Guidelines for Child Care

Our goal is to provide optimum health care for your child by working together with you to prevent disease and accidents, and to treat acute and chronic illnesses. Below you will find practical suggestions for managing your child at home when he or she has a cold, constipation, diarrhea, fever, or vomiting. If you still have questions, please don’t hesitate to call your child’s pediatrician during normal office hours.

 

Colds

Viruses can cause colds and other upper respiratory infections. It is common for children to get 6-8 colds per year, with most of these occurring during the winter months. Colds typically cause sneezing, runny nose, and cough and may be accompanied by fever, which may last 2-4 days. Frequently children will also have a decreased activity level and decreased appetite. Often, there will also be a sore throat. Colds typically last for 1-2 weeks. Children get colds from being around other people who have colds, such as children in day care. Children who are around smoke tend to get more frequent colds that last longer, and are more likely to develop pneumonia, bronchitis, ear infection and asthma.

There are not any medications, including antibiotics or cold medicines, which make colds go away or prevent children from getting colds. Antibiotics will not do anything for colds and may cause side effects such as rash, diarrhea or upset stomach. We do not use antibiotics to treat colds. Over the counter cold medications can sometimes relieve some of the runny nose and cough that accompany colds. We do not routinely recommend them for children less than 4 years of age because they usually don’t help much and they may cause side effects such as drowsiness, fussiness or upset stomach. Ear infections sometimes accompany colds. Ear infections are treated with antibiotics. Symptoms of ear infection can include ear pain or drainage, poor feeding, diarrhea, playing with ears and/or poor sleeping.

 

There are several things you can do to help your child to feel better when he/she has a cold:

  1. Cool mist vaporizer when sleeping.
  2. Encourage plenty of liquids.
  3. Sometimes elevating the head of the bed by putting something under the mattress for a baby will help a child sleep more comfortably.
  4. Salt-water nose drops followed by gentle suctioning with a bulb syringe (1/4 teaspoon salt dissolved in 1 cup of warm water. Put 1-2 drops in each nostril, let sit for 30-60 seconds, then suction). (Suction only when mucus is visible.) This is especially helpful prior to eating or sleeping.
  5. Don’t smoke in the house or car.
  6. Acetaminophen (See section on fever) often helps relieve symptoms of sore throat, body aches and fever that can accompany colds.
  7. Over the counter cold medicines are only necessary if the child’s cough is interrupting sleep or regular activities. A box of Kleenex® is cheaper and causes fewer side effects. The most effective cold medicines are those that contain a decongestant. Decongestants should not be used in children under three years of age without consulting your provider.
     

Call our office during regular office hours if:

  1. A runny nose lasts more than two weeks.
  2. After one week the cold seems to be getting worse instead of better.
  3. Your child has a sore throat and has been exposed to someone with strep throat or has a sore throat that lasts longer than 48 hours.
  4. Your child has a significant cough and is less than six months old.
  5. There is an associated fever of greater than 101° which lasts longer than 72 hours.
  6. You are worried that your child may have an ear infection.
     

Call our office anytime if:

  1. Your child seems to be having trouble breathing which doesn’t improve after nose is cleaned.
  2. Your child is less than 4 months old and has a fever higher than 101° rectal.
  3. Your child is wheezing (making noise when he breathes out).
  4. Your child is having severe ear pain that is not improved after acetaminophen or ibuprofen. Refer to appropriate dosages. If during the night and your child is unable to sleep because of ear pain you may wish to take her to the emergency department rather than waiting to be seen the next day in our office.

 

Constipation in Infants

“My baby is constipated” is a comment we frequently hear from parents of babies we see in our clinic. We find that most parents and grandparents expect their babies to have at least one bowel movement (B.M.) every day. This frequently is not the case. Some babies normally will go two to three days without a B.M. and there are no harmful effects. Constipation is a problem when the baby has hard, dry, marble-like stools. Many parents also worry that when their babies grunt, make faces, and turn red and/or purple along with a B.M., that they are constipated; not so, this too can be normal. Although the first appearance of this activity may be scary to new parents, the baby is not in distress or pain. This is caused by the baby receiving the message they have to go, pushing the stomach muscles down and instead of relaxing, the rectal opening gets tight. It is during this time a baby can have a lot of grimacing or frowning while trying to have a B.M.
 

Remember:

  1. Babies frequently don’t have a B.M. every day.
  2. Constipation is a problem when the baby has hard, dry, marble-like stools.
  3. If a baby grunts, makes faces, and/or changes colors along with a B.M., this can be normal.
     

Treatment:
Infants under 2 months

  1. Rectal stimulation with thermometer.
  2. Add 1oz. water twice a day for 2-3 days.
  3. May give apple/pear/prune juice diluted with equal parts of water. (example: 1oz. juice to 1oz. water) Can give once in morning and once in the evening.
     

Babies 2 months to 4 months

  1. Increase fluids (water and juices)
  2. Milk of Magnesia ½ tsp. in a.m. and p.m., if necessary (one day only).
    • NOTE: Don’t give Milk of Magnesia if vomiting or fever.
      Babies older than 4 months
  1. Increase fluids.
  2. Juices as above.
  3. Give strained fruits such as prunes, pears, peaches, plums, and applesauce.
  4. If #1, 2, 3 get no results. Milk of Magnesia ½ tsp. in a.m. and p.m. (one day only).
    • NOTE: Don’t give Milk of Magnesia if vomiting or fever.

