Fever
Fever is helpful in combating illness, and it alerts us to watch for other symptoms. The thermometer reading is not nearly as important as how badly the child feels. Do not be so preoccupied with the degree of the fever that you fail to recognize other symptoms. Other symptoms can help us understand the reason for the fever and determine the appropriate treatment and follow up. Always take a rectal or oral temperature with a mercury or digital thermometer.

Infants less than 3 months of age are considered to have fever and are potentially very sick if the temperature is more than 100.4 rectally. Please notify us immediately (night or day) in this situation. Your child will need to be seen. Infants less than 2 months will need to be seen right away. Infants between 2 and 3 months may be able to be seen the next morning depending on the circumstances. Please call us to discuss fever in any infant less than 3 months. Do not give any fever medications before talking to us if your child is an infant under 3 months old.

For infants and children over 3 months of age, temperatures less than 104 degrees (rectal or oral) can usually be managed at home until we can see them during office hours. In children 6 months and older, one can alternate Tylenol and Advil every 3-4 hours for fevers of 103-104 and they should usually be seen the following morning. This regimen should bring the fever down and keep the child relatively interactive and comfortable. You should call for a temperature over 103 despite medicine, fever lasting more than three days, or fever in ill-appearing children who do not appear better even after Advil or Tylenol are given.
Note: Advil and Motrin are both Ibuprofen and can be given to children 6 months and older with high fever as long as they are well hydrated. For lower grade fever (less than 102), we recommend Tylenol every 4-6 hours.

Other measures that will help bring down the fever and make your child more comfortable:

• Keep your child at rest.
• Dress your child in light clothing.
• Offer plenty of fluids. If he or she feels like eating (many children will not when they are sick), offer a bland diet. Foods such as crackers, bananas, applesauce, toast, and cheerios are usually well tolerated. Yogurt and bananas are good when children are having diarrhea.
• A lukewarm bath is often helpful.
• If fever is the only sign of illness, you need to watch for other symptoms.
If your child has no localized pain, feels better after anti-fever drugs, and is drinking fluids, it is to their advantage to let the body fight the infection for 2-3 days. Antibiotics are only helpful in a minority of cases. If there is localized pain or fever past 3 days, we need to evaluate them. If you are unsure, please call us.
• If your child is vomiting or refusing anti-fever drugs, rectal Tylenol suppositories are available over the counter. The rectal dose would be the same as the oral dose.

The Common Cold
A child will have more colds as they are in the process of building up antibody production with each successive illness. Colds are caused by viruses and are not cured by antibiotics. You should expect up to 7-8 colds per year in young children.

• Symptoms of upper respiratory infections or colds

  • Fever up to 102 or 103 for 2 to 3 days.
  • Muscle aches and pains.
  • Mucous and watery discharge from the nose, sneezing, hoarseness and cough.
  • Occasionally mild headache.
  • Green nasal discharge doesn't necessarily indicate the need for antibiotics because this can occur with cold viruses.

• Management of these symptoms

  • Use a cool mist humidifier
  • Give Tylenol or Advil for fever and aches. If your child is not drinking or eating well, Tylenol is the safest medication to use.
  • Use saline nose drops. Nose drops can be made with 1 cup of warm water and 1/4 tsp. of salt. Let the solution cool and place 2 drops down each side of the nose, wait several seconds and suction well with a bulb syringe. Be careful not to over-suction as the “trauma” of putting the bulb into the nose can cause additional swelling and bleeding. This should be done before putting the child to bed, before nursing or feeding, or any other time the nose appears blocked. Make a fresh batch daily or purchase over the counter nasal saline at your pharmacy. If the nose is just stuffy and there is little mucous, use the drops and don't suction.
  • The FDA and Academy of Pediatrics recommend not using cough and cold medications in children less than 6 years old. We may occasionally make exceptions to this advice as some children will do better at night if given a small dose of a cough medication.

• When to seek medical advice

  • Symptoms lasting more than 7-8 days.
  • Fever more than 3 days.
  • Localizing signs such as pain in the ears, chest, or throat.
  • Return of fever several days after it has resolved. This may be a signal of a secondary bacterial infection and antibiotics may be in order.
  • When your child appears ill even when the fever is down.

