NECK OR BACK

Back Pain

Definition Pain or discomfort in the upper, mid or lower back Minor muscle strain from overuse and back injury are included Causes of Back Pain Strained Back Muscles. New backaches in teens are mostly from strained back muscles (muscle overuse). The pain is mostly in the lower back and near the center. There are 200 muscles in the back that allow us to stand upright. Work Triggers. Carrying something too heavy or lifting from an awkward position can cause back pain. Bending too far backward or sideways can cause back pain. Digging in the garden for too long causes overuse of back muscles. Exercise. New exercises or changes in an exercise routine can cause back pain. This is also called muscle overuse. Back Packs. In school-age children, heavy backpacks have become a common cause. They also can cause shoulder and neck pains. Children who have not gone into puberty are at greater risk. Reason: They lack the muscle mass. Kidney Infection (Serious). Pain is on one side in the middle of the back. Other symptoms are fever and pain when passing urine. Kidney Stone (Serious). Pain is on one side of the mid-back and shoots into the lower belly. The pain is extremely severe. The urine has blood in it. Sciatic Nerve Pain (Serious). Sciatica is pain caused by a pinched nerve in the lower back. Sciatica gives a burning pain in one buttock. The pain shoots into the back of the leg on that side. The most intense pain can be in the lower leg and foot. Leg weakness, numbness or tingling can also occur. A ruptured disk causes the pressure on the nerve. Sciatica is rare in children but common in adults. Symptoms of Back Pain Strained back muscles cause most of these symptoms: The pain is in the middle or lower back The pain is made worse by bending The muscles near the spine are tender to the touch The muscles may be tight (in spasm) Pain Scale Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: The pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Pain starts after major injury (such as a car crash or football). Caution: do not move your child until a spine board is put on. You think your child has a life-threatening emergency Go to ER Now Can't pass urine or can only pass a few drops Can't walk or can barely walk Call Doctor or Seek Care Now Severe pain Pain shoots into the buttock or back of the thigh Tingling or numbness (loss of feeling) in the legs or feet Blood in urine Pain or burning when passing urine and fever Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Pain or burning when passing urine, but no fever Fever Walks different than normal for more than 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Age is less than 5 years Pain in the upper back Cause is not clear (no history of overuse or twisting) Cause is bending backwards (such as in gymnastics) Back pain from overuse (exercise or work) lasts more than 2 weeks Back pains are a frequent problem You have other questions or concerns Self Care at Home Strained back muscles (from exercise or work) present less than 2 weeks Care Advice What You Should Know About Back Pain: Most new lower back pain is caused by lifting heavy objects. Lifting while the back is twisted is a common cause. Muscle overuse from exercise also causes strained back muscles. Pain is not the only symptom. Walking a little bent over or stiff may occur for a few days. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Reason: Helps back pain and muscle spasms. Cold Pack for Pain: For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Reason: Helps with the pain and muscle spasms. Caution: Avoid frostbite. Use Heat After 48 Hours: If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Reason: Increase blood flow and improve healing. Caution: Avoid burns. Sleep on the Side: Sleep on the side with a pillow between the knees. If your child only sleeps on the back, put a pillow under the knees. Avoid sleeping on the stomach. The mattress should be firm. Do not sleep on a waterbed. Activity: Avoid any sports or work that increase the pain. Avoid lifting or jumping until well. After 48 hours, start gentle back stretching exercises. Complete bed rest is not needed. Prevent Backpack Pain: Limit the weight of what is carried. It needs to less than 15% of body weight. That means a 100-pound (45 kg) child should not carry more than 15 pounds (7 kg). A sign of carrying too much weight is having to lean forward when walking. Buy a well-made backpack with wide, padded shoulder straps. Never carry the pack on just one shoulder. Reason: causes shoulder and neck pain. What to Expect: New back pain without a reason most often goes away in a few days. Back pain from muscle overuse (strained back muscles) goes away in 1 to 2 weeks. Call Your Doctor If: Pain becomes severe Walks different than normal for more than 3 days Pain starts to shoot into the leg Fever occurs Pain lasts more than 2 weeks You think your child needs to be seen Pain gets worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Lymph Nodes - Swollen

