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

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

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.

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

Fainting is sudden brief loss of consciousness with falling down

A return to being awake and alert happens within 1 minute

Also called passing out or blacking out

Fainting Basics

Fainting is a brief loss of consciousness. Normal awareness returns in less than 1 minute if the person is allowed to lie down.

If standing, the person falls to the ground.

If sitting, the person slumps over.

The medical name for fainting is syncope.

Fainting happens in 15% of healthy teens. Simple fainting doesn't occur before age 6. It is not common before age 10.

Causes: In teens, 98% is simple fainting. Less than 1% have heart problems. In older adults, serious causes are much more common.

Cause of Simple Fainting: Decreased blood flow to the brain.

Risk Factors: mild dehydration, fasting, hot weather, lack of sleep, recent illness, change in altitude.

Most fainting is harmless. There is a risk of a head or face injury from sudden falling.

Simple Fainting (Benign Fainting): Types

Standing too long in one place before fainting is the most common type. The medical name is orthostatic or postural syncope. Happens at church, graduations, weddings or at events when standing a long time. More common if one keeps the knees "locked." This pools the blood in the leg veins. A person who stands long enough in one place will faint.

Standing up quickly (often after lying down) before fainting is a less common cause. Often this just causes a person to feel dizzy for a short time. More common in the morning after not eating or drinking during the night.

Sudden stressful feelings before fainting. This is called vasovagal syncope. Seeing a badly injured person or pet can trigger fainting. Other examples are seeing someone vomit, bleed or pass a stool. Also, stressful events such as speaking or performing in public can cause fainting.

Sudden physical pain before fainting such as getting a shot or a blood test. Having slivers or stiches taken out can also trigger fainting. The stress of the event may cause the fainting rather than the pain itself.

Warning Signs For Simple Fainting

Dizziness (light-headed), blurred vision, nausea, sweating, feeling cold.

These last for 5 to 10 seconds before passing out.

The person may look pale just before passing out.

Serious Causes of Fainting

Cardiac syncope. Any fainting that happens during exercise needs a heart work-up. This cause is rare in children.

Blood loss - large amount or bleeding inside the body

Concussion or head injury

Sudden drop in blood sugar. Mainly happens in people with diabetes.

Poisoning

Drug or alcohol abuse

Seizure

When To Call

Call 911 Now

Still passed out or hard to wake up after 2 minutes

Caused by choking on something

Fainted suddenly after medicine, allergic food or bee sting

Trouble breathing and not a breath-holding spell

Bleeding large amount

You think your child has a life-threatening emergency

Go to ER Now

Talking or acting confused for more than 5 minutes

Feels too dizzy to stand after drinking fluids

Fainted during exercise

Heart is beating too fast

Chest pain

Muscle jerking or shaking during fainting

Call Doctor or Seek Care Now

Followed a head injury

Followed a belly injury

First fainting spell

Passed out for more than 1 minute after laying down

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

Fainted 2 times in one day

Age less than 10 years

Cause of fainting is unknown (Not if cause is long standing, sudden standing, pain or stressful event)

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

Call Doctor During Office Hours

Simple fainting from long standing, sudden standing or pain is a frequent problem

You have other questions or concerns

Self Care at Home

Simple fainting and now alert and feels fine

Prevent simple fainting

Care Advice

Fainting Treatment

What You Should Know About Simple Fainting:

Fainting is common and happens in 15% of teens.

Standing too long in one place is the most common cause of fainting. It's caused by blood pooling in the legs.

Standing up quickly after lying down can cause anyone to feel dizzy. If your child doesn't sit down when this happens, he may faint.

These are normal types of fainting.

Simple fainting doesn't cause any long-term problems.

Here is some care advice that should help.

Lie Down:

Lie down flat with the feet up for 10 minutes.

Reason: This will increase blood flow to the brain. Simple fainting is due to a sudden drop in blood flow to the brain.

Caution: Getting up too soon can cause your child to faint again.

Drink Some Water:

Give your child a large glass of water. Reason: to increase blood volume.

Do this before he stands up again.

Offer fruit juice if your child hasn't eaten breakfast yet. Reason: also raises blood sugar.

In hot weather, drink extra water to stay hydrated.

Ease Stress:

If fainting was due to stress or fear, help your child talk about what happened.

Talk about what scared them.

Try to calm your child with a soothing voice.

Comfort them. Tell them they are safe and you will protect them.

What to Expect:

Most children with a simple faint are alert within 2 minutes.

They feel normal after lying down for 10 minutes.

They are able to stand without feeling dizzy.

Call Your Doctor If:

Still feeling faint or dizzy after 15 minutes

Passes out again on the same day

You think your child needs to be seen

Your child becomes worse

Prevent Simple Fainting

When Dizzy, Lie Down or Sit Down:

Most fainting can be prevented.

Learn the early warning signs for fainting. They are feeling dizzy, blurry vision, and nausea.

If you feel these warning signs, lie down right away.

If you can only sit, put your head down by your knees.

You only have 5 - 10 seconds to prevent fainting and falling down.

Move Your Leg Muscles:

If long standing in one place is needed, tighten and relax your leg muscles. Do this a few times each minute. This will pump the blood back to your heart. Caution: never stand with your knees locked.

For long sitting in one place, move your feet and legs every few minutes.

When getting out of bed, sit on the edge for a few minutes before standing. If you feel dizzy, lie down again.

If getting out of a hot tub or bath, go very slowly.

Extra Water and Salty Foods:

If you tend to faint, extra water and salt are key.

Drink extra fluids every day. Your goal is 8 cups (2 liters) per day. You may need more during sports or hot weather.

Add some salty foods to your diet. Too little salt in your diet also isn't healthy. It can cause low blood pressure.

Call Your Doctor If:

Fainting is a frequent problem

You have other questions or concerns

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

Definition

An abnormal high body temperature

Fever is the only symptom. Your child has a true fever if:

Rectal (Bottom), Ear or Forehead temperature: 100.4° F (38.0° C) or higher

Oral (Mouth) temperature: 100° F (37.8° C) or higher

Under the arm (Armpit) temperature: 99° F (37.2° C) or higher

Caution: Ear temperatures are not accurate before 6 months of age

Caution: Forehead temperatures must be digital. Forehead strips are not accurate.

Causes of Fever

Overview. Almost all fevers are caused by a new infection. Viruses cause 10 times more infections than bacteria. The number of germs that cause an infection are in the hundreds. Only a few common ones will be listed.

Viral Infections. Colds, flu and other viral infections are the most common cause. Fever may be the only symptom for the first 24 hours. The start of viral symptoms (runny nose, cough, loose stools) is often delayed. Roseola is the most extreme example. Fever may be the only symptom for 2 or 3 days. Then a rash appears.

Bacterial Infections. A bladder infection is the most common cause of silent fever in girls. Strep throat is also a common cause of unexplained fever.

Sinus Infection. This is a problem caused by a cold. The main symptom is the return of fever after it has been gone for a few days. The sinus congestion also changes to sinus pain. Color of nasal discharge is not very helpful for making this diagnosis.

Vaccine Fever. Fever with most vaccines begins within 12 hours. It lasts 2 to 3 days. This is normal and harmless. It means the vaccine is working.

Newborn Fever (Serious). Fever that occurs during the first 3 months of life can be serious. All of these babies need to be seen as soon as possible. The fever may be due to sepsis (a bloodstream infection). Bacterial infections in this age group can get worse quickly. They need rapid treatment.

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

Overheated. The fever is usually low grade. Can occur during heat waves or from being overdressed. The temp becomes normal in a few hours after moving to a cooler place. Can also occur during hard exercise. Fever goes away quickly with rest and drinking extra fluids.

Not Due to Teething. Research shows that "getting teeth" does not cause fevers.

Fever and Crying

Fever on its own shouldn't cause much crying.

Frequent crying in a child with fever is caused by pain until proven otherwise.

Hidden causes can be ear infections, kidney infections, sore throats and meningitis.

Roseola: Classic Cause of Unexplained Fever in Young Children

Most children get Roseola between 6 months and 3 years of age.

Cause: human herpes virus 6

Rash: pink, small, flat spots on the chest and stomach. Rash is the same on both sides of the body.

Then spreads to the face.

Classic feature: 2 or 3 days of high fever without a rash or other symptoms.

The rash starts 12 to 24 hours after the fever goes away.

The rash lasts 1 to 3 days.

By the time the rash appears, the child feels fine.

Normal Temperature Range

Rectal. A reading of 98.6° F (37° C) is just the average rectal temp. A normal low can be 96.8° F (36° C) in the morning. It can change to a high of 100.3° F (37.9° C) late in the day. This is a normal range.

By mouth. A reading of 97.6° F (36.5° C) is just the average mouth temp. A normal low can be 95.8° F (35.5° C) in the morning. It can change to a high of 99.9° F (37.7° C) late in the day. This is a normal range.

