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Well Child Advise from the American Academy of Pediatrics
Suggestions from "Bright Futures" experts (from the American Academy of Pediatrics) for each Well Care visit - listed by age.
Click on the age of of your child's well care visit for a PARENT HANDOUT:
(Handouts for patients older than ten years old will be posted in the near future.)
Q. How do I know if my child has an emergency? When do I call on the emergency phone line?
A. Call our emergency phone line if your child has a situation that cannot wait until the next scheduled office hours. Such examples include difficulty breathing (not head congestion or stuffy nose), laceration, head trauma, etc. To maximize your convenience and ours, please visit our Suggested Schedule Call Times under the Contact Us tab at the top of the page. https://www.drexelhillpeds.com/contact-us
Q. When does a “fever” mean that my child is sick?
A. Fever is the body’s normal response to an infection. Fever is a symptom, not a disease.
A temperature of 100.4 degrees or greater is considered a fever. Temperatures under 101 degrees do not need to be treated with Tylenol, Tempra, Panadol, etc. In general, fevers do not hurt children but can make them uncomfortable.
More important than the height of the fever is how the child is acting. If child has a temperature of 102 degrees but is drinking, playing and sleeping comfortably, there is little reason for concern. If child has a temperature of 100.5 degrees but refuses to drink or is awake crying most of the night, you should call our office and determine if your child needs an appointment.
*IMPORTANT: Any infant age 12 weeks or younger, with rectal temperature of 100.4 degrees or above, should be seen by a doctor.
Q. When is my child’s behavior considered medically lethargic?
A. Words like “lethargic” and “listless” imply a very ill child who won’t get out of bed or off the couch, refuses to play, sleeps most of the time, or is difficult to arouse.
Children are smarter than adults: when they don’t feel well, they slow down. As long as your child has 2 or 3 periods a day when he/she perks up and feels better, drinks fluids and is urinating, your child, although ill, is not considered lethargic.
Q. How do I know if my child is wheezing?
A. Some signs of wheezing are: rapid or labored breathing, cough that keeps the child awake, refusing to drink, and the chest or abdomen sinking in when the child inhales.
Head and chest congestion that seem loose or rattly are not symptoms of wheezing.
Q. Why won’t the Doctor prescribe an antibiotic for my child’s virus and fever?
A. An antibiotic will kill bacteria. If your child has a bacterial infection (such as ear infection or strep throat), an antibiotic will help. If your child has a virus, an antibiotic will not help. Fevers are very common with viral infections.
Q. Why not treat all colds with an antibiotic, because my child always gets a sinus infection or ear infection?
A. Antibiotics can have many potentially harmful side effects. For many years, doctors over-prescribed antibiotics to treat infections that were not bacterial. This over-prescribing has led to the development of bacteria that are resistant to the commonly-prescribed antibiotics. The more antibiotics your child is prescribed, the greater the likelihood that bacteria will develop resistance. Antibiotics can also kill many good bacteria that live in our intestines and aid with digestion. By killing these bacteria we can harm our digestive tracts and cause diarrhea. Of course if an ear infection were to occur during a cold, the risks of an untreated ear infection would usually outweigh the potential side effects of the antibiotic.
How is the Flu Transmitted?
You can get the flu if someone around you who has the flu coughs or sneezes. The flu viruses are passed through tiny airborne droplets, which enter your body through your nose and mouth. If you've touched a contaminated surface, they can pass from your hand to your nose or mouth.
For all families, infection control is the most important way to prevent becoming ill from the flu virus. Follow these tips:
Wash your hands before and after eating and using the bathroom. Wash your hands after handling any soiled tissues. Wash your hands after being in public or around anyone with a cold or the flu. Use an alcohol based antibacterial hand solution if you are unable to wash your hands.
When coughing or sneezing, turn head and cough or sneeze into a disposable tissue; dispose of promptly. Always cover your mouth and nose when coughing.
Don't take young children or those with immune system problems into large crowds unnecessarily when the flu is in your community.