Croup
Croup is a common viral infection that causes varying degrees of upper airway obstruction. The most common symptom is sudden onset of a loud barky cough often beginning late at night. Some children will have noisy breathing especially when taking air into the lungs (stridor). There are several things to do at home that may help:

• Keep your child calm. Agitation makes obstruction worse. Hold your child upright.
• If it is a cool night, try taking your child outside into the night air.
• Run hot water in the bathtub and have your child sit in your lap near the tub. Let him or her breathe in the moist hot air.
• Open the refrigerator or freezer and allow your child to breathe in the cool air and offer cold drinks and popsicles
• If none of the above seem to help please call us. This is a very common reason for ER visits and we recommend going to your nearest ER if your child has stridor at rest or worsening symptoms after trying the home remedies.

Vomiting and Diarrhea
Acute gastroenteritis is usually caused by a virus and is self-limiting. Vomiting usually begins first, followed by diarrhea. It is best treated with dietary management. The following will help prevent your child from becoming dehydrated:

• When your child begins to vomit repeatedly, stop any oral intake for at least one hour.
• When no vomiting has occurred for one hour, offer 1/2 ounce or 15 ml of a clear liquid such as Pedialyte, Ricelyte, flat Sprite, or Gatorade. Offer only this small amount every 15 to 30 minutes. If your child appears thirsty between times, moisten their mouths with a wet cloth. The trick is to sneak small amounts past the stomach. If you give too much too fast, it will come back up.
• After your child has tolerated 15 ml ounce of clear fluids every 15 minutes for several hours, move up to 30-60 ml every 15-30 minutes.
• After your child has tolerated clear liquids for 12 hours, you may begin to add lactose free milk or formula or soy milk back to their diets. With infants you may have to start with 1/2 strength formula.
• The goal is to get back to a semi normal diet by 24 to 48 hours. After liquids are tolerated, start adding solid bland foods such as rice, toast, noodles, potatoes, bananas, applesauce, and other starches. Try to avoid fatty foods for several days. It is okay to add in some yogurt, lean meats, and vegetables as tolerated.
• If your child begins to vomit again once you have started the above treatment, wait for 1 hour and start with the clear liquids. If your child is having several episodes of diarrhea a day, it may help to give them a daily probiotic like Culturelle which is dairy-free. The granules can be mixed in applesauce.
• If your child has a diaper rash, we recommend cleaning with mild soap and water. Air dry whenever possible. Apply a thick mixture of Aquaphor and Maalox to the diaper rash with every diaper change.

• Things to watch for and reasons call:

  • Urinating less than 3 times in 24 hours.
  • Persistent localized abdominal pain or severe pain.
  • Bright red or tarry stools.
  • Persistent vomiting despite following the above suggestions.
  • More than 10-15 stools a day or diarrhea longer than 7 days.
  • Infants are more easily dehydrated so it is important to watch for:
    • listlessness
    • sunken eyes
    • noticeable weight loss
    • poor fluid intake
    • decreased urination (less than once every 8 hours)
    • dry mouth.
• An interactive child who is eating, drinking, and playing well, who happens to have diarrhea does not usually require any intervention.

Chicken pox
Chicken pox is a common self-limiting disease that may cause fever for up to 3 days and an itchy/blistery rash. Use Tylenol for the fever and oral Benadryl for the itching. Do not give Ibuprofen or aspirin to children with chicken pox. The main complication we see is infection of the pox lesions. Wash your child with Dial soap frequently and cut and clean the fingernails to help prevent infection. Please inspect the lesions daily and call us day or night if there is expanding redness around any of the lesions, fever more than 3 days, or if your child is ill appearing. Children are contagious until all areas are scabbed over. Call us during office hours if you suspect your child has chicken pox and is well appearing.

Hives
Hives are very common in children. They are often caused by viral illnesses and can last several days. Give a daily dose of a 24-hr anti-histamine such as Zyrtec or Claritin, and give Benadryl every 4-6 hrs as needed. If your child is taking a medication, especially an antibiotic or a seizure medication, and develops a rash, please call us to discuss management.