When To Call

Call 911 Now

Not moving or too weak to stand

Can't wake up

Trouble breathing with bluish lips or face

Purple or blood-colored spots or dots on skin

You think your child has a life-threatening emergency

Go to ER Now

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

Age less than 1 year and soft spot bulging or swollen

Hard to wake up

Had a seizure with the fever

Call Doctor or Seek Care Now

Trouble breathing

Great trouble swallowing fluids or spit

Not alert when awake ("out of it")

Acts or talks confused

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

Fever over 104° F (40° C)

Shaking chills (shivering) lasting more than 30 minutes

Nonstop crying or cries when touched or moved

Won't move an arm or leg normally

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

Pain or burning when passing urine

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

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 3-6 months old with fever

Age 6-24 months old with fever that lasts more than 24 hours. There are no other symptoms (such as cough or diarrhea).

Fever lasts more than 3 days

Fever returns after being gone more than 24 hours

Recent travel outside the country to high risk area

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

Fever with no other symptoms and your child acts mildly ill

Care Advice

What You Should Know About Fever:

Having a fever means your child has a new infection.

It's most likely caused by a virus.

You may not know the cause of the fever until other symptoms develop. This may take 24 hours.

Most fevers are good for sick children. They help the body fight infection.

Use the ranges below to help put your child's level of fever into perspective:

100° - 102° F (37.8° - 39° C) Low grade fever: helpful, good range. Don't treat.

102° - 104° F (39 - 40° C) Average fever: helpful. Treat if causes discomfort.

Over 104° F (40° C) High fever: causes discomfort, but harmless. Always treat.

Over 106° F (41.1° C) Very high fever: important to bring it down. Rare to go this high.

Over 108° F (42.3° C) Dangerous fever: fever itself can be harmful.

Treatment for All Fevers - Extra Fluids

Fluids alone can lower the fever. Reason: being well-hydrated helps the body give off heat through the skin.

Offer your child extra water or other fluids by mouth. Cold fluids are better. Until 6 months old, only give extra formula or breastmilk.

For all children, dress in 1 layer of light weight clothing, unless shivering. Reason: also helps heat loss from the skin.

Caution: if a baby under 1 year has a fever, never overdress or bundle up. Reason: babies can get over-heated more easily than older children.

For fevers 100°-102° F (37.8° - 39°C), fever meds are rarely needed. Fevers of this level don't cause discomfort. They do help the body fight the infection.

Exception: if you feel your child also has pain, treat it.

Fever Medicine:

Fevers only need to be treated with medicine if they cause discomfort. Most often, that means fevers above 102° F (39° C). Also use for shivering (shaking chills). Shivering means the fever is going up.

For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).

Another choice is an ibuprofen product (such as Advil).

Goal of treatment: Bring the temperature down to a comfortable level. Most often, the fever meds lower the fever by 2° to 3° F (1 - 1.5° C). They do not bring it down to normal. It takes 1 or 2 hours to see the effect.

Do not use aspirin. Reason: Risk of Reye syndrome, a rare but serious brain disease.

Do not use both acetaminophen and ibuprofen together. Reason: Not needed and a risk of giving too much.

Sponging With Lukewarm Water:

Note: Sponging is an option for high fevers, but not required. It is rarely needed.

When to Use: Fever above 104° F (40° C) AND doesn't come down with fever meds. Always give the fever medicine at least an hour to work before sponging.

How to Sponge: Use lukewarm water (85 - 90° F) (29.4 - 32.2° C). Sponge for 20-30 minutes.

If your child shivers or becomes cold, stop sponging. Other option: You can also make the water warmer.

Caution: Do not use rubbing alcohol. Reason: Can cause a coma.

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.

What to Expect:

Most fevers with viral illnesses range between 101° and 104° F (38.4° and 40° C).

They may last for 2 or 3 days.

They are not harmful.

Call Your Doctor If:

Your child looks or acts very sick

Any serious symptoms occur such as trouble breathing

Fever goes above 104° F (40° C)

Any fever occurs if less than 12 weeks old

Fever without other symptoms lasts more than 24 hours (if age less than 2 years)

Fever lasts more than 3 days (72 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

Hair loss in patches or throughout the scalp

The missing hairs can be broken off or just fall out

The medical term for hair loss is alopecia

Causes

Common causes of hair loss are listed below. Most don't usually require medical treatment.

Ringworm of the Scalp. This is the main cause of patchy hair loss that needs medical treatment. Your child's doctor will prescribe a medicine to treat ringworm of the scalp. It's taken by mouth.

Newborn Hair Loss. The hair of many newborns falls out during the first few months of life. This baby hair is replaced by permanent hair.

Rubbing or Friction. Babies can rub off a patch of hair on the back of the head. This most commonly occurs in infant 3 to 6 months old. It is a result of friction during head-turning against a firm surface. Examples are crib mattresses, playpens, and infant seats. The hair grows back once the baby starts sitting up. Also called friction alopecia or pressure alopecia. Repeated or severe friction can cause hair loss at any age.

Tight Hair Styles. If hair is pulled too tight, it will eventually break. Mostly seen with tight braids, pony tails or dreadlocks (especially corn row styles). Hair can also be lost because of vigorous hair-brushing or back combing. Hot hairstyling tools can also cause hair damage. Also known as traction alopecia, mechanical alopecia, or "hair abuse."

Twisting or Pulling Out the Hair. This is a nervous habit called trichotillomania. Frequent twisting of the hair results in broken hairs of different lengths. The missing hair occurs in patches of different shapes. This creates bald spots. Rarely, it can include plucking of the eyebrows or eyelashes. Can occur with nail biting, lip biting or sucking, and sore picking habits. In older children, may be associated with OCD.

Stress. Hair follicles are very sensitive to physical or emotional stress. The hair begins to fall out about 3-4 months after a severe stress. Reason: Hair follicles are very sensitive to physical or emotional stress. Examples are a high fever, severe illness or surgery. Also, an emotional crisis or a crash diet can be triggers. In pregnant teens, the stress can be childbirth. After hair stops shedding, the hair will slowly grow back. This can take 6 to 8 months for all the hair to grow back. The whole cycle takes about 12 months. This type of hair loss is called telogen effluvium.

When To Call

Call Doctor or Seek Care Now

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

Scalp is red and very swollen in area of hair loss

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

Call Doctor During Office Hours

Scabs or crusts are present in the hair

Ringworm of the scalp suspected. (Round patch of hair loss with scales, rough surface, redness or itching)

Broken hairs from tight hair style and pimples are present in scalp

Patch of hair loss and cause not known

Widespread hair thinning and cause not known

Hair loss from nervous habit of twisting the hair (needs counseling)

Hair loss is a chronic problem

Normal hair loss suspected, but doesn't grow back within 6 months

You have other questions or concerns

Self Care at Home

Newborn normal hair loss in infancy

Hair loss on back of head from chronic rubbing and friction

Hair loss from tight hair style

Widespread hair thinning follows a major stress about 3 months ago

Care Advice

Newborn Normal Hair Loss in Infancy

What You Should Know About Newborn Normal Hair Loss:

Newborns are born with varying amounts of hair.

The baby hair of many newborns falls out during the first 6 months of life. Hair loss peaks at 3 months old. The mother may also lose some of her hair at this time.

This baby hair is then replaced by permanent hair.

The normal hair comes in between 6 and 12 months.

This shedding phase in newborns is always normal.

Hair loss is not caused by shampoos.

Call Your Doctor If:

Hair does not grow back by 12 months old

You have other questions or concerns

Hair Loss on Back of Head from Chronic Rubbing and Friction

What You Should Know About Rubbing Off Hair on Back of Head:

Babies can rub off a patch of hair on the back of the head. This most commonly occurs in infant 3 to 6 months old.

The hair loss is from friction during head-turning against a firm surface. Examples are crib mattresses, playpens, activity mats and infant seats.

The hair grows back once the baby starts to sit up.

This may take 6 to 12 months.

Can also occur in any bedridden child (e.g., severe cerebral palsy).

Treatment for Hair Loss from Friction and Too Much Time on Back:

After 1 month old, give your baby more tummy time.

Caution: Tummy time should always occur under adult supervision. Reason: Risk of suffocation until child reaches an age when can turn over.

Tummy time has many benefits.

It will help the back of head become more rounded and less flat.

It will also build up strength in shoulder muscles.

Call Your Doctor If:

Hair does not grow back by 6 months after learning to sit

You have other questions or concerns

Hair Loss From Tight Hair Style

What You Should Know About Hair Loss from Tight Hair Style:

Symptoms: Broken hairs are seen at the hairline or where the hair is parted. It's usually the same on both sides of the head.

Cause: If hair is pulled too tight, it will eventually break. This gives a frizzy look from hairs broken off at various lengths.

Examples: It's most commonly seen with tight braids, pony tails or dreadlocks. Hair can also be lost because of vigorous hair-brushing or back combing. Hot hairstyling tools can also cause hair damage. Can also occur during exercise while wearing head phones.