Avoid close contact (holding, kissing) between infants and anyone who has a cold or the flu.
Stay home from work or school if you have the flu or flu-like symptoms.
Do not share things that go into or near the mouth, such as drinking cups, straws, toothbrushes, wash cloths and pillows.
Frequently clean commonly touched surfaces (door knobs, refrigerator handle, phone, water faucets) with an antibacterial solution if someone in your house has a cold or the flu.
Do not smoke around children.
Ensure you and your child maintain a healthy diet and drink plenty of fluids.
If your child is more than 6 months old, we recommend that he or she get the influenza vaccine. This injected immunization can be given at a scheduled visit or to our established patients with a lab appointment. See information from the CDC website about the flu vaccine at: http://www.cdc.gov/flu/protect/keyfacts.htm
If the flu virus infects you, you will usually feel symptoms 1 to 4 days later. You can spread the flu to others before your symptoms start and for another 3 to 4 days after your symptoms appear. The symptoms start very quickly and may include:
Typically, the fever begins to decline on the second or third day of the illness. The flu almost never causes symptoms in the stomach and intestines. The illness that people often call "stomach flu" is not influenza.
Colds or Upper Respiratory Tract infections are caused by viruses which the body’s own defenses will cure in about a week. Antibiotics are not helpful in treating colds. Over the counter cold medicines will not cure the cold, will not shorten the duration of the cold, may cause irritability, and may not be very effective for children under the age of 5 years. Really then, if your child is not uncomfortable in the first place it’s just as well not to give any medicine at all. Tylenol should ONLY be given IF your child has a fever. It is not uncommon for children to have a fever during the first few days of a cold, however, your child should be checked if he develops a fever AFTER having a cold for a few days.
There are several general measures which will help in treating a child who has a cold:
1. Give lots of extra fluids to help keep congestion loose.
2. Encourage resting or quiet activities.
3. Elevate the head end of the bed or crib when sleeping. For older children,
use an extra pillow.
4. Use a cool mist humidifier or a vaporizer when your child sleeps.
SALT WATER NOSE DROPS – for young infants
Stir together a pinch of salt in 2 ounces of warm water.
Put 2 drops in each nostril.
Wait a minute and draw out the mucous with a NOSE BULB
HOMEMADE COUGH MEDICINE:
2 ounces of water
2 tablespoons of light Karo Syrup
1 teaspoon of lemon juice
Give 1 teaspoon every 2 or 3 hours as needed.
Constipation is a concern shared by many parents. Some children stool daily, other children will not have a bowel movement daily. True constipation is the passage of hard, dry stool usually causing discomfort. We at DHPA prefer to take a natural approach to this problem. The following advise may be helpful to your child if you feel that he/she is constipated.
1) Give your child plenty of fluids.
2) Apple juice and prune juice are helpful.
3) Offer your child whole-grain breads, not processed (white) breads.
4) Cereal grains are high in fiber: All-Bran, Wheat Bran with or without raisins, Oat Flakes, Puffed Wheat, Corn Bran Cereal, Shredded Wheat, Corn Flakes.
5) Green, leafy vegetables (broccoli, spinach, lettuce, brussels sprouts), peas, corn (over 2 years old), baked beans, carrots, potatoes, cabbage are also good sources of fiber.
6) Some fruits may be helpful also: peaches, pears, strawberries, plums, apples, grapes, melons. Avoid bananas and applesauce.
7) Raisins and popcorn (without butter) are good snacks to offer. (Do not give to child under 2 years of age).
If you have been following this diet, but you child continues to have a problem with constipation, contact our office for additional advice.
Most children who are vomiting or have diarrhea will get better quickly if their diets are adjusted so that their digestive system does not get overworked. During this time, they lose large amounts of fluid which must be replaced to prevent dehydration. It is best to give frequent, small amounts of simple clear liquids at first, and then slowly add a few binding, easy to digest foods.
STEP #1: VOMITING INSTRUCTIONS:
Wait 1 hour from the time your child last vomited, then start with 1 ounce
of one of the liquids listed below including breast milk. If there is no
vomiting, increase the liquids below to 2 ounces every hour and increase
amount as tolerated over the next 24 hours.
