We at Glendale Pediatrics are always available to answer your concerns about your child. The following information is a set of guidelines to help you with decision-making regarding your ill child. Please do not hesitate to contact us or to seek medical attention if after reading the information below, you are still uncertain of what to do, or if your gut instinct is telling you that your child is not OK.
Fever is an elevation of the body temperature caused by our immune system to help our bodies fight infections. Fever can help us get better faster. The height of the fever tells us very little about the seriousness of the illness. Children commonly get fevers over 105 degrees with minor illnesses. There is no good evidence that fever can cause brain damage. When children have a fever, they breathe rapidly and may be fussy and tired. In general, how sick your child looks is much more important than the actual temperature.
Convulsions with fever occur in approximately 2% of normal children (1 in 50), most commonly between six months to six years. Although frightening to watch, they are generally harmless. There is little or no relationship between these seizures and the height of the fever. In fact, they often occur before the fever is noticeable. Fever-reducing measures do not appear to prevent these seizures.
Children under two months of age: In infants under two months old, any fever is concerning, and you should call immediately. Normal temperature in babies is up to 100.3 rectally, and a fever is any rectal temperature of 100.4 or more. All infants should have their temperature taken rectally only. Other methods are not accurate. Make sure that your baby is not overdressed, as this will sometimes raise the temperature. Do not give fever-reducers (i.e. Tylenol) to children under 2 months of age. Other concerning signs of infection in infants under 2 months of age include lethargy/sleepiness (i.e. you are unable to wake the baby for 2 feedings in a row) and irritability (i.e. you are unable to console your baby despite a variety of attempts).
Children two months of age or older: If your child has a fever but does not have any of the symptoms listed below, then it is probably better to leave the fever alone. You may give Tylenol (or Motrin if your child is over 6 months of age) if he or she is in pain or is miserable from the fever. These medications may not reduce the fever completely but will provide some relief from the discomfort.
NOTE: NEVER USE ASPIRIN IN CHILDREN UNDER 18 YEARS!!!
Call the doctor immediately if your child:
Call during office hours if your child:
A cold is an infection caused by a virus that causes runny nose, cough, and occasionally sore throat and fever. Young children often get a new cold every 2 to 3 weeks in the winter and every 3 to 5 weeks in the summer. Colds usually get worse for 48-72 hours before they begin to improve. The runny nose often becomes yellow or green after the first 2 to 3 days and can last up to 2 weeks. Antibiotics do not help or prevent colds.
Elevate her head. You may put 3 to 10 saline nose drops in each nostril, wait 30 to 60 seconds and suction with a bulb syringe or have the child gently blow her nose if the mucus is bothersome. Don’t use cough medications because cough is helpful in clearing mucus from the lungs. Unless your child is also experiencing allergy problems, avoid medication containing antihistamines for colds because they thicken mucus and appear to promote ear and sinus infections. In children over one year of age, honey frequently relieves cough and sore throat. DO NOT USE HONEY IN INFANTS UNDER 12 MONTHS OF AGE.
Call our office if your child develops a cold with these symptoms:
The flu (influenza A) is a viral respiratory infection that begins with the very sudden onset of severe lethargy, weakness and sleepiness accompanied by a high fever. The flu is often described as feeling fine one minute and then suddenly feeling very ill. The first 48 hours are usually spent sleeping, with headache, muscle aches and weakness. The next 36 to 48 hours the fever continues but the child is less sleepy. He or she will develop increasing congestion and coughing with persistent muscle aches, pains and weakness. Many patients develop wheezing (whistling exhalation). The congestion, cough and weakness slowly resolve over the next 2 to 4 weeks. The fevers are usually quite high and are part of the immune response.
Influenza B is also sudden, but usually not as severe. Patients with influenza B have more muscle aches and longer-lasting fevers.
Influenza is not a cold with a fever. It does not come on gradually. It is not a vomiting and diarrhea illness (i.e. “stomach flu”), although vomiting may occur.
Call the office for an evaluation. For older children, some medicines can help if initiated in the first 24 to 48 hours.
Call immediately if:
Call the office if:
Many conditions can cause sore throats, including viruses, sinus infections, strep and allergies. Viruses cause most sore throats, especially if there is an associated runny nose or cough. Strep throat is a throat infection caused by bacteria called Streptococcus pyogenes and can only be diagnosed by a lab test. White spots on the throat do not necessarily mean strep. It is important to treat strep throat with antibiotics.