If these things do not help in three days, or if you have continued concerns or questions regarding your child’s B.M.s, call the office during regular hours.

 

Diarrhea

Most of the time, diarrhea is caused by a viral infection. The infection causes frequent loose or watery stools and may also cause fever. It may last from two days to two weeks. Usually the child will also have a decreased appetite and often experience a decreased activity level. There are no medicines to make these infections go away. We do not recommend over-the-counter diarrhea medicines. When a child has diarrhea it is important to try and keep him or her from getting dehydrated and to watch for signs of dehydration including dry mouth, no tears, and decreased urination. As long as he or she is urinating at least twice each day, his fluid intake is probably adequate (infants should urinate at least 3 times a day). If your child’s mouth is moist and he or she makes tears when crying, these are also good signs.


When your child has diarrhea it is best not to give apple juice or prune juice and you may want to cut down on milk products. Infants may continue to nurse or take their formula. They may need increased liquids between feedings and then it is fine to use something like Pedialyte®, but otherwise it is not necessary to alter their diet very much. Other clear liquids such as water, Gatorade® diluted with water or frozen pops may also be used between feedings for children over 12 months of age. For children over one year of age you may continue their usual diet but keep it bland, such as the “BRAT” diet -- bananas, rice, applesauce, toast.
 

Call our office during regular hours if:

  1. Diarrhea lasts for more than 2 weeks.
  2. There is blood in the stool.
  3. There is an associated fever of greater than 101°, which lasts longer than 48 hours.
     

Call our office any time if:

  1. Your child will not take liquids and is showing signs of dehydration.
  2. There is blood in the stool and your child has severe belly pain.
  3. Your child is less that 4 months old and has a fever greater than 101° degrees.
  4. Your child is very fussy.

 

Fever

Fever accompanies many different childhood illnesses. In particular, it is very common with many of the frequent viral infections that children may contract such as colds, vomiting, diarrhea and chicken pox. We consider your child to have a fever if temperature is over 101° rectal or 100° orally. Rectal temperature is recommended for a child under three years of age. We do not recommend axillary or under arm readings. Fever is often very frightening for parents. It is, however, part of the body’s way to help fight off infections. The fever, by itself, is usually not something you need to worry about.

There are several things you can do to help your child to be more comfortable when he/she has a fever.

  1. Encourage plenty of liquids.
  2. Keep him dressed lightly. Heavy clothes or blankets may cause the fever to increase.
  3. Luke-warm tub or sponge bath. Shivering can cause the fever to increase so don’t use water that is too cool. If shivering occurs, stop the bath.
  4. Acetaminophen (or ibuprofen if a child is 6 months or older) is only recommended if your child is very uncomfortable or is unable to sleep because of the fever. The appropriate dose is based on your child’s weight. It may be given every 4-6 hours as needed.
     

Call our office during regular office hours if your child:

  1. Has a temperature of greater than 101°, which lasts for more than 72 hours.
  2. Complains of ear pain.
  3. Has a sore throat for more than 48 hours.
  4. Is between 3 months and 2 years old and has a fever higher than 102° without any obvious reason.
     

Call our office any time if your child:

  1. Is less than 4 months old and has a fever of 101° or greater (rectal).
  2. Has a fever of greater than 105° rectal or 104° oral.
  3. Complains of severe headache or pain in the back of his neck when he tries to touch his chin on his chest.
  4. Is difficult to awaken, seems confused, or doesn’t seem to recognize you.
  5. Has inconsolable crying.
  6. “Blood Spots” (petechiae) (little red dots under the surface of the skin).

 

Poisoning

The best treatment for poisoning is prevention. Keep all medications, cleaning compounds and other toxic substances out of the reach of children. In case of accidental ingestion, call the Poison Control Center (800.222.1222) immediately for advice. Your call will be automatically forwarded to the Regional Poison Center in Madison. If a referral for treatment needs to be made, the professionals at the Poison Center will contact the facility nearest you
that is able to provide the needed treatment. With certain substances, making the child vomit is not recommended and can cause more problems. If you are requested to bring the child to the office or emergency room, please bring the container, the remaining contents and any information about the ingested substance with you.
 

Poison Control Center 800.222.1222
 

Vomiting

Vomiting, especially when associated with diarrhea, is usually caused by a viral infection. There are not any medicines to make such infections go away. Vomiting typically lasts less than 72 hours, and often less than 24 hours. As with diarrhea, it is important to prevent dehydration (refer to section on diarrhea). The best way to do this is to offer the child frequent sips of clear liquids such as Pedialyte®. Sometimes it is necessary to give as little as 1-3 teaspoons every 15-30 minutes. If the child keeps these small amounts down, he can be offered more the next time. Clear liquids such a Gatorade® diluted with water, plain water, flattened pop or frozen pops may also be used. For children over twelve months of age you should not limit the diet to these liquids for longer than 12-24 hours. When the child is keeping down liquids you may offer her a bland diet.
 

Call our office during regular hours if:

  1. Vomiting lasts for more than 48 hrs.
  2. There is an associated fever of greater than 101°, which lasts for longer than 48 hours.
  3. Your child is less than 12 months old and vomiting lasts longer than 24 hours.
     

Call our office any time if:

  1. Your child complains of stomach pain low on the right side.
  2. Abdominal pain seems severe.
  3. Your child is showing signs of dehydration. (no tears, dry mouth, less than three wet diapers in 24 hours)
  4. Your child is less than 4 months old and has a fever greater than 101° degrees.

 

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