If child has diarrhea only, you may offer the liquids listed below in
Moderate to large amounts as tolerated.
on formula or milk: offer Pedialyte for 6 -12 hours depending on degree of vomiting. Then offer full strength formula.
on breast milk: offer breast milk, shortened, more frequent
nursings for 24 hours to 48 hours. If necessary, pump or
express milk to keep up milk supply.
TODDLERS AND OLDER CHILDREN:
offer Pedialyte, Gatorade, flat Coke, Pepsi, ginger ale or
7-Up. For diarrhea it is best to add foods back in the first
* avoid milk, milk products and real fruit juices, although
if this is all the child will drink he/she may have these.
STEP # 2: If you child is improving on the above clear liquids, you can add very small amounts of simple foods from the following list at frequent
The B.R.A.T. Diet: Bananas, Rice or rice cereal, Applesauce, Toast.
In addition you can add: dry Cheerios, jelly, Jello, crackers, simple cookies, pretzels, rice cakes and sherbet. Small, frequent feedings are better then on large meal.
STEP # 3: The next foods to add back to the diet on (day 2 & 3) –
Age Appropriate: milk, cooked orange vegetables (carrots, squash, sweet potatoes), baked or mashed potatoes, chicken or turkey (baked or broiled), yogurt, peanut butter.
* if at any time you child seems to be getting worse or is not getting better call the office for further instructions.
This list of nonprescription drugs and supplies will be sufficient to relieve symptoms in the majority of acute illnesses that affect every family. Since these medicines will not shorten the course of the illnesses, give them only when symptoms are really bothering your child. When calling our office we may suggest you use some of these items. Observe all label precautions.
acetaminophen (Tylenol): for fever or pain
ibuprofen (Advil, Motrin): for pain or fever
thermometers, rectal and oral types
rubber suction bulb: for stuffy, blocked nose (after using warm-water nosedrops)
cough drops or corn syrup (as effective as expectorant cough syrups): for mild coughs
dextromethorphan-containing cough syrup (cough suppressant): for severe coughs and nighttime coughs
humidifier (cool mist type): for coughs or croup
cotton balls: for cleaning infected eyes
sunscreen (cream and lip balm)
1% hydrocortisone: for itchy skin conditions such as mosquito bites and poison ivy
bacitracin or Betadine antibiotic ointment: for skin infections
acetone (nail polish remover): for removing tape from the skin
rubbing alcohol (70% isopropyl alcohol): for sterilizing the skin or needles
Ipecac, syrup of (30-ml bottle): for inducing vomiting in some types of poisoning –Use only after calling Poison Control at 1-800-222-1222 and they advise you.
antihistamine medicine (for example, Benedryl): for hives, hay fever, and eye allergies (optional for many families, but definitely needed if family members have allergies)
gastrointestinal medicines: Vomiting and diarrhea respond best to dietary changes, and the numerous nonprescription medicines that are available are unnecessary or harmful. (See our “Ask the Nurse” section for suggestions on this topic)
tincture of time (the passage of time): cures the majority of mild illnesses.
TLC (tender loving care): makes the time pass more quickly.Back to Top
Asthma is a chronic disease of the tubes that carry air to the lungs. These airways become narrow and their linings become swollen, irritated and inflamed. In patients with asthma, the airways are always irritated and inflamed, even though symptoms are not always present. The degree and severity of airway inflammation varies over time.
Symptoms of asthma include:
Shortness of breath
Tightness in the chest
If you are concerned your child may have asthma, talk to your health care provider. She will test your child's airway function. It is important to remember that asthma is a complicated disease to diagnose, and the results of airway function testing may be normal even if your child has asthma.
Certain things cause asthma "attacks" or make asthma worse. These are called triggers. Some common asthma triggers are:
Infections of the airways
Irritants in the environment (outside or indoor air you breathe)
Decreasing your child's exposure to triggers will help decrease symptoms and the need for asthma medications.