Hair loss is not caused by shampoos.

Treatment of Broken Hairs from Tight Hair Style:

Change the hair style to one that doesn't put tension on the hair.

If that is not acceptable, loosen the ponytail or braids.

These hair styles are at risk if they feel tight or cause any pain.

Outcome: If tight hair styles are avoided, the hair will return to normal.

Warning: If tight braiding continues over 10 years, permanent hair loss can occur.

Pimples in the Hair and on the Scalp:

Cause: Most pimples are caused by blocked hair follicles.

Treatment: Stop using any ointments or oils in the hair. Reason: they block the hair follicles.

Stop any hair style that puts tension on the hair. Reason: damages the hair follicle and makes it prone to infection.

Wash any ointment or greasy pomade off the scalp with soap and water.

Antibiotic Cream: Apply an antibiotic cream to the pimples. Do not use ointment. Use it 2 times a day for 3 days. No prescription is needed.

Outcome: Most pimples will clear up in 3 days.

Call Your Doctor If:

Hair does not grow back by 6 months after hair style changed

You have other questions or concerns

Widespread Hair Thinning Following Major Stress About 3 Months Ago

What You Should Know About Hair Loss after Stress:

Symptoms: Lots of hair is noticed in a comb or brush. The hair falls out from all parts of the scalp. This leads to major thinning of the hair, but no bald spots.

Cause: Severe stressful event. Hair follicles are very sensitive to physical or emotional stress. Examples are a high fever, severe illness or surgery. Also, an emotional crisis or a crash diet can be triggers. In pregnant teens, the stress can be childbirth. Hair loss is not caused by shampoos.

Time Frame: The hair begins to fall out about 3-4 months after a severe stress. It continues to fall out excessively over the next 3 or 4 months. After hair stops shedding, the hair will slowly grow back. This can take 6 to 8 months for all the hair to grow back. The whole cycle takes about 12 months.

There's no way to hurry the process. The hair growth cycle needs to run its course.

Here is some care advice that should help.

Hair Care:

Treat the hair gently.

Wash the hair no more than once per day. Always use a hair conditioner.

Comb the hair rather than brushing it.

Be careful at combing out any tangled hair.

Avoid any tight hair styles such as braids or a pony tail.

Don't put tension on the hair.

No special shampoo or cream is needed or helpful.

What to Expect:

No more than 50% of the hair will be lost.

Once it starts to regrow, all the hair will grow back in about 6 months.

The new hair will look normal.

Call Your Doctor If:

Hair does not grow back by 12 months after stressful event

You have other questions or concerns

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

Definition

Injuries to the head

Includes the scalp, skull and brain

Types of Head Injuries

Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling. It is common for children to fall and hit their head while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries. This is because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later. This is caused by blood spreading downward by gravity.

Skull Fracture. Only 1% to 2% of children with head injuries will get a skull fracture. Most often, there are no other symptoms except for a headache. The headache occurs at the site where the head was hit. Most skull fractures occur without any injury to the brain. They heal easily.

Concussion. A head injury that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Most children bump or hit their heads without causing a concussion. The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache or vomiting. Dizziness or acting dazed can also be signs. A person does not need to be knocked out to have had a concussion. Following a concussion, some children have ongoing symptoms. These can include headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks.

Brain Injuries (Serious) are uncommon. This includes bleeding, bruises or swelling within the brain. They are suspected by the symptoms listed below:

Hard to wake up or keep awake or

Acts or talks confused or

Slurred speech or

Weakness of arms or legs or

Walking is not steady.

These symptoms are an emergency. If they happen, call 911.

Concussion Treatment

Treating a concussion requires both Physical Rest and Brain Rest.

Brain rest means a gradual return to full studying and school attendance.

Physical rest means a gradual return to normal activity, work and gym class.

If symptoms occur (like a headache), the child needs to return to the previous level of physical and mental activity. In 24 hours, they can try again to take it to the next level.

Athletes involved in sports need to have a stepwise plan for "return to play." Progressing through stages should be supervised by a doctor or athletic trainer.

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

Seizure occurred

Knocked out (unconscious) for more than 1 minute

Not moving neck normally. Caution: protect the neck from any movement.

Hard to wake up

Acts or talks confused or slurred speech present now

Walking not steady or weakness of arms/legs present now

Major bleeding that can't be stopped

You think your child has a life-threatening emergency

Go to ER Now

Mild concussion suspected (awake but not alert, not focused, slow to respond)

Neck pain after head injury

Had confused talking, slurred speech, unsteady walking or weakness of arms/legs but fine now

Blurred vision lasted more than 5 minutes

Injury caused by high speed (car crash)

Vomited 2 or more times

Severe headache or crying that won't stop

Can't remember what happened or store new memories

Large deep cut that will need many stitches

Call Doctor or Seek Care Now

Age less than 1 year old

Knocked out (unconscious) for less than 1 minute

Skin is split open or gaping and may need stitches

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

Large swelling (larger than 1 inch or 2.5 cm)

Large dent in skull

Blow from hard object (such as a golf club)

Fall from a dangerous height

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

Headache lasts more than 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

You have other questions or concerns

Self Care at Home

Minor head injury

Care Advice

What You Should Know About Mild Head Injuries:

Most head injuries only cause a swelling or bruise to the scalp.

The main symptom is pain.

Swelling of the scalp does not mean there is any swelling of the brain. The scalp and brain are not connected. They are separated by the skull bone.

The skull bone protects the brain from getting injured.

Big lumps or bruising can occur with minor injuries to the scalp. This is normal. Reason: the scalp has a large blood supply.

The mildest brain injury is a concussion. Most of those also turn out fine.

Here is some care advice that should help.

Wound Care:

If there is a scrape or cut, wash it off with soap and water.

For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.

Cold Pack For Swelling:

Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.

Reason: Prevent big lumps ("goose eggs"). Also, helps with the pain.

Repeat in 1 hour, then as needed.

Watch Your Child Closely for 2 Hours:

Watch your child closely during the first 2 hours after the injury.

Have your child lie down and rest until all symptoms have cleared. Note: mild headache, mild dizziness and nausea are common.

Allow your child to sleep if he wants to, but keep him nearby.

Wake him up after 2 hours of sleeping. Check that he is alert and knows who you are. Also, check that he can talk and walk normally.

Diet - Start With Clear Fluids:

Offer only clear fluids to drink, in case he vomits.

Allow a regular diet after 2 hours.

Exception: babies can continue breastfeeding or formula.

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.

Exception: Do not give until 2 hours have passed from injury without any vomiting.

Caution: Never give aspirin to children and teens. Reason: Always increases risk of bleeding.

Special Precautions For 1 Night:

Mainly, sleep in same room as your child for the first night.

Reason: If a problem occurs, you will recognize it if you are close by. Problems include a bad headache, vomiting or confusion. Also, look for any change in your child's normal behavior.

Option: If you are worried, wake your child once during the night. Check how he walks and talks.

After 24 hours, return to a normal sleep routine.

What to Expect:

Most head trauma only causes a scalp injury.

The deep headache usually clears in 24 hours.

The scalp pain at the site of impact may last 3 days.

The swelling may take a week to go away.

Call Your Doctor If:

Pain or crying becomes severe

Vomits 2 or more times

Your child becomes hard to wake up or confused

Walking or talking is not normal

Headache lasts more than 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.

Definition

A scalp infection with tiny gray bugs called lice

Lice lay many white eggs (nits) in the hair

Symptoms of Head Lice

The eggs are easier to see than the lice. Nits (eggs) are tiny white specks attached to hairs. Unlike dandruff or sand, nits can't be shaken off the hair shafts.

Itching of the scalp is the main symptom.

A scalp rash may be present. The back of the neck is the favorite area.

Cause

Lice are 1/16-inch (2 mm) long gray-colored bugs. They move quickly and are difficult to see.

They are the size of a sesame seed.

The lice feed on blood from the scalp. While the bug is sucking blood, some of its secretions get mixed in. Any scalp rash or bumps is the body's reaction to the bug's saliva.

Lifespan of Lice

The nits (eggs) hatch into lice in about 1 week.

Nits (eggs) that are over ½ inch (1 cm) from the scalp are empty egg cases. They are very white in color.

Off the scalp, nits (eggs) can't survive over 2 weeks.

Adult lice survive 3 weeks on the scalp or 24 hours off the scalp.

Transmission of Head Lice: Live Lice, Not Nits

Only live lice can give lice to another child.

Nits (lice eggs) cannot pass on lice. Nits are attached to the child's hair.

Almost all spread of lice is from direct hair-to-hair contact. Lice cannot jump or fly to another person's hair.

The spread of lice from hats, hair brushes or combs is not common. Headphones and other objects also do not usually spread lice.

Most often, the spread of lice to others occurs at home, not school. Sleepovers and bed-sharing are a major source.

