingy phase" without a reason.

If the crying stops with comforting, it's not serious.

Here is some care advice that should help.

Comfort Your Child:

Try to comfort your child by holding, rocking, or massage.

Talk in a quiet, calm voice.

Undress Your Child- Check the Skin:

Sometimes, part of the clothing is too tight. Loosen it.

Also, check the skin for redness or swelling (such as an insect bite).

Stop Any Over-the-Counter Medicines:

If your child is taking a cough or cold med, stop it.

The crying should stop within 4 hours.

Allergy meds like Benadryl can cause screaming in a small number of children. Also, may cause some children to be more fussy than normal.

Drugs that lessen congestion like Sudafed can cause crying.

The FDA does not approve any of these drugs for children under 4 years old.

Sleep - Take a Nap:

If your child is tired, put him to bed.

If he needs to be held, hold him quietly in your arms. Sometimes, lying next to him will comfort him.

Some overtired infants need to fuss themselves to sleep.

Warning: Never Shake a Baby

It can cause bleeding on the brain. Severe brain damage can happen in a few seconds.

Never leave your baby with someone who is immature or has a bad temper.

If you are frustrated, put your baby down in a safe place.

Call or ask a friend or relative for help.

Take a break until you calm down.

What To Expect:

Most fussiness with illnesses goes away when the illness does.

Fussiness may be due to family stress or change (such as new child care). Fussiness due to this cause lasts less than 1 week.

Call Your Doctor If:

Nonstop crying lasts more than 2 hours

Crying with an illness gets worse

Mild crying lasts more than 2 days

You think your child needs to be seen

Your child becomes worse

Normal Protest Crying

What You Should Know:

Normal children cry when they don't get their way.

Normal children cry when you make changes in their routines.

Crying is how young children communicate in the first years of life.

Crying can mean, "I don't want to."

This is called normal protest crying and is not harmful.

Do not assume that crying means pain.

Call Your Doctor If:

Crying becomes worse

Your child does not improve with this advice

You have other questions or concerns

Temper Tantrum Crying

What You Should Know:

Crying is the most common symptom of a temper tantrum.

Temper tantrums occur when your child is angry or trying to get his way.

This is likely the cause of the crying if it occurs at these times.

All kids have some temper tantrums, starting at about 9 months of age.

Tips for Dealing with Temper Tantrums:

Ignore most tantrums (such as wanting something the child doesn't need).

Don't give your child an audience. Leave the room.

For tantrums from frustration (such as when something doesn't work), help your child.

For tantrums that involve hitting or throwing objects, put in timeout. Leave your child there until he calms down.

Don't give in to tantrums. No means No.

Be a good role model. Do not yell or scream at others (adult tantrums).

Call Your Doctor If:

Crying becomes worse

Your child does not improve with this advice

You have other questions or concerns

Sleep Problem Crying

What You Should Know:

Sleep problems can cause crying. Suspect this if most of your child's crying occurs in his crib or bed. The crying mainly occurs when you put him down for naps and at night. Also, suspect a sleep problem if your child acts normal during the daytime.

Sleep problems are common in childhood.

Tips for Treating the Sleep Problem:

Re-train your child to be a good sleeper at bedtime and naptime.

Place your child in the crib "sleepy but awake."

Once placed in the crib, don't take your child out again.

If needed, visit your child every 10 minutes or so until asleep.

For waking at night, it's fine to hold your child until calm.

Do all of this in a loving way with a calm voice.

Never feed until asleep. Always stop before asleep.

Never sleep in the same bed with your child.

Call Your Doctor If:

Crying becomes worse

Your child does not improve with this advice

You have other questions or concerns

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

Pain or discomfort of the throat

Made worse when swallows

Rare symptom before 2 years old

Not caused by an injury to the throat

Causes of Sore Throat

Colds. Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours. Then a cough and runny nose occur.