Children with asthma symptoms that occur only once in a while are given medications only when needed to relieve the symptoms. These are called quick-relief “rescue” medications. Children with asthma whose symptoms occur more often need to take medications every day. These are called controller medications.
There is no one magic medication that controls all asthma. Sometimes it is necessary to take several medications at the same time to control and prevent symptoms. Your health care provider will choose the best medications for your child and talk to you about when to use them.
Most asthma medications can be inhaled directly into the lungs. Inhalation has major advantages over other ways of taking medication because the medicine passes straight into the airways. As a result, side effects are reduced or avoided altogether. In addition, asthma medications work much faster when inhaled than when taken orally.
Peak Flow Meter
To help control asthma, your child may need to use a peak flow meter. This is a handheld device that measures how fast a person can blow air out of the lungs. The peak flow meter uses three colors — green, yellow and red, like traffic lights — to show if the airway is opening or closing up. It also has a scale to help you determine if your child's asthma is getting better or worse. Peak flow rates decrease (the numbers on the scale go down) when your child's asthma is getting worse or is out of control. Peak flow rates increase (the numbers on the scale go up) when the asthma treatment is working and the airways are opening up.
Asthma and School
Children spend a significant part of their day at school. That is why it is so important that asthma symptoms are well managed while they are there. It also is important that you are aware of your child's symptoms and any problems with how your child's asthma is managed in school. Because exercise is so important to a child's overall health, every effort should be made to keep your child active in school sports while also keeping asthma symptoms under good control.
As you can see, asthma is a complicated yet treatable condition. By using medications, avoiding triggers and environments that can cause asthma attacks, and carefully managing symptoms, children with asthma can lead normal and healthy lives.
If you have any questions about your child's health, symptoms of asthma, or how your child's asthma is being managed, talk to one of the doctors or nurses at our office. He or she is the best source of information about your child's health.
Fever is an elevation of body temperature above the normal. There are many different reasons for a child to have a fever. Children are likely to develop much higher temperatures than adults. They also tolerate fever much better than adults do. Most temperatures will be higher at night. Fever itself is not a disease and is not dangerous but rather it is a SIGN that the child is ill.
OVERALL, HOW SICK YOUR CHILD SEEMS TO BE IS FAR MORE IMPORTANT THAN THE NUMBER OF FEVERS.
There is some evidence that having a higher than normal temperature is one way that your body helps fight illness to make you well. In view of this, slight elevations of temperature – up to 101.5° or so – probably are better off left alone. Although higher temperatures will not hurt your child, treatment will usually make your child feel more comfortable.
TAKING A CHILD’S TEMPERATURE:
Rectal temperature should be taken whenever possible in a child who is too young to hold a thermometer in his mouth. Leave the thermometer in place for approximately 3 minutes. “Fever Strips” are very inaccurate. Axillary (under the arm) and ear temperatures, are acceptable except in infants under 6 months.
1. TREAT FEVER ONLY IF CHILD IS UNCOMFORTABLE, IT IS NOT
NECESSARY TO “GET THE FEVER DOWN.
2. Keep your child quiet.
3. Do not over dress or over bundle your child. Keep him cool.
4. Give extra cool liquids, Kool Aid, flat soda or diluted fruit juices.
5. Bath or sponge bath in lukewarm water is fine. DO NOT use alcohol.
6. DO NOT give enemas or other home remedies for fever.
7. NOTIFY US IF YOU INFANT IS UNDER 3 MONTHS OF AGE AND HAS A FEVER.
Acetaminophen (Tylenol, Panadol, or Tempra) can be used to treat elevated
temperatures. Doses may be given every 4 hours if necessary.
* Do NOT exceed more than 5 doses in 24 hours
* Use only the dosing devise that comes with a specific product
We recommend starting solids (fruits and vegetables) at approximately six months of age. This recommendation is based on studies that show that newborns started sooner on baby foods have a higher chance of allergic problems, especially eczema or dry itchy skin patches. Cereals may be started after 4 months of age when it seems necessary. If your baby is content, we recommend maintaining breast feeding or formula alone for the first six months.