Definition Increased size of one or more lymph nodes. Most are in the neck. Also, includes swollen lymph nodes in the armpit or groin It's larger than the same node on the other side of the body Normal nodes are usually less than ½ inch (12 mm) across. This is the size of a pea or baked bean. Causes of Swollen Lymph Nodes Neck Nodes. The cervical (neck) nodes are most commonly involved. This is because of the many respiratory infections that occur during childhood. Viral Throat Infection. This is the most common cause of swollen nodes in the neck. The swollen nodes are usually ½ to 1 inch (12 -25 mm) across. They are the same on each side. Bacterial Throat Infection. A swollen node with a bacterial throat infection is usually just on one side. It can be quite large; over 1 inch (25 mm) across. This is about the size of a quarter. Most often, it's the node that drains the tonsil. Tooth Decay or Abscess. This causes a swollen, tender node under the jawbone. Only one node is involved. The lower face may also be swollen on that side. Armpit Swollen Nodes. Causes include skin infections (such as impetigo). A rash (such as poison ivy) can do the same. Groin Swollen Nodes. Causes include skin infections (such as athlete's foot). A retained foreign object (such as a sliver) can be the cause. Shaving. Teen girls can cause low-grade infections when shaving the legs. Widespread Swollen Nodes. Swollen nodes everywhere suggest an infection spread in the blood. An example is infectious mono. Widespread rashes such as eczema can also cause all the nodes to enlarge. Normal Nodes. Lymph nodes can always be felt in the neck and groin. They are about the size of a bean. They never go away. Lymph Nodes: What They Drain The lymph nodes are filled with white blood cells. They filter the lymph fluid coming from certain parts of the body. They fight infections. Neck Nodes in Front. These drain the nose, throat and lower face. Neck Nodes in Back. These drain the scalp. Armpit Nodes. These drain the arms and upper chest wall. Groin Nodes. These drain the legs and lower stomach wall. Common Objects Used to Guess the Size Pea or pencil eraser: ¼ inch or 6 mm Dime: ¾ inch or 1.8 cm Quarter: 1 inch or 2.5 cm Golf ball: 1 ½ inches or 3.8 cm Tennis Ball: 2 ½ inches or 6.4 cm When To Call Call Doctor or Seek Care Now Node in the neck causes trouble with breathing, swallowing or drinking Fever over 104° F (40° C) Skin over the node is red Node gets much bigger over 6 hours or less Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours 1 or more inches (2.5 cm or more) in size by measurement Very tender to the touch Age less than 1 month old Node limits moving the neck, arm or leg Toothache with a swollen node under the jawbone Fever lasts more than 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours In the neck and also has a sore throat Large nodes at 2 or more parts of the body Cause of the swollen node is not clear Large node lasts more than 1 month You have other questions or concerns Self Care at Home Mildly swollen lymph node Care Advice What You Should Know About Normal Nodes: If you have found a pea-sized or bean-sized node, this is normal. Normal lymph nodes are smaller than ½ inch or 12 mm. Don't look for lymph nodes, because you can always find some. They are easy to find in the neck and groin. What You Should Know About Swollen Nodes from a Viral Infection: Viral throat infections and colds can cause lymph nodes in the neck to get bigger. They may double in size. They may also become tender. This reaction is normal. It means the lymph node is fighting the infection and doing a good job. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Do Not Squeeze: Don't squeeze lymph nodes. Reason: This may keep them from shrinking back to normal size. Return to School: Swollen lymph nodes alone cannot be spread to others. If the swollen nodes are with a viral illness, your child can return to school. Wait until after the fever is gone. Your child should feel well enough to participate in normal activities. What to Expect: After the infection is gone, the nodes slowly return to normal size. This may take 2 to 4 weeks. However, they won't ever completely go away. Call Your Doctor If: Node gets 1 inch (2.5 cm) or larger in size Big node lasts more than 1 month You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Neck Pain or Stiffnes