Viral Pharyngitis. Some viruses cause a sore throat without other symptoms. A cough and runny nose don't become part of the illness. An antibiotic won't help.

Strep Pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of sore throats without any cold symptoms. Pus is seen on the tonsils. Peak age is 5 to 15 years. An antibiotic is helpful.

Mono. Infectious Mono mainly occurs in teens and young adults. The main symptoms are sore throat, fever and widespread swollen lymph nodes. Like Strep, Mono also has pus on the tonsils. Patients with Mono also may have a large spleen. It's located in the upper left side of the stomach. Mono is diagnosed with special blood tests.

Post-nasal Drip. Drainage from a sinus infection can cause a sore throat. The throat clearing that goes with the drainage may cause most of the irritation. The sinus infection is more likely to be viral than bacterial.

Mouth Breathing. Breathing with the mouth open during sleep can cause a sore throat. After eating breakfast, it often goes away.

Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It's also hard to fully open the mouth. The peak age is teens.

Epiglottitis (Very Serious). A bacterial infection of the flap of tissue above the vocal cords. It normally covers the windpipe during swallowing. The main symptoms are severe sore throat, drooling, spitting and fever. It can shut off the airway. Needs a 911 response.

Strep Throat: When to Suspect

Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.

Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause.

Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.

Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.

If you think your child has Strep, call your doctor.

Your doctor will do a Strep test. If the test is positive, they will start treatment. There is no risk from waiting until a Strep test can be done.

Standard treatment is with antibiotics by mouth.

Symptoms in Infants and Toddlers

Children less than 2 years of age usually don't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using Drinking Fluids - Decreased care guide.

When To Call

Call 911 Now

Severe trouble breathing (struggling for each breath, can barely speak or cry)

You think your child has a life-threatening emergency

Go to ER Now

Can't swallow any fluids and new onset drooling

Call Doctor or Seek Care Now

Trouble breathing, but not severe

Great trouble swallowing fluids or spit

Can't open mouth all the way

Stiff neck or can't move neck like normal

Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.

Purple or blood-colored spots or dots on skin

Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.

Fever over 104° F (40° C)

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent. Note: a Strep test alone is not urgent.

Call Doctor Within 24 Hours

Sore throat pain is severe and not better 2 hours after taking ibuprofen

Large lymph nodes in the neck

Pink rash that's widespread

Earache or ear drainage

Sinus pain (not just congestion) around cheekbone or eyes

Fever lasts more than 3 days

Fever returns after being gone more than 24 hours

Age less than 2 years old

Close contact to a person with Strep within last 7 days

Sores on the skin

You think your child needs to be seen, but the problem is not urgent (or needs a Strep test)

Call Doctor During Office Hours

Sore throat is the main symptom and lasts more than 48 hours

Sore throat with cold/cough symptoms lasts more than 5 days

You have other questions or concerns

Self Care at Home

Viral throat infection suspected

Care Advice

What You Should Know About Sore Throats:

Most sore throats are just part of a cold and caused by a virus.

A cough, hoarse voice or nasal discharge points to a cold as the cause.

Most children with a sore throat don't need to see their doctor.

Here is some care advice that should help.

Sore Throat Pain Relief:

Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.

Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.

Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.

Medicated throat sprays or lozenges are generally not helpful.

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.

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.

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. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solid foods.

Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.

Return to School:

Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.

Most often, having just a sore throat is not a reason to miss school.

Children with Strep throat need to be taking an antibiotic for 24 hours.

What to Expect:

Most often, sore throats with a viral illness last 4 or 5 days.

Call Your Doctor If:

Sore throat is the main symptom and lasts more than 48 hours

Sore throat with a cold lasts more than 5 days

Fever lasts more than 3 days or goes above 104° F (40° C)

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.

Enter your answer here

Definition

Bites from bed bugs

Symptoms of Bed Bug Bites

Usually cause itchy, red bumps in a group or line

Often they look like a hive or mosquito bite

Bite may have a red dot (puncture) in the center. This is where the bed bug bit through the skin.