When solid foods are started we suggest 1-2 tablespoons of a new food once or twice a day for 3 days as a trial. If no vomiting, diarrhea, rash, constipation or irritability, then you may increase the volume to 4 tbsp. or more of that food per feeding. Although there are many approaches to the order of foods introduced, we suggest that you follow this one:
Juices and teas are not recommended and are not a necessary part of your child’s diet. They have little nutritional value. If you would like to offer juice or herbal tea check first with your baby’s Doctor.
FINGER FOODS are an important part of the baby’s development and should be introduced when the baby develops the pincer grasp (ability to pick up food with fingers) – usually at about 8 months. Continue to spoon-feed your baby during this time. It is essential that your baby is sitting down while eating and that the adult remains with the baby at all times to prevent choking. Foods that require cooking, should be cooked well and cut into small pieces.
The following are some finger food suggestions:
cooked carrots, green beans, peas, sweet potatoes, potatoes
Cheerios, rice puffs
banana, peach, pear, cantaloupe, fruit cocktail
cooked pasta noodles (Ditalini, elbow macaroni, pastina, cooked rice)
French toast, pancakes, melted cheese on toast
soup with some of broth drained – vegetable, chicken noodle, chicken rice
very well cooked small pieces of chicken, turkey, beef
small pieces of grilled cheese sandwich
baby may hold and chew on Zwieback, baby crackers, or cookies, bagel, English muffin
AFTER 12 MONTHS OF AGE: scrambled eggs, small pieces of peanut butter and jelly or tuna sandwich
Some common allergens that should not be introduced until after 12 months of age are: chocolate, strawberries, citrus fruits, pineapple, peanut butter, and shellfish.
Eczema is a skin condition characterized by areas of very itchy, dry red skin. It is usually inherited and often starts in infancy. Eczema cannot be cured but can be controlled with good skin care. Most children outgrow this condition by adolescence, sometimes sooner.
Skin Care Instructions:
Bathing: Give short baths no more than 5 minutes in the tub and no more than three times a week. Too much soap and water will make eczema worst because the skin’s natural protective oils get washed away. Do not use bubble bath. Be gentle, no scrubbing. Use lukewarm, never hot water, and gentle soap such as Dove. Pat skin dry gently with a towel, and apply a moisturizer. On non-bath days, wash only mouth, dirty parts of face, hand, and private areas.
Moisturizing: Apply a generous coating of a moisturizing cream at least two times a day to the entire body. Use a cream, not a lotion – Eucerin, Nivea, Moisturel or Aveeno cream. (Note: if your child is prescribed a steroid cream, apply moisturizer one hour after steroid cream.)
Other Helpful Information:
Foods – In about 30% of infants with eczema, certain foods cause the eczema to flare-up. If you suspect a particular food item, avoid that food for 2 weeks, then give that food to your child one time. If your child’s eczema seems worse within 2 hours, do not give this food to your child for at least one year. If eczema runs in your family, you may want to consider breastfeeding your next infant because some formulas and food can irritate eczema.
Clothing – Clothes made of wool and other scratchy fibers make eczema worse. Cotton clothes should be worn as much as possible. Use long pants and long sleeves whenever possible. This will help cut down on scratching and itching.
Climate – Air conditioning or fans in the summer, as well as a humidifier and lowering the thermostat in the winter, can make your child more comfortable.
Stress or Illness – Be aware that these can cause an eczema flare-up in children.
The information provided by the Drexel Hill Pediatric Associates website is information of a general nature and is intended for informational purposes only. It should not be relied on for personal medical reasons and should not be relied upon as providing specific medical advice or for diagnosis or treatment. All information contained on this website is presented as is, without any warranties of any kind, express or implied.
Please note that visiting this website alone does not establish a physician-patient relationship with any physician engaged by Drexel Hill Pediatric Associates, and you should consult your own physician for specific advice for your own personal situation.