When To Call

Call Doctor Within 24 Hours

Age less than 2 months old

Scalp looks infected (such as pus, soft scabs, open sores)

Call Doctor During Office Hours

You think your child needs to be seen

Not sure your child has head lice

New head lice or nits are seen after treatment

Scalp rash or itch lasts more than 7 days after treatment

You have other questions or concerns

Self Care at Home

Head lice

Care Advice

What You Should Know About Head Lice:

Head lice can be treated at home.

With careful treatment, all lice and nits (lice eggs) are usually killed.

There are no lasting problems from having head lice.

They do not carry any diseases.

They do not make your child feel sick.

Here is some care advice that should help.

Anti-Lice Shampoo:

Buy some anti-lice creme rinse (such as Nix) and follow package directions. No prescription is needed.

First, wash the hair with a regular shampoo. Then, towel dry it before using the anti-lice creme. Do not use a conditioner or creme rinse after shampooing. Reason: It will interfere with Nix.

Pour 2 ounces (full bottle or 60 mL) of Nix into damp hair. People with long hair may need to use 2 bottles.

Work the creme into all the hair down to the roots.

If needed, add a little warm water to work up a lather.

Nix is safe above 2 months old.

Leave the shampoo on for a full 10 minutes. If you don't, it won't kill all the lice. Then rinse the hair well with water and dry it with a towel.

Repeat the anti-lice shampoo in 9 days. Be sure to do this or the lice may come back. Two treatments are always needed. The second treatment will kill any new lice that have hatched from eggs.

Remove the Dead Nits:

Nit removal is not necessary. It should not interfere with the return to school.

Some schools, however, have a no-nit policy. They will not allow children to return if nits are seen. The American Academy of Pediatrics advise that no-nit policies be no longer used. The National Association of School Nurses also takes this stand. If your child's school has a no-nit policy, call your child's doctor.

Reasoning: Only live lice can spread lice to another child. One treatment with Nix kills all the lice.

Nits (lice eggs) do not spread lice. Most treated nits (lice eggs) are dead after the first treatment with Nix. The others will be killed with the 2nd treatment.

Removing the dead nits is not essential or urgent. However, it prevents others from thinking your child still has untreated lice.

Nits can be removed by backcombing with a special nit comb.

You can also pull them out one at a time. This will take a lot of time.

Wetting the hair with water makes removal easier. Avoid any products that claim they loosen the nits. (Reason: Can interfere with Nix)

Hairwashing Precautions to Help Nix Work:

Don't wash the hair with shampoo until 2 days after Nix treatment.

Avoid hair conditioners before treatment. Do not use them for 2 weeks after treatment. Reason: Coats the hair and interferes with Nix.

Treating Close Contacts:

Check the heads of everyone else living in your home. If lice or nits are seen, they also should be treated. Use the anti-lice shampoo on them as well.

Also, anyone with an itchy scalp rash should be treated.

Bedmates of children with lice should also be treated. If in doubt, have your child checked for lice.

Return to School:

Lice are spread by close contact. They cannot jump or fly.

Your child can return to school after 1 treatment with the anti-lice shampoo.

A child with nits doesn't need to miss any school or child care. Nits do not spread to others, nor do they cause lice in others.

Remind your child not to share combs and hats.

Be sure to tell the school nurse or child care center director. She can check other students in your child's class.

Cleaning the House - Preventing Spread:

Avoid close contact with others until after the first anti-lice treatment.

Lice that are off the body rarely cause infection. Reason: Lice can't live for over 24 hours off the human body. Vacuum your child's room.

Soak hair brushes for 1 hour in a solution containing some anti-lice shampoo.

Wash your child's sheets, blankets, and pillow cases. Wash any clothes worn in the past 2 days. Wash in hot water (130° F or 54° C). This kills lice and nits.

Items that can't be washed (hats, coats, or scarves) should be set aside. Put them in sealed plastic bags for 2 weeks. This is the longest period that nits can survive. (Note: This is an option. This step probably is not needed.)

What to Expect:

With 2 treatments, all lice and nits should be killed.

If lice come back, it can mean another contact with an infected person. It can also be that the shampoo wasn't left on for 10 minutes. It may also mean that hair conditioner was used.

Also, make sure the Nix is repeated in 9 days. If you don't, the lice may come back.

Call Your Doctor If:

New lice or nits are seen in the hair

Scalp rash or itch lasts more than 1 week after the anti-lice shampoo

Sores on scalp start to spread or look infected

You think your child needs to be seen

Your child becomes worse

Extra Care Advice - Cetaphil Cleanser for Nix Treatment Failures:

Go to your drugstore and buy Cetaphil cleanser in the soap department. No prescription is needed. It works by coating the lice and suffocating them.

Apply the Cetaphil cleanser throughout the scalp to dry hair.

After all the hair is wet, wait 2 minutes for Cetaphil to soak in.

Comb out as much excess cleanser as possible.

Blow dry your child's hair. It has to be thoroughly dry down to the scalp to suffocate the lice. Expect this to take 3 times longer than normal drying.

The dried Cetaphil will smother the lice. Leave it on your child's hair for at least 8 hours.

In the morning, wash off the Cetaphil with a regular shampoo.

To cure your child of lice, repeat this process twice in 1 and 2 weeks.

The cure rate can be 97%.

Detailed instructions can be found online: Nuvo Method for Head Lice.

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

Definition

Pain or discomfort of the head

This includes the forehead to the back of the head

Not caused by a head injury

Causes of Acute Headaches

Viral Illnesses. Most acute headaches are part of a viral illness. Flu is a common example. These headaches may relate to the level of fever. Most often, they last a few days.

Hunger Headaches. About 30% of people get a headache when they are hungry. It goes away within 30 minutes of eating something.

MSG Headache. MSG is a flavor enhancer sometimes added to soups or other foods. In larger amounts, it can cause the sudden onset of a throbbing headache. Flushing of the face also occurs.

Common Harmless Causes. Hard exercise, bright sunlight, blowing a wind instrument or gum chewing have been reported. So has severe coughing. "Ice cream headaches" are triggered by any icy food or drink. The worse pain is between the eyes (bridge of nose).

Head Injury. Most just cause a scalp injury. This leads to a painful spot on the scalp for a few days. Severe, deeper or entire-head pain needs to be seen.

Frontal Sinus Infection. Can cause a headache on the forehead just above the eyebrow. Other symptoms are nasal congestion and postnasal drip. Rare before 10 years old. Reason: the frontal sinus is not yet formed. Other sinus infections cause face pain, not headaches.

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. Younger children are lethargic or so irritable that they can't be consoled. If not treated early, child can suffer brain damage.

Causes of Recurrent Headaches

Muscle Tension Headaches. Most common type of frequent headaches. Muscle tension headaches give a feeling of tightness around the head. The neck muscles also become sore and tight. Tension headaches can be caused by staying in one position for a long time. This can happen when reading or using a computer. Other children get tension headaches as a reaction to stress or worry. Examples of this are pressure for better grades or family arguments.

Migraine Headaches. Severe, very painful headaches that keep your child from doing normal activities. They are throbbing and often occur just on one side. Symptoms have a sudden onset and offset. Vomiting or nausea is present in 80%. Lights and sound make them worse. Most children want to lie down in a dark, quiet room. Migraines most often run in the family (genetic).

School Avoidance. Headaches that mainly occur in the morning on school days. They keep the child from going to school. The headaches are real and due to a low pain threshold.

Rebound Headaches. Caused by overuse of pain medicines in high doses. Most often happens with OTC meds. Caffeine is present in some pain meds and may play a role. Treatment is taking pain meds at the correct dosage.

Not Due to Needing Glasses (Vision Headaches). Poor vision and straining to see the blackboard causes eye pain. Sometimes, it also causes a muscle tension headache. But, getting glasses rarely solves a headache problem that doesn't also have eye pain.

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

Hard to wake up or passed out

Acts or talks confused

Weakness of arm or leg on one side of the body

You think your child has a life-threatening emergency

Go to ER Now

Walking is not steady

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

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

Severe migraine that persists after migraine medicines and going to sleep

Call Doctor or Seek Care Now

Vomiting

Blurred vision or seeing double

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

Sinus pain (not just congestion) of forehead

Swelling around the eye with pain

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

Call Doctor During Office Hours

Headache without other symptoms lasts more than 24 hours

Migraine headache suspected, but never diagnosed

Sore throat lasts more than 48 hours

Any headache lasts more than 3 days

Headaches are a frequent problem

You have other questions or concerns

Self Care at Home

Mild headache

Migraine headache, just like past ones

Care Advice

Treatment for Mild Headache

What You Should Know About Mild Headaches:

Headaches are very common with some viral illnesses. Most often, these will go away in 2 or 3 days.

Unexplained headaches can occur in children, just as they do in adults. They usually pass in a few hours or last up to a day.

Most recurrent headaches that can occur in anyone are muscle tension headaches.