Occasionally, a small blister can occur in the center

Bites are usually on exposed skin (arms, legs and face)

Bites are usually first noted in the morning

Diagnosis of Bed Bug Bites

Live bed bugs hide and are not usually seen. Close inspection of the mattress may find some.

They are ¼ inch (6 mm), flat, oval shaped, reddish-brown bugs.

Suspect bed bugs if over 3 red bumps in a row are on exposed skin. The bumps or bites are very itchy.

Bed bug waste is found on bedding or mattress seams. It looks like dark brown flecks or coffee grounds.

A blood stain on the sheet may sometimes be found. This is from a bug smashed after feeding.

Cause of Bed Bug Bite Reactions

The skin bumps are the body's reaction to the bug's saliva.

While the bug is sucking blood, some of its secretions get mixed in.

Bed bugs are small visible blood-sucking bugs. They are about ¼ inch (6 mm) in length.

During the day, bed bugs hide in the corners of mattresses. They may also be found in bed crevices, floors, and walls.

At night, the bed bugs come out of hiding. They feed on humans for about 5 minutes.

Prevention of Getting Bed Bugs

Over half of bed bug infestations within homes start after recent travel.

Avoid hotels and hostels where bed bugs have been reported.

When you check into a hotel room, look for signs of bed bugs. Look for flecks of their waste (like coffee grounds) in the bedding and mattress. If present, ask for another room.

Keep your luggage and clothing on a luggage rack off the floor.

When you return from a trip, place all travel clothing into the clothes dryer. Run the dryer for 20 minutes. (Reason: The heat will kill any bed bugs or their eggs that are present). One pregnant bed bug can spread bed bugs to an entire house.

Frequent Questions (FAQs)

Can bed bugs transmit HIV or hepatitis? This is highly unlikely. It has never been reported.

Do bed bugs like dirt? Not really. What bed bugs like is the warmth of the human body. Dirty and cluttered spaces just give bed bugs a place to hide.

Are bed bugs too small to be seen? No. You can see adult bed bugs. They are about the size of an apple seed (4-7 mm; ¼ inch).

Are bed bugs scared of the light? They do prefer darkness. But keeping the light on will not stop bed bugs from biting you.

When To Call

Call 911 Now

Life-threatening allergic reaction suspected. Symptoms include sudden onset of trouble breathing or swallowing.

You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Spreading red area or streak with fever

Spreading red area or streak that's very large

Your child looks or acts very sick

Call Doctor Within 24 Hours

Painful spreading redness started more than 24 hours after the bite. Note: any redness starting in the first 24 hours is a reaction to the bite.

More than 48 hours since the bite and redness gets larger

You think your child needs to be seen

Call Doctor During Office Hours

Severe itching not better after 24 hours of using steroid cream

Scab that looks infected (drains pus or gets bigger) not better with antibiotic ointment

After 7 days, bites not better

After 14 days, bites not gone

You have other questions or concerns

Self Care at Home

Normal bed bug bite

Care Advice

What You Should Know About Bed Bug Bites:

Bed bug bites cause itchy red bumps.

They are usually less than ½ inch (12 mm) in size.

Some are larger (like a hive). These are normal reactions to a bed bug.

A large hive does not mean your child has an allergy.

The redness does not mean the bite is infected.

Bed bugs do not carry any infectious diseases.

Don't panic: You can get rid of bed bugs from your home.

Here is some care advice that should help.

Steroid Cream for Itching:

To reduce the itching, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.

Apply 3 times a day until the itch is gone.

If you don't have, apply a baking soda paste until you can get some.

Allergy Medicine For Itching:

If the bite is still itchy, try an allergy medicine by mouth.

Benadryl is a good one. No prescription is needed.

Try Not to Scratch:

Cut the fingernails short.

Help your child not to scratch.

Reason: Prevent a skin infection at the bite site.

Bed Bug Repellents - Not Helpful:

Insect repellents do not keep bed bugs from biting.