Definition Pain or discomfort in the back, side or front of the neck Minor muscle strain from overuse and neck injury are included Pain in the front of the neck often is from a sore throat. It can also be from a swollen lymph node. Causes of Neck Pain Strained Neck Muscles. In teens, new neck pain is mostly from stretched neck muscles (muscle overuse). The most common modern cause is working with the head flexed down. Such head bending occurs with texting or looking at smartphones and mobile devices. Reading lying in bed or working on a computer for hours can trigger neck pain. The neck likes to keep the head in a neutral position. This is because the head is heavy (12 pounds or 5.4 kilograms). Other triggers are sleeping in an awkward position or fixing something on the ceiling. Infected Lymph Node. At all ages, it can be from a swollen lymph node. That can irritate and cause spasm of the neck muscle it lies against. Whiplash Injury. Caused by sudden movement of the head and neck. The head snaps back and forth. Neck muscles, nerves and ligaments are stretched. Can occur with a rear-end auto collision. Can also be from a sports injury. Needs to be examined. Major Neck Injury (Serious). The neck protects the spinal cord. A fracture or other injury of the neck can damage the cord. Therefore, all neck injuries need to on a spine board until they are cleared. Meningitis (Very Serious). A bacterial infection of the membrane that covers the spinal cord and brain. The main symptoms are a stiff neck, headache, confusion and fever. A stiff neck means your child can't touch the chin to the chest. Younger children are lethargic or so irritable that they can't be consoled. If not treated early, child can suffer brain damage. Symptoms Neck pains due to strained muscles cause these symptoms: The head is often cocked to one side Can't bend the head backward or put the chin to each shoulder. Often, can still bend the neck forward (touch the chin to the chest). The neck muscles are often sore to the touch Pain Scale Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: The pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Pain starts after a major injury such as with contact sports or car crash Not moving or too weak to stand You think your child has a life-threatening emergency Go to ER Now Stiff neck (can't touch chin to chest) with fever Headache with fever Numbness, tingling or pain in arms, upper back or legs Muscles in the arms or legs are weak (loss of strength) Call Doctor or Seek Care Now Pain started after a minor injury Can't move neck normally with fever Severe pain Not alert when awake ("out of it") Acts or talks confused Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Can't move neck normally Headache without fever Fever lasts more than 24 hours Age less than 5 years old You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Cause of neck pain is not clear (no history of overuse) Neck pain (from lots of turning) lasts more than 2 weeks Neck pains are a frequent problem You have other questions or concerns Self Care at Home Strained neck muscles (from turning or overuse) present less than 2 weeks Care Advice What You Should Know About Neck Pain: Most new neck pain is from stretching and turning the neck muscles too much. Muscle overuse causes strained neck muscles. Long periods of looking down is a common cause of neck pain. Seen mainly with texting or looking down at other mobile devices. When muscle pain starts without reason, it can be from sleeping in an awkward position. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Cold Pack for Pain: During the first 2 days, use a cold pack or ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Reason: Reduces pain and any spasm. Caution: Avoid frostbite. Use Heat After 48 Hours: If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Reason: Increase blood flow and improve healing. Caution: Avoid burns. Sleep Position: Sleep on the back or side, not the stomach. Sleeping with a neck collar helps some people. Use a foam neck collar (from a drug store). If don't have one, wrap a small towel around the neck. Reason: Keep the head from moving too much during sleep. Activity: Protect the neck. Avoid any activity that increases the pain. Avoid any sports or work that increase the pain. After 48 hours, start a gentle stretching program. Stretching Exercises: Do 3 minutes of gentle stretching exercises each day. Reason: improve the tone of the neck muscles. Touch the chin to each shoulder. Touch the ear to each shoulder. Move the head forward and backward. Don't apply any resistance during these stretching exercises. What to Expect: New neck pain without a reason most often goes away in a few days. Neck pain from muscle overuse (strained neck muscles) goes away in 1 to 2 weeks. Call Your Doctor If: Neck pain becomes severe Stiff neck occurs Pain starts to shoot into the arms, upper back or legs Pain lasts more than 2 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Sore Throat