Most headaches (including muscle tension headaches) are helped by the following measures.

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.

Headaches due to fever are also helped by bringing the fever down.

Food May Help:

Give fruit juice or food if your child is hungry.

If your child hasn't eaten in more than 4 hours, offer some food.

Reason: Skipping a meal can cause a headache in many children.

Rest - Lie Down:

Lie down in a quiet place and relax until feeling better.

Cold Pack for Pain:

Put a cold pack or a cold wet washcloth on the forehead.

Do this for 20 minutes. Repeat as needed.

Stretch Neck Muscles:

Stretch and rub any tight neck muscles.

Muscle Tension Headache Prevention:

If something bothers your child, help him talk about it. Help him get it off his mind.

Teach your child to take breaks when he is doing school work. Help your child to relax during these breaks.

Teach your child the importance of getting enough sleep.

Some children may feel pressure to achieve more. This may cause headaches. If this is the case with your child, help him find a better balance.

Caution: Frequent headaches are often caused by too much stress or worry. To be sure, get your child a medical checkup first.

Call Your Doctor If:

Headache becomes severe

Vomiting occurs

Headache without other symptoms lasts more than 24 hours

Headache lasts more than 3 days

You think your child needs to be seen

Your child becomes worse

Treatment for Migraine Headache

What You Should Know About Migraine Headaches:

This headache is like the migraine headaches that your child has had before.

The sooner a migraine headache is treated, the more likely the treatment will work.

Often the most helpful treatment is going to sleep.

Here is some care advice that should help.

Migraine Medicine:

If your child's doctor has prescribed a medicine for migraines, use it as directed. Give it as soon as the migraine starts.

If not, you can use ibuprofen (such as Advil). It is the best over-the-counter drug for migraines. Give it now. Repeat in 6 hours if needed.

Try to Sleep:

Have your child lie down in a dark, quiet place.

Try to fall asleep.

People with a migraine often wake up from sleep with their migraine gone.

Prevention of Migraine Attacks:

Drink lots of fluids.

Don't skip meals.

Get enough sleep each night.

What to Expect:

With treatment, migraine headaches usually go away in 2 to 6 hours.

Most people with migraines get 3 or 4 attacks per year.

Return to School:

Children with a true migraine headache are not able to stay in school.

Children with migraine headaches also commonly get muscle tension headaches. For those, they should take a pain medicine and go to school.

Call Your Doctor If:

Headache becomes much worse than past migraines

Headache lasts longer than past migraines

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

Symptoms after being in high temperatures (such as heat waves)

Symptoms after hard work or sports during hot weather

Heat cramps, heat exhaustion and heatstroke are covered

Prevention of heat exposure symptoms also covered

Types of Heat Reactions

There are 3 main reactions to hot temperatures and heat waves.

Heatstroke or Sunstroke (Serious). Symptoms include hot, flushed skin with high fever over 105° F (40.5° C). A rectal temperature is more accurate than an oral temperature in these cases. 50% of children with heatstroke do not sweat. Heatstroke can cause confusion, coma or shock. Heatstroke is a life-threatening emergency. It has a high death rate if not treated promptly.

Heat Exhaustion. Symptoms include pale skin, profuse sweating and nausea. Dizziness, fainting, or weakness can also be signs. Can have a mild fever 100 - 102° F (37.8 - 39° C) for a short time. Most of the time, there is no fever. Most of these symptoms are caused by dehydration from sweating. A person can progress from heat exhaustion to heatstroke. So, all patients with severe symptoms (such as fainting) need to be seen now. Mild symptoms (such as dizziness) can be treated at home with fluids and rest. But, if these don't resolve with treatment, these children also need to be seen.

Heat Cramps. Severe muscle cramps in the legs (calf or thigh muscles) and stomach are present. No fever. Tightness or spasms of the hands may occur. After your child drinks fluids and cools down, he or she will feel better. All symptoms should go away in a few hours.

Causes of Heat Reactions

All 3 reactions are caused by exposure to high temperatures often with high humidity.

During hot weather, hard work or sports can cause heat production to exceed heat loss.

Poor hydration interferes with sweating and increases the risk of heat reactions.

Babies are at more risk because they are less able to sweat when hot.

A hot humid climate can also add risk if you aren't used to it. This happens on vacations. The first heat wave of the summer can cause similar problems. It takes 8 to 10 days for you to become used to high summer temperatures.

Heatstroke is a breakdown in how the body regulates temperature. It usually follows exposure to a very high temperature. Examples are being inside a hot car or in a steam tent. Being indoors without air-conditioning during heat waves is also a risk factor.

When To Call

Call 911 Now

Hard to wake up or can't wake up

Acts or talks confused

Seizure occurred

Signs of shock (very weak or gray, cool skin)

Fever over 105° F (40.5° C)

You think your child has a life-threatening emergency

Go to ER Now

Passed out (fainted) or too weak to stand

Fever over 104° F (40° C)

Can't walk or can barely walk (not steady, needs support)

Call Doctor or Seek Care Now

Age less than 12 weeks old and not acting normal after heat exposure

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

Vomiting keeps from drinking fluids

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

Fever or dizziness still there after drinking fluids for more than 2 hours

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

Self Care at Home

Normal muscle cramps or sore muscles from heat exposure

Normal dizziness from heat exposure

Normal fever (under 104° F or 40.0° C) from heat exposure

Prevention of heat reactions

Care Advice

Drink Lots of Fluids:

All the symptoms of heat reactions respond to fluid replacement.

Type of Fluid. Give your child as much cold water as he will drink. Do this until he feels better.

If you have a sports drink (such as Gatorade), give it instead. Sports drinks contain water, salt and sugar.

How Much (Teens). Start with 3 cups (24 ounces or 720 mL). Then give 1 cup (240 mL) every 15 minutes for the next 1-2 hours.

Preteens (6-12). Start with 2 cups (16 ounces or 480 mL). Then give 6 ounces (180 mL) every 15 minutes for the next 1-2 hours.

Urine Color. The urine color can tell you if drinking enough fluids. Dark yellow urine means mild dehydration. Clear or light yellow urine means your child is drinking enough fluids.

Heat Cramps - What You Should Know:

Heat cramps are the most common reaction to heat exposure. They are never serious. Sometimes, they can be an early warning sign of heat exhaustion.

The cramps occur in the muscles that were working the hardest.

Heat cramps can be quite painful.

Heat cramps mean that the body needs rest and more liquids and salt.

Heat cramps should clear in 1 to 2 hours after lost fluids are replaced.

Heat Exhaustion:

Put the child in a cool place. Have him lie down with the feet elevated.

Undress him (except for underwear) so the body surface can give off heat.

Sponge the entire body surface constantly with cool water. Make the water as cold as tolerated without causing shivering.

Weakness should clear in 2 to 3 hours after lost fluids are replaced.

Dizziness - What You Should Know:

Dizziness and weakness can be caused by mild dehydration. This occurs from all the sweating that happens when hot.

Dizziness should clear in 1 to 2 hours after the lost fluids are replaced.

Mild dehydration can also cause nausea. It should pass after drinking enough fluids.

Fever - What You Should Know:

The body can become overheated from activity when it's hot outdoors. The temperature should come down to normal after drinking fluids and resting. This may take 1 or 2 hours.

Fluids: First, have your child drink some liquids.

Cool Bath: Second, take a cool bath or shower for 5 minutes. Reason: Brings down the temperature faster.

No Meds: Fever medicines are of no value for this type of fever.

Salty Food:

After your child has taken 2 or 3 glasses of water, offer some salty foods. Potato chips or pretzels are helpful.

Don't give salt tablets. Reason: They slow down the absorption of water and may cause vomiting.

Rest - Lie Down:

Rest in a cool place with a fan until feeling better.

Prevention Of Heat Reactions:

When working outside, have your child drink large amounts of cool water. This helps to prevent dehydration. For teens, this means at least 8 ounces (240 mL) every 15 to 30 minutes. Water is the ideal solution for replacing lost sweat. Very little salt is lost.

Most often, special sports drinks offer no advantage over water. But, they are helpful if working out for longer than an hour. If that is the case, replace 1 water drink per hour with a sports drink.

Have your child take water breaks every 15 minutes in the shade. Have him drink some water even if he's not thirsty. Thirst can be delayed until a person is almost dehydrated.

Do not use salt tablets. They slow down stomach emptying and delay the absorption of fluids.

Have your child wear a single layer of lightweight clothing. Change it if it becomes wet with sweat.

Physical activity in hot weather should be increased slowly.

Sports coaches suggest that exercise sessions be shortened and made easier when it's hot. This is usually when the temperature is over 82°F (28°C). Also, this is very important if the humidity is high.

Protect babies with fevers from heatstroke by not bundling them in blankets. Also, do not dress them in too many clothes. Children usually need the same number of clothing layers as adults.

During heat waves, spend as much time as possible inside with air-conditioning. Electric fans also help. Slow down. It takes at least a week to get used to hot summer temperatures.