Repellents containing DEET (used on skin) and permethrin (used on clothing) do not help.

Removing Bed Bugs from Your Home:

Getting rid of bed bugs requires a licensed pest control service.

Look in the phone book or on the internet under Pest Control.

What to Expect:

Any pinkness or redness usually lasts 3 days.

The swelling may last 7 days.

The itch may last for 2 weeks.

Call Your Doctor If:

Bite looks infected (redness gets larger after 48 hours)

Large red bumps last 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.

Definition

Pain or discomfort in the chest (front or back)

The chest includes from the top to the bottom of the rib cage

Causes of Chest Pain

Muscle Overuse. Chest pain can follow hard sports (such as throwing a baseball). Lifting (such as weights) or upper body work (such as digging) can also cause it. This type of muscle soreness often increases with movement of the shoulders.

Muscle Cramps. Most brief chest pain lasting seconds to minutes is from muscle cramps. The ribs are separated by muscles. These fleeting pains can also be caused by a pinched nerve. These chest wall pains are harmless. Brief muscle cramps are also the most common cause of recurrent chest pains. The medical name is precordial catch syndrome.

Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.

Asthma. Children with asthma often have a tight chest. They may refer to this as chest pain. They also get chest pain when they have lots of coughing.

Heartburn. Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone).

Caffeine. A rapid and pounding heart beat may be reported as chest pain. Too much caffeine as found in energy drinks is a common cause. Drugs prescribed for ADHD also can cause a fast heartbeat. Illegal drugs, such as cocaine, can cause a high heart rate as well.

Chest Wall Injury. Blunt trauma usually just causes a bruised rib. Sometimes, it causes a rib fracture.

Heart Disease (Serious). Heart disease is hardly ever the cause of chest pain in children. Chest pain that only occurs with exercise could have a cardiac cause.

Pleurisy (Serious). Pleurisy is another problem of pneumonia. If the infection involves the lung's surface, that area of the chest will hurt.

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

Severe trouble breathing (struggling for each breath, can barely speak or cry)

Passed out (fainted)

Bluish lips or face

Not moving or too weak to stand

You think your child has a life-threatening emergency

Go to ER Now

Severe constant pain (child not able to move or do anything)

Call Doctor or Seek Care Now

Your child has heart disease

Trouble breathing, but not severe

Taking a deep breath makes the pain worse

Heart is beating very rapidly

After a direct blow to the chest

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

Cause of chest pain is not clear. Exception: pain due to coughing, sore muscles, heartburn or other clear cause.

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Chest pains only occur with hard exercise (such as running)

Sore muscles last more than 7 days

Heartburn lasts more than 2 days on treatment

Chest pains are a frequent problem

You have other questions or concerns

Self Care at Home

Normal chest pain from sore muscles

Normal chest pain from heartburn

Care Advice

Sore Muscle Pain Treatment

What You Should Know About Mild Chest Pain:

Chest pains in children lasting for a few minutes are usually harmless. The pain can be caused by muscle cramps. They need no treatment.

Chest pains that last longer can be from hard work or sports. The shoulders are usually involved. Sore muscles can start soon after the event.

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.

Continue this until 24 hours have passed without pain.

Cold Pack for Pain:

For the first 2 days, use a cold pack to help with the pain.

You can also use ice wrapped in a wet cloth.

Put it on the sore muscles for 20 minutes, 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.

A hot shower may also help.

Stretching the Muscles:

Gentle stretching of the shoulders and chest wall may help.

Do sets of 10 twice daily.

This may prevent muscle cramps from coming back.

Stretching can be continued even during the chest pain. Do not do any exercises that increase the pain.

What to Expect:

For sore muscles, the pain most often peaks on day 2.

It can last up to 6 or 7 days.

Call Your Doctor If:

Pain becomes severe

Pain lasts over 7 days on treatment

You think your child needs to be seen

Your child becomes worse

Heartburn (Reflux) Pain Treatment

What You Should Know About Heartburn:

Heartburn is common.