Definition Pain or discomfort of the throat Made worse when swallows Rare symptom before 2 years old Not caused by an injury to the throat Causes of Sore Throat Colds. Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours. Then a cough and runny nose occur. Viral Pharyngitis. Some viruses cause a sore throat without other symptoms. A cough and runny nose don't become part of the illness. An antibiotic won't help. Strep Pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of sore throats without any cold symptoms. Pus is seen on the tonsils. Peak age is 5 to 15 years. An antibiotic is helpful. Mono. Infectious Mono mainly occurs in teens and young adults. The main symptoms are sore throat, fever and widespread swollen lymph nodes. Like Strep, Mono also has pus on the tonsils. Patients with Mono also may have a large spleen. It's located in the upper left side of the stomach. Mono is diagnosed with special blood tests. Post-nasal Drip. Drainage from a sinus infection can cause a sore throat. The throat clearing that goes with the drainage may cause most of the irritation. The sinus infection is more likely to be viral than bacterial. Mouth Breathing. Breathing with the mouth open during sleep can cause a sore throat. After eating breakfast, it often goes away. Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It's also hard to fully open the mouth. The peak age is teens. Epiglottitis (Very Serious). A bacterial infection of the flap of tissue above the vocal cords. It normally covers the windpipe during swallowing. The main symptoms are severe sore throat, drooling, spitting and fever. It can shut off the airway. Needs a 911 response. Strep Throat: When to Suspect Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting. Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause. Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat. Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep. If you think your child has Strep, call your doctor. Your doctor will do a Strep test. If the test is positive, they will start treatment. There is no risk from waiting until a Strep test can be done. Standard treatment is with antibiotics by mouth. Symptoms in Infants and Toddlers Children less than 2 years of age usually don't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using Drinking Fluids - Decreased care guide. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) You think your child has a life-threatening emergency Go to ER Now Can't swallow any fluids and new onset drooling Call Doctor or Seek Care Now Trouble breathing, but not severe Great trouble swallowing fluids or spit Can't open mouth all the way Stiff neck or can't move neck like normal Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Purple or blood-colored spots or dots on skin Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent. Note: a Strep test alone is not urgent. Call Doctor Within 24 Hours Sore throat pain is severe and not better 2 hours after taking ibuprofen Large lymph nodes in the neck Pink rash that's widespread Earache or ear drainage Sinus pain (not just congestion) around cheekbone or eyes Fever lasts more than 3 days Fever returns after being gone more than 24 hours Age less than 2 years old Close contact to a person with Strep within last 7 days Sores on the skin You think your child needs to be seen, but the problem is not urgent (or needs a Strep test) Call Doctor During Office Hours Sore throat is the main symptom and lasts more than 48 hours Sore throat with cold/cough symptoms lasts more than 5 days You have other questions or concerns Self Care at Home Viral throat infection suspected Care Advice What You Should Know About Sore Throats: Most sore throats are just part of a cold and caused by a virus. A cough, hoarse voice or nasal discharge points to a cold as the cause. Most children with a sore throat don't need to see their doctor. Here is some care advice that should help. Sore Throat Pain Relief: Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream. Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help. Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed. Medicated throat sprays or lozenges are generally not helpful. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Fluids and Soft Diet: Try to get your child to drink adequate fluids. Goal: Keep your child well hydrated. Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices. Solid Foods: Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solid foods. Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces. Return to School: Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities. Most often, having just a sore throat is not a reason to miss school. Children with Strep throat need to be taking an antibiotic for 24 hours. What to Expect: Most often, sore throats with a viral illness last 4 or 5 days. Call Your Doctor If: Sore throat is the main symptom and lasts more than 48 hours Sore throat with a cold lasts more than 5 days Fever lasts more than 3 days or goes above 104° F (40° C) You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Strep Throat Exposure