Prevention - Hot Tubs:

Age limit: Do not use hot tubs in children less than 3 years old.

Reason: Poor heat tolerance and increased risk for rapid onset of high body temperature.

When using a hot tub, limit use to 15 minutes. Use a "buddy" system in case a heat reaction suddenly occurs.

Do not use a hot tub if your child has a fever. Also, do not use them right after hard work or sports. The body needs to get rid of heat.

Call Your Doctor If:

Vomiting keeps from drinking

Signs of dehydration occur

Muscle cramps last more than 4 hours

Fever goes above 104°F (40.0°C)

Fever lasts more than 2 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

A scalp infection with tiny gray bugs called lice

Lice lay many white eggs (nits) in the hair

Symptoms of Head Lice

The eggs are easier to see than the lice. Nits (eggs) are tiny white specks attached to hairs. Unlike dandruff or sand, nits can't be shaken off the hair shafts.

Itching of the scalp is the main symptom.

A scalp rash may be present. The back of the neck is the favorite area.

Cause

Lice are 1/16-inch (2 mm) long gray-colored bugs. They move quickly and are difficult to see.

They are the size of a sesame seed.

The lice feed on blood from the scalp. While the bug is sucking blood, some of its secretions get mixed in. Any scalp rash or bumps is the body's reaction to the bug's saliva.

Lifespan of Lice

The nits (eggs) hatch into lice in about 1 week.

Nits (eggs) that are over ½ inch (1 cm) from the scalp are empty egg cases. They are very white in color.

Off the scalp, nits (eggs) can't survive over 2 weeks.

Adult lice survive 3 weeks on the scalp or 24 hours off the scalp.

Transmission of Head Lice: Live Lice, Not Nits

Only live lice can give lice to another child.

Nits (lice eggs) cannot pass on lice. Nits are attached to the child's hair.

Almost all spread of lice is from direct hair-to-hair contact. Lice cannot jump or fly to another person's hair.

The spread of lice from hats, hair brushes or combs is not common. Headphones and other objects also do not usually spread lice.

Most often, the spread of lice to others occurs at home, not school. Sleepovers and bed-sharing are a major source.

When To Call

Call Doctor Within 24 Hours

Age less than 2 months old

Scalp looks infected (such as pus, soft scabs, open sores)

Call Doctor During Office Hours

You think your child needs to be seen

Not sure your child has head lice

New head lice or nits are seen after treatment

Scalp rash or itch lasts more than 7 days after treatment

You have other questions or concerns

Self Care at Home

Head lice

Care Advice

What You Should Know About Head Lice:

Head lice can be treated at home.

With careful treatment, all lice and nits (lice eggs) are usually killed.

There are no lasting problems from having head lice.

They do not carry any diseases.

They do not make your child feel sick.

Here is some care advice that should help.

Anti-Lice Shampoo:

Buy some anti-lice creme rinse (such as Nix) and follow package directions. No prescription is needed.

First, wash the hair with a regular shampoo. Then, towel dry it before using the anti-lice creme. Do not use a conditioner or creme rinse after shampooing. Reason: It will interfere with Nix.

Pour 2 ounces (full bottle or 60 mL) of Nix into damp hair. People with long hair may need to use 2 bottles.

Work the creme into all the hair down to the roots.

If needed, add a little warm water to work up a lather.

Nix is safe above 2 months old.

Leave the shampoo on for a full 10 minutes. If you don't, it won't kill all the lice. Then rinse the hair well with water and dry it with a towel.

Repeat the anti-lice shampoo in 9 days. Be sure to do this or the lice may come back. Two treatments are always needed. The second treatment will kill any new lice that have hatched from eggs.

Remove the Dead Nits:

Nit removal is not necessary. It should not interfere with the return to school.

Some schools, however, have a no-nit policy. They will not allow children to return if nits are seen. The American Academy of Pediatrics advise that no-nit policies be no longer used. The National Association of School Nurses also takes this stand. If your child's school has a no-nit policy, call your child's doctor.

Reasoning: Only live lice can spread lice to another child. One treatment with Nix kills all the lice.

Nits (lice eggs) do not spread lice. Most treated nits (lice eggs) are dead after the first treatment with Nix. The others will be killed with the 2nd treatment.

Removing the dead nits is not essential or urgent. However, it prevents others from thinking your child still has untreated lice.

Nits can be removed by backcombing with a special nit comb.

You can also pull them out one at a time. This will take a lot of time.

Wetting the hair with water makes removal easier. Avoid any products that claim they loosen the nits. (Reason: Can interfere with Nix)

Hairwashing Precautions to Help Nix Work:

Don't wash the hair with shampoo until 2 days after Nix treatment.

Avoid hair conditioners before treatment. Do not use them for 2 weeks after treatment. Reason: Coats the hair and interferes with Nix.

Treating Close Contacts:

Check the heads of everyone else living in your home. If lice or nits are seen, they also should be treated. Use the anti-lice shampoo on them as well.

Also, anyone with an itchy scalp rash should be treated.

Bedmates of children with lice should also be treated. If in doubt, have your child checked for lice.

Return to School:

Lice are spread by close contact. They cannot jump or fly.

Your child can return to school after 1 treatment with the anti-lice shampoo.

A child with nits doesn't need to miss any school or child care. Nits do not spread to others, nor do they cause lice in others.

Remind your child not to share combs and hats.

Be sure to tell the school nurse or child care center director. She can check other students in your child's class.

Cleaning the House - Preventing Spread:

Avoid close contact with others until after the first anti-lice treatment.

Lice that are off the body rarely cause infection. Reason: Lice can't live for over 24 hours off the human body. Vacuum your child's room.

Soak hair brushes for 1 hour in a solution containing some anti-lice shampoo.

Wash your child's sheets, blankets, and pillow cases. Wash any clothes worn in the past 2 days. Wash in hot water (130° F or 54° C). This kills lice and nits.

Items that can't be washed (hats, coats, or scarves) should be set aside. Put them in sealed plastic bags for 2 weeks. This is the longest period that nits can survive. (Note: This is an option. This step probably is not needed.)

What to Expect:

With 2 treatments, all lice and nits should be killed.

If lice come back, it can mean another contact with an infected person. It can also be that the shampoo wasn't left on for 10 minutes. It may also mean that hair conditioner was used.

Also, make sure the Nix is repeated in 9 days. If you don't, the lice may come back.

Call Your Doctor If:

New lice or nits are seen in the hair

Scalp rash or itch lasts more than 1 week after the anti-lice shampoo

Sores on scalp start to spread or look infected

You think your child needs to be seen

Your child becomes worse

Extra Care Advice - Cetaphil Cleanser for Nix Treatment Failures:

Go to your drugstore and buy Cetaphil cleanser in the soap department. No prescription is needed. It works by coating the lice and suffocating them.

Apply the Cetaphil cleanser throughout the scalp to dry hair.

After all the hair is wet, wait 2 minutes for Cetaphil to soak in.

Comb out as much excess cleanser as possible.

Blow dry your child's hair. It has to be thoroughly dry down to the scalp to suffocate the lice. Expect this to take 3 times longer than normal drying.

The dried Cetaphil will smother the lice. Leave it on your child's hair for at least 8 hours.

In the morning, wash off the Cetaphil with a regular shampoo.

To cure your child of lice, repeat this process twice in 1 and 2 weeks.

The cure rate can be 97%.

Detailed instructions can be found online: Nuvo Method for Head Lice.

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

Definition

Mental health problems that often need urgent help

Examples are anxiety attacks, depression, substance (drug) abuse and acting out

Resources include hotlines, mental health experts and your child's doctor

Types of Serious Mental Health Problems

Suicide thoughts, threats or attempts

Homicide thoughts or threats

Child abuse

Drug or alcohol abuse

Anxiety attacks or panic attacks

Depression

Types of Non-Serious Behavior Problems

Many childhood behavior problems are common and not serious. Your child's doctor can often manage them. Pediatricians are often the first point of contact for these problems. Examples are:

Temper tantrums

Sleep problems

Toilet training problems

Eating problems

Developmental delays

Behavior Scale: How to Judge Severity

Mild Symptoms: Symptoms do not keep the child from any normal activities. School, play, relationships and sleep are not changed. Treatment: parenting groups or books.

Moderate Symptoms: Symptoms keep the child from doing some normal activities. New behaviors mainly occur at home. They affect how the child and parent interact. They may also keep him or her from going to child care or school. Your child may not sleep well because of these symptoms. Treatment: Most often, brief counseling from a mental health provider or your child's doctor.

Severe Symptoms: Symptoms keep the child from doing most normal activities. They affect the way the child acts with parents. Symptoms also impact relations with siblings and friends. Adults at child care or school may also be impacted by the child's actions. Treatment: These patients often need to be seen urgently by a mental health provider.

When To Call

Call 911 Now

Physical harm or abuse is occurring now. Reason: police are needed.