It's due to stomach acid going up into the esophagus. The esophagus is the tube from the mouth to the stomach.

Heartburn causes a burning pain behind the lower part of the breastbone. It also causes a sour (acid) taste in the mouth and belching.

Here is some care advice that should help.

Antacids:

Heartburn is usually easily treated. Give a liquid antacid by mouth (such as Mylanta or the store brand). No prescription is needed.

Dose: Give 1 to 2 tablespoons (15 - 30 mL).

If you don't have an antacid, use 2 to 3 ounces (60 - 90 mL) of milk.

For heartburn that keeps coming back, give an antacid 1 hour before meals. Also, give a dose at bedtime. Do this for a few days.

Heartburn Prevention:

Do not eat too much at meals. This overfills the stomach.

Do not eat foods that make heartburn worse. Examples are chocolate, fatty foods, spicy foods, carbonated soda, and caffeine.

Do not bend over during the 3 hours after meals.

Do not wear tight clothing or belts around the waist.

What to Expect:

Most often, heartburn goes away with treatment.

But, heartburn also tends to come back. So, preventive measures are important.

Call Your Doctor If:

Heartburn doesn't go away after 2 days of 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.

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.

Causes of Dizziness

Main Cause. Usually due to reduced blood flow to the brain for a short time. It can be triggered by many normal events:

Standing too long in one place. Reason: This causes pooling of blood in the legs.

Standing up suddenly. Reason: This causes sudden drop in blood pressure.

Dehydration. This can be from losing fluids and/or from not drinking enough fluid.

Low Oxygen (such as when running and out of breath). Reason: Lower than normal oxygen levels can't meet body's needs for a short time.

Too Much Sun or Hot Tub Use. Reason: Increased sweating causes fluid loss.

Sweating from Sports or Hard Work. Reason: Sweating causes fluid loss.

Fasting. Skipping a meal causes low blood sugar.

Fever

Motion Sickness. Main symptoms are dizziness and nausea.

Viral Syndrome. Patients with viral illnesses (e.g., colds, flu) often say they are a bit dizzy. This is never the only symptom. It may relate to weakness from being sick.

Vertigo (Serious). In addition to dizziness, the child complains that the room is spinning. They can't walk if they have vertigo. True vertigo is very rare in children. It's usually caused by middle ear disease.

Symptoms of Dizziness

Feeling dizzy or light headed

Feeling unsteady with slight loss of balance

Feeling "woozy" or not thinking clearly

May also have brief blurring of vision

Dizziness Scale

Mild: walks normal

Moderate: interferes with normal activities such as playing, school or sports

Severe: can't stand, needs support to walk, feels like passing out now

When To Call

Call 911 Now

You think your child has a life-threatening emergency

Go to ER Now

Severe dizziness (unable to walk, requires support to walk)

Follows bleeding. Exception: small amount and dizzy from sight of blood.

Passed out (fainted) and not caused by prolonged standing

Acts or talks confused

Poisoning suspected (usually 8 months to 4 years old)

Drug abuse suspected (especially if psych. problems and more than 8 years of age)

Severe headache

Child complains of heart pounding differently

Too weak to stand and not caused by prolonged standing

Call Doctor or Seek Care Now

Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.

Dizziness caused by heat exposure, prolonged standing, or poor fluid intake. It's not gone after 2 hours of rest and fluids.

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

Passed out (fainted) and caused by sudden or prolonged standing

Moderate dizziness (interferes with normal activities) present now. Exception: dizziness caused by heat exposure, prolonged standing, or poor fluid intake.

Fever lasts more than 3 days

Ear pain or congestion

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Mild dizziness (normal walking) lasts more than 3 days

Dizziness is a frequent problem

You have other questions or concerns

Self Care at Home

Sudden or prolonged standing caused the dizziness

Poor fluid intake caused the dizziness

Mild dizziness from unknown cause present less than 3 days

Care Advice

Dizziness from Sudden or Prolonged Standing

What You Should Know:

Standing up quickly is the most common cause of dizziness. This type of dizziness only lasts a short time. Getting out of bed is when it usually happens.