Definition Close contact with someone who has a Strep throat infection. Close contact means living in the same house with the infected person. It also includes close physical contact such as having a kissing relationship. Strep Exposure (Close Contact) Household Close Contact. Lives with a person whose Strep test was positive. This can be a sibling, parent, or other household member. Kissing relationship with someone (boyfriend, girlfriend) who has a positive Strep test. Close contact should be within 10 days of onset of symptoms in exposed child. Reason: time from contact to Strep symptoms usually is 2 to 5 days. Throat cultures and rapid Strep tests aren't urgent. Most can be done in your doctor's office. Types of Limited Contact with Strep Contact with someone outside the home with a positive Strep test. This type of contact occurs at school. Sometimes, the contact is with someone who was treated for Strep without testing. Children taking antibiotics for over 24 hours do not spread Strep to others. When To Call Call Doctor or Seek Care Now Stiff neck or can't move neck like normal Great trouble swallowing fluids or spit Trouble breathing or working hard to breathe Fever over 104° F (40° C) Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent. Note: a Strep test alone is not urgent. Call Doctor Within 24 Hours Sore throat pain is severe and not better 2 hours after taking ibuprofen Age less than 1 year old Earache or sinus pain (not just congestion) Mild symptoms that could be from Strep throat. (Some are sore throat, cries during feeds, large lymph nodes in the neck, fever) You think your child needs to be seen, but the problem is not urgent (or needs a Strep test) Call Doctor During Office Hours You have other questions or concerns Self Care at Home Strep contact but no symptoms Care Advice Treatment for Contacts With Symptoms (Pending a Strep Test) What You Should Know About Strep Exposure and Sore Throats: A Strep test is not urgent. It could be a Strep throat or just a viral infection of the throat. A sore throat is often part of a cold. Until you get a Strep test, here is some care advice that should help. Sore Throat Relief: Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream. Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help. Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed. Medicated throat sprays or lozenges are generally not helpful. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Fluids and Soft Diet: Try to get your child to drink adequate fluids. Goal: keep your child well hydrated. Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices. Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solids. Swollen tonsils can make some solid foods hard to swallow. Return to School: Your child may have a Strep throat infection. Wait for the result of the rapid Strep test. If it is negative, your child can go back to school. Call Your Doctor If: Your child becomes worse Treatment for Contacts Without Symptoms What You Should Know About Strep Exposure Without Symptoms: Many children have contact with someone with Strep throat. Most will not come down with an infection. This is especially true if the contact occurs outside the home. Strep tests are not needed for children without any symptoms. Time It Takes to Get Strep Throat: Time from contact to Strep symptoms usually is 2 to 5 days. Return to School: If your child has no symptoms, he does not need to miss any school. Call Your Doctor If: Your child gets any Strep symptoms in the next 7 days And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.



Strep Throat Infection

Definition Your child was diagnosed with a Strep throat infection A doctor has told you your child probably has Strep throat or Your child has a positive Strep test Your child is taking an antibiotic for Strep throat and you have questions You are worried that the fever or sore throat is not getting better fast enough Symptoms of Strep Throat Infection Pain, discomfort or raw feeling of the throat Pain is made worse when swallows Children less than 2 years of age usually can't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Other symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting. Cough, hoarseness, red eyes, and runny nose are not seen with Strep throat. These symptoms point more to a viral cause. Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat. If you look at the throat with a light, it will be bright red. The tonsil will be red and swollen, often covered with pus. Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep. Cause of Strep Throat Group A Strep is the only common bacterial cause of a throat infection. The medical name is Strep pharyngitis. It accounts for 20% of sore throats with fever. Any infection of the throat usually also involves the tonsils. The medical name is Strep tonsillitis. Diagnosis of Strep Throat Diagnosis can be confirmed by a Strep test on a sample of throat secretions. There is no risk from waiting until a Strep test can be done. If your child has cold symptoms too, a Strep test is usually not needed. Prevention of Spread to Others Good hand washing can prevent spread of infection. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Fainted or too weak to stand You think your child has a life-threatening emergency Go to ER Now Can't swallow any fluids and new onset drooling Call Doctor or Seek Care Now Trouble breathing, but not severe Great trouble swallowing fluids or spit Stiff neck or can't move neck like normal Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Purple or blood-colored spots or dots on skin Fever over 104° F (40° C) Will not drink or drinks very little for more than 8 hours Can't open mouth all the way 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 Urine is pink or tea (brown) color Taking antibiotic more than 24 hours, and sore throat pain is severe. (The pain is not better 2 hours after taking pain medicines) Taking antibiotic more than 48 hours and fever still there or comes back Taking antibiotic more than 3 days and other Strep symptoms not better 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 Strep throat infection on antibiotic with no other problems Care Advice What You Should Know About Strep Throat: Strep causes 20% of throat and tonsil infections in school age children. Viral infections cause the rest. Strep throat is easy to treat with an antibiotic. Complications are rare. Here is some care advice that should help. Antibiotic by Mouth: Strep infections need a prescription for an antibiotic. The antibiotic will kill the bacteria that are causing the Strep throat infection. Give the antibiotic as directed. Try not to forget any of the doses. Give the antibiotic until it is gone. Reason: To stop the Strep infection from flaring up again. Sore Throat Pain Relief: Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream. Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help. Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed. Medicated throat sprays or lozenges are generally not helpful. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Fluids and Soft Diet: Try to get your child to drink adequate fluids. Goal: Keep your child well hydrated. Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices. Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solids. Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces. What to Expect: Strep throat responds quickly to antibiotics. The fever is usually gone by 24 hours. The sore throat starts to feel better by 48 hours. 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. Children with Strep throat need to be taking an antibiotic for 24 hours. Call Your Doctor If: Trouble breathing or drooling occurs Dehydration suspected Fever lasts more than 2 days after starting antibiotics Sore throat lasts more than 3 days after starting antibiotics 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.



Swallowed Foreign Object

Definition Swallows a non-food solid object Adult suspects an object was swallowed Includes object found in the stool with no history of it being swallowed. Sometimes, a young child swallows an object when no one is around. Finding it in a stool is the first evidence that this has happened. Types of Objects Swallowed by Children Coins. The most common swallowed object. Usually safe except for quarters. Call your child's doctor to be sure. Coin diameters are 18 mm (dime), 19 mm (penny), 21 mm (nickel) and 24 mm (quarter). Source: U.S. Mint. Small blunt (non-sharp) objects. Toy parts, game parts, small buttons, rings, some earrings, paper clips, teeth. Usually safe if not sharp. Button batteries (serious). Needs urgent removal. See below for details. Magnets (serious). Needs urgent removal. See below for details. Sharp or pointed objects (serious). Include needles, pins, pushpins, tacks, nails, screws, toothpicks, some earrings. Pine needles, bones, bottle caps, aluminum pull tabs are also considered sharp. Most need urgent removal. Sharp objects can become stuck and lead to a puncture in the digestive tract. Small pieces of glass generally pass without any symptoms. Food Chunks. Large pieces of meat can get stuck on the way to the stomach. Mainly occurs in adults. Button Batteries Button batteries can cause low-voltage burns within 2 hours if stuck in the esophagus. The esophagus is the tube between the mouth and the stomach. A battery burn can lead to a puncture in this tube. Even "dead" batteries can be harmful if swallowed. All these children need an urgent x-ray to see where the battery is. If the battery is hung up or stuck, it needs urgent removal. Once it makes it to the stomach, it will usually safely pass. This may take a few days. These children need to be followed closely until the battery is passed. If you have it at home, honey may be helpful in preventing this kind of injury. Caution: just for children 1 year and older. Dose: 10 mL (2 teaspoons) every 10 minutes until you can get to the ER. Multiple Magnet Ingestion When multiple magnets are swallowed, problems can