Sore throat is not generally an emergency, except as noted below. Treatment is designed to relieve pain.
Call the doctor immediately if your child has a sore throat and:
Call during office hours if your child has a sore throat that:
Many earaches are not due to ear infections but rather to conditions such as sore throats, colds and sinus infections. Ear pulling in children less than 24 months of age is usually not a sign of ear infections, and most children with ear infections do not pull on their ears.
In younger children, the main signs of an ear infection are fussiness, sleeplessness, and fever.
There are two kinds of ear infections. The most common is the middle ear infection, which usually starts during a cold, sinus infection or when allergies act up. There may be drainage from the ear if the eardrum ruptures, a not uncommon event with ear infections. The other type of ear infection is called swimmer’s ear. This infection usually occurs after swimming and results in an ear that is tender to touch or gentle pulling.
Many earaches begin in the middle of the night. Antibiotics will not relieve the pain immediately. Ear pain generally does not improve much faster with antibiotics. If your child has pain, take the following steps:
Croup is an infection that results in noisy inspiration (breathing in) and a cough that sounds just like the bark of a seal. Croup is usually caused by a virus that causes swelling near the vocal cords. This occurs mostly during the night in children under six years of age. Most children are normal during the day and at bedtime except for a mild cold and possibly a hoarse voice. They awaken suddenly during the night with very noisy breathing, painful cough and are often frightened. After the croup resolves, your child may have cold symptoms for several days to a week.
Take the following steps if your child develops croup:
After you have settled your child down:
Call during the day if your child:
Call immediately if:
Diarrhea is a condition in which our bodies make many watery bowel movements per day. Most cases are caused by viruses, can last from one day to two weeks, and may be accompanied by vomiting. If diarrhea and vomiting occur together, it is important to treat the vomiting first (see instructions on vomiting below). Some cases of diarrhea are caused by dietary choices, such as excess juice or fruit consumption.
If your infant develops diarrhea, he or she will need extra fluids, preferably Pedialyte or a similar electrolyte replacement solution. If the diarrhea is not severe, give 2 ounces for every diarrheal stool in addition to his or her normal formula or breastmilk.
For severe diarrhea:
Older Children and Adolescents
The diarrhea may last for days. As long as you are able to keep up with the fluid losses and the stools are gradually improving, don’t worry.
Call the doctor if:
If your child begins to vomit, DON'T PANIC. Don’t rush to give him or her fluids. Wait until the vomiting slows down to less than once an hour. Then you can begin to give fluids as follows:
Call the doctor if:
There are many causes of diaper rash. The most common is irritation from stool or urine, which results in some areas of redness or raw skin. For this rash:
Another common diaper rash is a yeast infection, which begins after several days of some other diaper rash, and has small red bumps or blisters around a red rash. For this rash:
Call during office hours if none of these measures work.
Constipation means hard bowel movements. Children and infants do not have to have bowel movements every day. Some breast-fed infants may suddenly start having bowel movements as little as every 3-10 days which is normal.
Constipation needs treatment if:
Infants under Six Months
Older Infants and Children
Call the doctor on call if the pain is severe and the above measures give no relief. Call during office hours if there is recurrent constipation.
Bloody noses are common. They occur frequently when the weather is hot and dry, the heater is on, or during colds or allergy attacks.
If your child has a nosebleed:
Call the doctor on call if the bloody nose does not stop with the above measures. Make an appointment if the bloody noses are frequent.
Pink eye is an inflammation of the eye caused by viruses, bacteria, allergies or irritants. Viral pink eye usually exhibits a mucousy or watery drainage. The white of the eye is usually pink or red. It is very contagious and antibiotic drops do not help. It runs its course in 2-10 days. Bacterial conjunctivitis usually has copious pus-like discharge that returns very quickly after you wipe it away. It too will resolve, usually in 7-10 days, but usually improves faster with antibiotic eye drops.
If this occurs in the evening, you can wipe it out with a damp cotton ball or soft cloth. If the eye is very itchy, any of the over-the-counter allergy drops will usually help.
Pink eye is not an emergency unless the eye is very painful. If the eye is very painful, call the on-call doctor. Otherwise, wipe the eye when needed and call the office in the morning.