Child is threatening serious harm to others now. Reason: police are needed.

Child has attempted or is threatening suicide now

Go to ER Now

Threats of harm to self or others, but not present now

You do not feel safe at home now

Substance abuse suspected and has symptoms now

Confused or bizarre behavior

Child is very upset (can't be calmed down)

Child is very angry (out-of-control)

You want an urgent psych exam for your child

You think your child needs to be in a hospital

Child abuse concerns and physical findings are present

Call Doctor or Seek Care Now

Child abuse concerns and no physical findings. You can also call your local Child Protection Services.

Needs mental health services and symptoms are urgent. You can also call a local mental health resource.

Call Doctor Within 24 Hours

Substance abuse or alcohol abuse suspected, but no symptoms now

Symptoms are constant and keep patient from doing their normal tasks of daily living

Needs mental health services and symptoms are not urgent. You can also call a local mental health resource.

Call Doctor During Office Hours

Common behavior problems (such as temper tantrums)

Toilet training problems

Sleep problems

Eating problems

School problems

You have other questions or concerns

Self Care at Home

Needs a resource or info on getting help for a mental health problem

Care Advice

Threats of Harm to Self or Others - How to Respond:

Children who threaten harm to self or other people need to be seen now. Emergent psych exams are done in the ER no matter the time of day.

The risk assessment for suicide or homicide must be made in person. It should not be done by phone. It is usually made by a mental health expert. ER doctors may do the first screening.

Some of these children may need to be in the hospital.

If anyone is in danger, call the police (911). Examples are spouse abuse.

For child abuse concerns, call the Child Protection Services (CPS) Hotline in your state.

Child or Teen Already In Treatment With A Mental Health Provider:

Contact your mental health provider first.

If can't reach your provider and problem is urgent, call another resource. See #3.

Local and National Mental Health Hotlines and Helplines (US numbers):

Call your local mental health resource first, if you have the number. If not, call a national hotline for help. They often can refer you to the best local resource.

National Suicide Prevention Lifeline: 1-888-784-2433

Domestic Violence Hotline: 1-800-799-7233

Child Abuse Hotline: 1-800-422-4453. Crisis counselors answer calls 24//7.

Substance Abuse Hotline: 1-800-662-4357. This is a 24/7 substance abuse and mental health referral line. They can give you local treatment choices and numbers for support groups.

Mental Health Helpline: 1-800-950-6264. This is an information and referral source for finding local mental health programs.

Postpartum Depression Helpline: 1-800-944-4773

National Poison Control Number: 1-800-222-1222

Website Resources for Mental Health Concerns:

American Academy of Pediatrics parenting website: www.healthychildren.org.

American Academy of Child and Adolescent Psychiatry: Talking to Children about Disasters.

Call Your Doctor If:

You think your child needs to be seen

Your child becomes worse

You have other questions or concerns

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

Definition

Dizziness or nausea from spinning or rolling motions

Symptoms of Motion Sickness

Dizziness and unsteady walking

Nausea and vomiting are also common

Before age 6, the main symptom is dizziness and the need to lie down.

After age 12, the main symptom is nausea (feeling sick to the stomach).

Causes of Motion Sickness

Symptoms are mainly triggered by motion. Sea sickness or amusement park sickness are the most common types. Fun-park rides that spin or whirl are some of the main causes. The Tilt-a-whirl is a good example of a ride to avoid. Also seen during travel by train, aircraft and even car.

The cause is a sensitive center in the inner ear. This center helps to maintain balance.

As a car passenger driving on winding roads, 25% of people will have symptoms. Under extreme conditions (e.g., high seas) over 90% of people have symptoms.

Strongly genetic: If one parent has it, 50% of the children will have it.

It is not related to emotional problems. The child cannot control it with will power.

Motion sickness symptoms are often worse in children.

When To Call

Call Doctor or Seek Care Now

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

Motion sickness symptoms last more than 8 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

Motion sickness symptoms

Care Advice

What You Should Know About Motion Sickness:

Motion sickness is a common normal reaction that occurs in 25% of people.

Caused by increased sensitivity of the inner ear.

It is not related to emotional problems or any physical disease.

In the future, take a special medicine ahead of time to prevent it.

Here is some care advice that should help.

Rest - Lie Down:

Have your child lie down and rest. If your child goes to sleep, all the better.

Fluids - Offer Sips:

Give only sips of clear fluids. Water is best. Do this until the stomach settles down.

Vomiting:

Prepare for vomiting. Keep a vomiting pan handy.

Usually, children don't vomit more than once with motion sickness.

What to Expect:

All symptoms of motion sickness usually go away in 4 hours after stopping the motion.

As for the future, people usually don't outgrow motion sickness. Sometimes, it becomes less severe in adults.

Motion Sickness Medicine - Dramamine:

Buy some dimenhydrinate tablets (such as Dramamine) at your drug store. No prescription is needed. In the future, give it to prevent motion sickness.

It comes in 50 mg regular and chewable tablets or in 25 mg Kids chewable tablets.

Dosage by age: do not use under age 2.

2 to 5 years (12.5 mg): ½ Kids chewable

6 to 11 years (25 mg): 1 Kids chewable

12 and older (50 mg): 1 regular tablet or chewable

Give the medicine 1 hour before traveling or going to a fun-park.

The tablets give 6 hours of protection and are very helpful.

Benadryl can also be used to prevent motion sickness. Use this if you do not have any Dramamine.

Prevention Tips for Car Trips:

If your child is over 12 years old, sit him in the front seat.

Before age 12, have your child sit in the middle back seat. This should help him look out the front window.

Have your child look out the front window, not the side one.

Discourage looking at books or movies during car travel.

Keep a window cracked to provide fresh air.

Avoid exhaust fumes from other vehicles.

Meals: Have your child eat light meals before trips. Some children can just tolerate crackers and water.

Plastic Bags: Always carry a ziplock plastic bag for vomiting emergencies.

Wrist Bands - Prevention:

Acupressure bands (such as Sea-Bands) are helpful for some adults.

There is no reason they shouldn't work for some children.

Put them on before car trips or other causes of motion sickness.

The pressure button goes over the center of the wrist. Place ½ inch (1 cm) above the wrist crease.

Call Your Doctor If:

Any symptoms last over 8 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

Fullness, pressure or pain on the face over a sinus

Sinus pain occurs above the eyebrow, behind the eye, and under the cheekbone

Other common symptoms can be a blocked nose, nasal discharge, or postnasal drip

Symptoms

Most often, the pain or pressure is just on one side of the face.

Swelling around just one eye.

Other common symptoms are a stuffy or blocked nose or nasal discharge. Your child may also have a nasal drip down the back of the throat. This is called a postnasal drip.

Less common symptoms are bad breath or mouth breathing. Also, may have a sore throat and throat clearing from postnasal drip.

Age Limit. Sinus pain is not a common symptom before 5 years of age.

Causes of Sinus Congestion

Viral Sinus Infection. Part of the common cold. A cold infects the lining of the nose. It also involves the lining of all the sinuses.

Bacterial Sinus Infection. A problem when the sinus becomes infected with bacteria. (Occurs in 5% of colds). It starts as a viral sinus infection. Main symptoms are increased sinus pain or return of fever. The skin around the eyelids or cheeks may become red or swollen. Thick nasal secretions that last over 14 days may point to a sinus infection. This can occur in younger children.

Allergic Sinus Reaction. Sinus congestion often occurs with nasal allergies (such as from pollen). Sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of Sinus Congestion

Viral Sinus Infection. Nasal washes with saline. Antibiotics are not helpful.

Bacterial Sinus Infection. Antibiotics by mouth.

Allergic Sinus Reaction. Treatment of the nasal allergy with allergy medicines also often helps the sinus symptoms.

All Thick Nasal Drainage. Nasal secretions need treatment with nasal saline when they block the nose. Also, treat if they make breathing through the nose hard. If breathing is noisy, it may mean the dried mucus is farther back. Nasal saline rinses can remove it.

Color of Nasal Discharge with Colds

The nasal discharge changes color during different stages of a cold. This is normal.

It starts as a clear discharge and later becomes cloudy.

Sometimes it becomes yellow or green colored for a few days. This is still normal.

Colored discharge is common after sleep, with allergy medicines or with low humidity. Reason: all of these events decrease the amount of normal nasal secretions.