Prolonged standing in one place is another common cause.

Not drinking enough fluids or eating enough salt always makes it worse.

Here is some care advice that should help.

Standing - Pump Legs:

In the mornings, sit up for a few minutes before you stand up.

This will help your blood flow stay steady and adjust before you stand up.

With prolonged standing, contract and relax your leg muscles. Reason: This helps pump the blood back to the heart.

Sit down or lie down if you feel dizzy.

Salt - Increase Intake:

Most people with this type of dizziness (due to standing) don't get enough salt.

Try to eat some salty foods (potato chips or pretzels) every day.

Fluids - Drink More:

Drink several glasses of fruit juice, other clear fluids or water.

This will improve your child's fluid status and blood sugar.

If the weather is hot, make sure the fluids are cold.

Lie Down:

Lie down with feet up for 1 hour.

Reason: This will increase blood flow to the brain.

Prevention:

Extra water and salty foods during sports or hot weather

Regular mealtimes and snacks

Enough sleep and rest

What to Expect:

With treatment, the dizziness usually goes away in 1 to 2 hours.

Call Your Doctor If:

After 2 hours of rest and fluids, still feels dizzy

Your child passes out (faints)

You think your child needs to be seen

Your child becomes worse

Dizziness from Poor Fluid Intake

What You Should Know:

Not drinking enough fluids and being a little dehydrated probably caused the dizziness.

It should go away with drinking fluids and resting in a cool place.

This is always made worse during hot weather. Too much sun exposure can also increase the body's need for fluid.

Here is some care advice that should help.

Fluids - Drink More:

Drink several glasses of fruit juice, other clear fluids or water.

This will improve your child's fluid status and blood sugar.

If the weather is hot, make sure the fluids are cold.

Cool Off:

If the weather is hot, use a cold pack or washcloth to the forehead.

Taking a cool shower or bath will help even more.

Lie Down:

Lie down with feet up for 1 hour.

Reason: This will increase blood flow to the brain.

Prevention:

Extra water and salty foods during sports or hot weather

Regular mealtimes and snacks

Enough sleep and rest

What to Expect:

With treatment, the dizziness usually goes away in 1 to 2 hours.

Call Your Doctor If:

After 2 hours of rest and fluids, still feels dizzy

Your child passes out (faints)

You think your child needs to be seen

Your child becomes worse

Dizziness from Unknown Cause

What You Should Know:

Dizziness that goes away is a harmless symptom.

It's usually due to not drinking enough water during sports or hot weather.

It can also be caused by skipping a meal or too much sun.

Sometimes, it's part of a viral illness.

Here is some care advice that should help.

Lie Down:

Lie down with feet up for 1 hour.

Reason: This will increase blood flow to the brain.

Fluids - Drink More:

Drink several glasses of fruit juice, other clear fluids or water.

This will improve your child's fluid status and blood sugar.

If the weather is hot, make sure the fluids are cold.

Cool Off:

If the weather is hot, use a cold pack or washcloth to the forehead.

Taking a cool shower or bath will help even more.

Prevention:

Extra water and salty foods during sports or hot weather

Regular mealtimes and snacks

Enough sleep and rest

What to Expect:

With treatment, the dizziness usually goes away in 1 to 2 hours.

Mild dizziness with a viral illness may last 1 or 2 days.

Call Your Doctor If:

After 2 hours of rest and fluids, still feeling dizzy

Mild dizziness lasts over 3 days

Your child passes out (faints)

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.

Definition

Earwax (cerumen) buildup or blockage

Questions about earwax removal

Symptoms of Earwax Buildup

Too much earwax can cause rubbing of the ear or poking in the canal.