occur. Magnets at different spots can become attracted to each other across the bowel wall. The problems include a bowel puncture or blockage. All children who are suspected of swallowing magnets need an urgent X-ray. When to Worry Objects 1 inch (25 mm) or larger often cause problems. Quarters (24 mm) are included. These larger objects can get stuck in the esophagus. The esophagus is the tube between the mouth and the stomach. Symptoms of a blocked esophagus are trouble swallowing and throat or chest pain. Your child may gag, vomit, drool, or spit. Also, your child may not want to eat or drink anything. In addition to large objects, batteries, magnets and sharp objects can also cause problems. Children younger than 2 years are at increased risk of objects getting stuck. What Doctors Recommend for Smooth, Small Harmless Objects If your child has no symptoms, doctors don't always agree on the best approach. They recommend one of the options below: Option 1. Do nothing. No X-ray and no checking the stools. They assume the object is in stomach and will pass unless child develops symptoms. Examples are stomach pain or vomiting. Option 2. Check all stools for the object. If object hasn't passed in the stool by 3 days (72 hours), get an x-ray (author's preference and used in this care guide). Option 3. Get an x-ray on all patients. This can be done to be sure the object is in the stomach. For harmless objects, the x-ray can be delayed for 24 hours. Reason: Object is more likely to reach the stomach after a night's sleep. When To Call Call 911 Now Trouble breathing Stridor (harsh sound with breathing in) is heard now Wheezing (high-pitched purring or whistling sound when breathing out) is heard now You think your child has a life-threatening emergency Go to ER Now Symptoms of blocked esophagus. These include: can't swallow like normal, drooling, spitting, gagging, or vomiting. Your child may not want to eat or swallow fluid or food. Pain or feeling like object is stuck in throat, neck, chest or stomach Sharp or pointed object Button battery (saw or suspect child swallowed). Note: give honey if you have it. See First Aid. Magnet (saw or suspect child swallowed it) High-risk child (narrow esophagus) swallowed any coin or object Child coughed up the object but continues to have coughing or wheezing Your child can’t swallow water or bread Call Doctor or Seek Care Now Object is 1 or more inches (25 mm) across and no symptoms Age less than 2 years old Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Poison Center Now Poisonous object suspected Call Doctor Within 24 Hours All swallowed coins and no symptoms Swallowed object hasn't passed after 3 days 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 Swallowed harmless, small object and no symptoms Object found in stool Care Advice Swallowed Harmless Small Object and No Symptoms What You Should Know About Swallowed Objects: Most small, smooth or blunt objects pass without problems into the stomach. Since your child has no symptoms, the object should be in the stomach. In general, anything that can get to the stomach will pass through the intestines. Just to be sure it isn't stuck, perform a swallow test. Swallow Test - Check Your Child's Ability to Swallow Food: Give some water to drink. If swallowed easily, give bread to eat. Reason: If bread becomes hung up, enzymes found in saliva (spit) can dissolve it. If child swallows bread and water well, a normal diet is safe. When to Check Stools for the Object: For small smooth objects, checking the stools is not needed. Small means less than ½ inch (12 mm). For larger objects or those that are not smooth, check the stools. Also, check the stools if you are concerned for any reason. You can collect stools by having your child wear a diaper. Another way to do this is to have your child poop on a piece of paper. Slice the poop with a knife. Do this until you find the object. What You Should Expect: Swallowed objects almost always make it to the stomach. Once there, they usually travel safely through the intestines. They are passed in a normal stool in 2 or 3 days. There is nothing you can do to hurry this process. Call Your Doctor If: Your child can't swallow water and bread Your child is gagging or doesn't want to eat or drink Stomach pain, vomiting or bloody stools occur Coughing occurs Object hasn't passed within 3 days Your child becomes worse Object Found in Stool What You Should Know About An Object Found in the Stool: Sometimes, a young child swallows an object when no one is around. Finding it in a stool is the first evidence that this has happened. Your child should be safe to watch at home. Check Your Floors and Carpets More Often: Pick up any objects you find on the floor that could be swallowed. Try to teach your child to only put food in the mouth. Call Your Doctor If: You have other questions or concerns And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.