Bacterial Sinus Infections: When to Suspect

Yellow or green nasal discharge is seen with both viral and bacterial sinus infections. Suspect a bacterial infection if the discharge becomes thick (like pus). But, it also needs one or more of these symptoms:

Sinus Pain, not just normal sinus congestion. Pain occurs mainly behind the cheekbone or eye or

Swelling or redness of the skin over any sinus or

Fever lasts more than 3 days or

Fever returns after it's been gone for over 24 hours or

Nasal discharge and post-nasal drip lasts over 14 days without improvement

When To Call

Call 911 Now

Not moving or too weak to stand

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

Acts or talks confused

Call Doctor or Seek Care Now

Trouble breathing not gone after cleaning out the nose

Redness or swelling on the cheek, forehead or around the eye

Severe pain and not better after using care advice

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

Headache lasts more than 48 hours

Fever lasts more than 3 days

Fever returns after being gone more than 24 hours

Earache occurs

Sinus pain (not just pressure) and fever

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

Call Doctor During Office Hours

Sinus pain (not just pressure or fullness) lasts more than 24 hours, after using nasal washes

Thick yellow or green pus draining from nose and not improved by nasal washes. Exception: yellow or green tinged secretions are normal.

Sinus congestion and fullness lasts more than 2 weeks

Nasal discharge lasts more than 2 weeks

You have other questions or concerns

Self Care at Home

Normal sinus congestion as part of a cold

Care Advice

What You Should Know About Sinus Congestion:

Sinus congestion is a normal part of a cold.

Nasal discharge normally changes color during different stages of a cold. It starts as clear, then cloudy, turns yellow-green tinged, then dries up.

Yellow or green-tinged discharge. This is more common with sleep, antihistamines or low humidity. (Reason: decrease the amount of normal nasal secretions.)

Usually, nasal washes can prevent a bacterial sinus infection.

Antibiotics are not helpful for the sinus congestion that occurs with colds.

Here is some care advice that should help.

Nasal Saline to Open a Blocked Nose:

Use saline (salt water) nose spray (such as store brand). This helps to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use bottled water, distilled water or boiled tap water. Teens can just splash a little water in the nose and then blow.

Step 1: Put 3 drops in each nostril.

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

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

How often: Do saline rinses when your child can't breathe through the nose.

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

Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.

Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus.

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

Fluids - Offer More:

Try to get your child to drink lots of fluids.

Goal: Keep your child well hydrated.

It also will thin out the mucus discharge from the nose.

It also loosens 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 nasal mucus thicker.

Decongestant Nose Spray (Age 12 years or Older):

Use this only if the sinus still seems blocked up after nasal washes. Use the long-acting type (such as Afrin).

Dose: 1 spray on each side. Do this 2 times per day.

Always clean out the nose before using.

Use for 1 day. After that, use only for symptoms.

Don't use for more than 3 days. (Reason: Can cause rebound congestion).

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.

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 over the sinus for 20 minutes.

Caution: Avoid frostbite.

Allergy Medicine:

If the child also has nasal allergies, give an allergy medicine.

Long-acting allergy medicines (such as Zyrtec) are a good first choice. Other options are Allegra or Claritin. Reason: these meds do not cause your child to act sleepy.

Benadryl can be used if these products do not control symptoms.

No prescription is needed.

What to Expect:

With this advice, the viral sinus blockage goes away in 7 to 14 days.

The main problem is a sinus infection from bacteria. This can occur if bacteria multiply within the blocked sinus. This leads to a fever and increased pain. It needs antibiotics. Once on treatment, the symptoms will improve in a few days.

Return to School:

Sinus infections cannot be spread to others.

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

Call Your Doctor If:

Sinus pain lasts more than 24 hours after starting treatment

Sinus congestion lasts more than 2 weeks

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

Weakness means decreased muscle strength.

Paralysis means severe loss of strength. The child can't move a part of the body.

Fatigue means feeling very tired and needing extra rest. Muscle strength is normal.

Symptoms of Weakness (loss of strength)

True weakness always interferes with function. Once a child is walking, weakness is seen more in the legs than the arms. Reason: muscle strength is needed for normal walking.

Leg Weakness. This is what you will see. Examples: trouble standing, walking, climbing stairs, getting off the floor, running and jumping. If severe, the child can't stand or walk.

Arm Weakness. This is what you will see. Examples: trouble feeding one's self, writing/drawing/typing, combing or washing the hair. Other children have trouble lifting objects above the head, turning door knobs or buttoning shirts. If the weakness is severe, the child starts dropping objects.

Face Weakness. Weak face muscles cause droopy eyelids or trouble moving the eyes. A droopy face or crooked smile may also occur. You might notice trouble sucking, swallowing or speaking.

Weakness in Babies. In infants not yet walking, you will see the loss of motor milestones (loss of normal development). These include new trouble turning over, sitting, crawling, and pulling up. In the early months, you will see the loss of head support, reaching or kicking. A weak cry or suck also may be seen.

Causes of New Onset Muscle Weakness

Most causes of new onset muscle weakness are serious. True weakness points to diseases of the spinal cord or its nerves. Nerves carry messages from the spinal cord to the muscles in the arms and legs. Diseases that cause muscle weakness are very rare.

Most children with new onset weakness need special tests to make the right diagnosis. If the weakness gets worse, most children need to be admitted to the hospital.

Specific Causes of New Onset Muscle Weakness

Polio. A severe spinal cord disease that causes paralysis. It is prevented by the polio virus vaccine. Polio is almost wiped out in the entire world. There have been no cases in the US since 1979. Now, it only occurs in 2 countries.

Acute Flaccid Myelitis (AFM). A rare infection of the spinal cord. It acts like polio did. It causes sudden onset of arm or leg weakness in one or more places. The main cause has been an enterovirus. There has been a rise in cases since 2014.

West Nile Virus myelitis. See the Mosquito Bite care guide for details. Also acts like polio did.

Guillain-Barre syndrome. A severe nerve weakness that starts in the feet and moves up the body over several days. It affects the same parts on both sides of the body. It can follow some viral infections.

Tick paralysis. A rare problem from a tick that has been attached for 5 or more days. Often it is hidden in the hair. Once the tick is removed, the weakness clears. It takes a few hours to a day.

Poisoning. Some types of poisoning can cause weakness, often with confusion.

Viral myositis. Muscle pain in the leg muscles is seen with some viral infections, such as influenza. The pain can make some children not want to walk. This is different than weakness. The muscle pain lasts a few days to a week.

When To Call

Call 911 Now

Hard to wake up or to keep awake. Exception: child needs normal sleep.

Awake but can't move

Trouble breathing or slow, weak breathing

Followed a head or neck injury

You think your child has a life-threatening emergency

Go to ER Now

Can't stand or walk

Confused or not alert when awake

Doesn't make eye contact or respond when awake

Crooked smile (weakness of 1 side of the face)

Not able to pass urine

Stiff neck (can't touch chin to chest)

Severe headache

Call Doctor or Seek Care Now

All other children with new onset of weakness

New onset of unsteady walking

Your child looks or acts very sick

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

Call Doctor Within 24 Hours

Weakness is a chronic problem and getting worse

Fever present more than 3 days with fatigue (tires easily but no weakness)

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

Call Doctor During Office Hours

Weakness is a chronic problem and not getting worse

Fatigue (tires easily but no weakness) lasts more than 2 weeks

Delays in motor development (sitting, crawling, walking)

You have other questions or concerns

Self Care at Home

Normal fatigue during a short-term illness (tires easily and needs more rest, but no true weakness)

Normal fatigue after hard work or sports

Care Advice

What You Should Know About Normal Fatigue (feeling very tired) When Sick:

Children who are sick are often less active.

They become easily tired and need extra rest. They take extra naps and sleep longer hours for many days. As long as your child is alert when awake, extra sleeping is normal.

This is different than the normal fatigue from exercise. Examples are a soccer game, manual labor or a long hike. This type of fatigue does not last long. It responds to a good night's sleep.

Sick children also are less hungry for meals but like to drink fluids. As long as they stay hydrated, this is normal.

Here is some care advice that should help.

Trust Your Child to Choose the Right Activity Level:

When they are awake, most sick kids want to watch TV. Some want to play with their toys. A few may want to play outside. That's also fine.

If they are feeling badly, they may just want to rest. They may prefer to stay in bed or on the sofa for a day or two.

As long as they are alert and able to walk normally, this is normal.

Avoid Trying to Force Bed Rest When Awake:

Most children sleep extra hours when they are sick with any infection. Their body tells them how much sleep they need. Getting enough sleep helps them fight the infection. Let them choose the amount.

Trying to force extra bed rest is not helpful for common childhood illness.

It doesn't reduce symptoms.

It doesn't help the body heal faster.

It doesn't shorten how long the illness lasts.

It doesn't prevent complications.

Bed rest also can't be enforced in children who don't want it.

An old myth was that sick children must stay in bed until their fever is gone. This is not true.

Return to School:

Your child can go back to school after the fever is gone and the fatigue is mild.

Your child should also feel well enough to join in normal activities.

What to Expect:

Being very tired during the first 2 or 3 days of an infection is normal.

Energy is often back to normal within 7 days.

After a major sickness like mono, it may take 2 weeks.

Call Your Doctor If:

Weakness (loss of muscle strength) occurs

Fever lasts more than 3 days

Extra sleepiness lasts more than 1 week

Fatigue (very tired) lasts more than 2 weeks

You think your child needs to be seen

Your child becomes worse

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