A piece of ear wax can become dry and hard in the ear canal. This creates a feeling that an object is in the ear.

Complete blockage (plugging) of the ear canal by wax causes more symptoms. These include decreased or muffled hearing.

A large piece of earwax may be seen inside the ear canal.

Causes of Earwax Buildup

Cotton Swabs. Earwax buildup is usually from using cotton swabs. They push the wax back in and pack it down.

Fingers. A few children (perhaps 5%) normally produce more wax than others. It usually will come out if it's not pushed back by fingers.

Ear Plugs. Wearing ear plugs of any type can also push wax back.

Earwax is Normal

Everyone has earwax. Earwax is normal and healthy. Earwax is not dirty or a sign of poor hygiene.

Earwax is also called cerumen.

Earwax is made by special glands in the outer third of the ear canal.

Earwax has a purpose. It protects the skin lining the ear canal. It is a natural water-proofing agent.

Earwax also has germ-killing properties.

New earwax is soft and a golden-yellow color.

Older earwax becomes dryer and turns to a brown or black color.

Ear Canals are Self-Cleaning

Ear canals are designed to clean themselves.

The ear canal skin slowly moves out of the ear canal. It carries the earwax along with it. The wax dries up and becomes flaky. It falls out of the ear on its own.

There are some people who produce much more earwax than others. For such people periodic ear cleaning may be needed.

Earwax only needs to be removed from inside the ear if it causes symptoms. Examples of symptoms are decreased hearing, discomfort, fullness or blockage.

Problems From Using Cotton-Tipped Swabs

The cotton-tipped swab pushes the wax back in. The earwax builds up and causes symptoms.

Decreased or muffled hearing.

Blocked or full ear canal sensation.

Trapped water behind the wax (can lead to Swimmer's Ear).

Itchy or painful canals, especially in teens who often use Q-tips. A dry ear canal is always itchy.

Sometimes, bleeding or damage to the eardrum.

Prevention of Blocked Ear Canals

Never put cotton swabs (cotton buds or Q-tips) into the ear canal.

Cotton swabs just push the earwax deeper into the ear canal. Reason: Cotton swabs are usually wider than a child's ear canal.

Earwax doesn't need any help getting out. You can't hurry the process.

Never try to dig out pieces of earwax with toothpicks, match sticks or other devices. Usually, doing this just pushes the wax back in.

These objects can also scratch the ear canal and cause an infection.

If all of the ear wax is removed (as with cotton swabs), the ear canals become itchy. They also become more prone to swimmer's ear. This can occur in teens when cotton swabs are smaller than the ear canal.

Limit the use of ear plugs.

When To Call

Call Doctor or Seek Care Now

Ear pain or bleeding after object (such as cotton swab) was inserted into ear canal

Ear pain after ear canal flushing to remove wax and it's severe

Walking is very unsteady

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

Ear pain after ear canal flushing and it lasts more than 1 hour

Pus (yellow or green discharge) from the ear canal

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

History of ear drum perforation, tubes or ear surgery. Reason: don't remove wax at home.

Complete hearing loss in either ear

Age less than 6 years with earwax problems

Earwax problems not better after using Care Advice

You don't want to try to remove earwax at home

You have other questions or concerns

Self Care at Home

Questions about earwax removal

Care Advice

What You Should Know About Earwax Buildup:

Earwax is good.

In general, leave earwax alone.

It will come out and fall away on its own.

If you see some wax right at the opening, you can flick it away. Use something that won't push it back in, such as a paper clip.

Reasons to Flush out the Ear Canal:

Earwax is completely blocking an ear canal and can't hear on that side.

If the hearing seems normal on that side, the blockage is only partial. You can leave it alone.

Age 6 Years and Older - Ear Canal Flushing with Water:

Under age 6, use only if advised by your child's doctor.

Buy a soft rubber ear syringe or bulb from the pharmacy. No prescription is needed.

Have your child lean over the sink. Reason: To catch the water.