A scalp infection with tiny gray bugs called lice. Lice are 1/16th inch long and move quickly. They lay eggs that are firmly attached to hair shafts near the skin. The eggs are called nits and are easier to see than lice. They do not shake off easily like dandruff or sand. Itching of the scalp is the main symptom. A scalp rash may also be present. The empty nits are white, the unhatched nits are dull and usually found closer to the scalp. Nits are best found on the back of the head.
Purchase over the counter NIX or RID and follow package directions. Safe for children older than 2 months.
Wash hair with regular shampoo; do not use conditioner, towel dry
Pour full bottle of NIX or RID into dry hair, work down into roots.
Leave on overnight and rinse off in the morning.
Allow the NIX or RID treatment at least 8 hours to kill the nits
Remove dead nits from damp hair by backcombing with special nit comb. Patience and diligence is key.
A vinegar solution may be helpful to loosen the nits from the hair shafts. Use equal parts of vinegar and warm water for 30 minutes under a towel wrap prior to combing.
Purchase Cetaphil Gentle Skin Cleanser. This is a soap-less cleanser that is usually found in the soap department at most stores.
Apply an ample amount and work into scalp making sure the cleanser covers the entire scalp. After hair is soaked through, wait 2 minutes
Comb out excess cleanser
Blow dry your child’s hair. It must be completely dry to the scalp to suffocate the lice
Leave on for 8 hours
Wash off with regular shampoo and comb out nits (see above section for combing)
Repeat twice in 1 and 2 weeks
Aggressive picking of nits can eliminate the mites, but every single nit needs to be removed. There are nit picking shops in the community that perform this, as well.
Any items that have been in contact with your child’s head within 24-48 hours prior to treatment will need to be cleaned such as bedding, jackets, hats, etc. Lice die within 1-2 days without a blood meal. Nits take 8-10 days to hatch and then it takes about nine or more days for the lice to become adults and lay eggs. Since it is possible for nits or lice to be on items used by the child prior to treatment, clothing and bedding should be washed in hot water. Dry on hot cycle for at least 20 minutes. Items that are not washable should be dry cleaned or put in a sealed plastic bag for two weeks to prevent hatched lice from getting a blood meal. Soak combs, brushes, hair bands, and barrettes in soapy hot water for one hour (or boil for five minutes). Carpets and furniture can be vacuumed daily. THERE IS NO NEED TO APPLY PESTICIDES
Call during Office Hours
• If above measure are not effective.
• Scalp looks infected (pus, soft scabs, open sores)
• Child is less than 2 months old
• Scalp rash or itch lasts more than a week after treatment
Hives are a type of rash that is blotchy, red, irregular, and itchy. They are commonly referred to as welts and they tend to move around. Hives can last from hours to weeks. Hives are often the result of an allergic reaction to food, medication, dyes or other allergens. They can be the first sign of a more severe allergic reaction. Hives also are commonly associated with viral infections.
Call immediately if:
Call during the day, preferably in the morning, if:
Call the office if:
Burns are heat (or friction) injuries of the skin. The injury can range from mild with just redness to severe injuries that go all of the way through all layers of the skin. The burn can begin as just a red spot and develop blisters minutes to several hours later.
Friction burns (a.k.a. ‘road rash’)
Call 911 if:
Call the doctor on call if:
Call the office if:
Minor head injuries are frequent and common. Most only require close parental observation.
Go To ER if your child:
We get many questions about prescribing antibiotics over the phone. With rare exceptions, it is against our office policy to do so. We consider prescribing antibiotics over the phone without examining your child poor medical practice. Many illnesses are caused by viruses, and antibiotics have no effect on such illnesses. Furthermore, your child may have an illness that is more serious than you suspect and giving an oral antibiotic may not be adequate treatment. Giving an antibiotic from a previous illness or from someone else’s prescription may mask serious symptoms and signs and can affect test results.
When you receive an antibiotic for your child, give it for the entire prescribed time. If you run out before the recommended time, call the office during the day for a refill. If your child develops allergic reactions to an antibiotic, stop the medication and call. If severe diarrhea develops, stop the medicine and call the office during the day.
See package directions for larger children.
* Avoid multisymptom medications.
** Avoid those containing antihistimines.