Glendale Peds Info for the Ill Child

What To Do When Your Child Is Sick

THIS INFORMATION IS ONLY FOR THE USE OF PARENTS AND PATIENTS OF GLENDALE PEDIATRICS

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.

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Fever

What is it?

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.

What you can do

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!!!

When to call

Call the doctor immediately if your child:

  • is extremely irritable or lethargic and does not improve after Tylenol or Motrin and a tepid bath.

  • has difficulty breathing.

  • has a stiff (not sore) neck or a spreading purple rash.

  • has a seizure (convulsion).

  • has a temperature over 105.5 taken rectally.

Call during office hours if your child:

  • is not improving after 48 to 72 hours of fever.

  • is becoming increasingly fussy.

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The Common Cold

What is it?

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.

What you can do

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.

When to call

Call our office if your child develops a cold with these symptoms:

  • Green or yellow discharge that lasts more than two weeks.

  • Congestion lasting more than two to three weeks.

  • Ear pain.

  • Difficulty breathing not improved with nasal suctioning and elevating her head.

  • Fever lasting more than three days.

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The Flu (Influenza)

What is it?

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.

What the flu is NOT

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.

What you can do

Call the office for an evaluation. For older children, some medicines can help if initiated in the first 24 to 48 hours.

  • REST!  Rest!  Rest!

  • Try to give fluids, including water, Gatorade and chicken soup.

  • The fever is not harmful. However, giving acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) can help relieve aches and pain. It is not recommended to give fever reducers around the clock, as the fever may help the illness resolve.

  • Elevating the head may help if your child cannot sleep at night due to nasal congestion.

  • Next year, consider getting a flu shot.

When to call

Call immediately if:

  • your child has very difficult or very rapid breathing. Note: Rapid heartbeat and rapid breathing are common with fever, so recheck when the fever is reduced.

  • your child has chest pain.

  • your child stops urinating for many hours.

  • he or she is not arousable or is delirious.

  • your child cannot keep down liquids or will not drink fluids.

Call the office if:

  • the extreme exhaustion is not better in 48 to 60 hours.

  • the fever is not going away in 96 hours.

  • the cough keeps getting worse after the first few days.

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Sore Throat

What causes it?

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.

What you can do

Sore throat is not generally an emergency, except as noted below. Treatment is designed to relieve pain.

  • Encourage fluids. Also, popsicles or cold milk products may relieve pain.

  • Chloraseptic spray and a pain reliever such as Motrin may help the discomfort (Motrin and Advil seem to help throat pain more than Tylenol).

  • Gargling with warm salt water may help in older children.

When to call

Call the doctor immediately if your child has a sore throat and:

  • one side of the throat is swollen and painful and the other side is normal.

  • he cannot open his mouth fully.

  • there is difficulty breathing.

Call during office hours if your child has a sore throat that:

  • lasts more than 24 hours and is not associated with a cough.

  • is accompanied by a rash.

  • is very painful.

  • is accompanied by severe vomiting or abdominal pain.

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Earache

What is it?

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.

What causes it?

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.

What you can do

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:

  • Give ibuprofen (Motrin or Advil).

  • Put anesthetic ear pain drops (such as Auralgan) or warm (not hot!) cooking oil into the ear. Do not do this if there is any discharge from the ear.

  • Elevating the head will reduce ear pain.

  • Elevate the head.

When to call

  • Notify the doctor on call if you have taken these steps and the pain is still severe.

  • If you suspect your child has an earache, call the office for an appointment. We cannot prescribe antibiotics over the phone. One third of earaches are not due to ear infections and not all many ear infections do not require antibiotics to resolve.

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Croup

What is it?

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.

What you can do

Take the following steps if your child develops croup:

  • Keep him or her calm.

  • Go out into the cool night air for 5 to 10 minutes to help breathing.

  • If this is not possible, steam up the bathroom or the shower.

  • If he or she is having a very difficult time, take a drive in the car with the windows down towards the nearest emergency room (dress appropriately).

  • IF THERE IS NO IMPROVEMENT, GO INTO THE EMERGENCY ROOM.

After you have settled your child down:

  • Keep the room cool and humid (a humidifier will help).

  • Elevate the head (he or she may sleep better in a car seat).

  • Avoid cold medicines.

  • You may find that sleeping in the same room with your child is easier so you can detect any changes in breathing.

When to call

Call during the day if your child:

  • has had a very difficult first night.

  • is still having noisy honking breathing in the day.

  • has croup that is not improving after a few nights.

  • has croup that comes on after a week of a cold.

Call immediately if:

  • the croup is severe and you cannot control the symptoms.

  • your child is sitting up, leaning forward, drooling, has his or her chin jutting out, and looks quiet.  This may be a very rare condition called epiglottitis, which is an extreme emergency.

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Diarrhea

What is it?

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.

What you can do

Infants

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:

  • Give only Pedialyte or similar fluid for 12 hours. Infants prefer plain Pedialyte.

  • Babies on milk formulas (such as Similac, Enfamil or Carnation Good Start) may need to switch to soy formula (Isomil, Prosobee, or Alsoy) or lactose-free formula for a week.

  • If he or she is on solid food, offer plain rice cereal with water, boiled potatoes, pasta, or bananas.

  • Probiotics may reduce the severity and duration of diarrhea.

  • Gradually return to a normal diet.

Older Children and Adolescents

  • Give Pedialyte or similar solution for 12-24 hours. Older children prefer grape, cherry or apple-flavored Pedialyte or Gerber electrolyte solution. Pedialyte popsicles are another form available.

  • Choose foods such as low-salt chicken broth with noodles, potatoes, crackers, bread, bananas, and cooked carrots. Probiotics may reduce diarrhea.

  • Lean meats provide the proteins needed to repair the bowel.

  • Avoid greasy or spicy foods, juices, milk, and soda.

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.

When to call

Call the doctor if:

  • your child appears to be dehydrated, with signs such as decreased urination, glassy eyes, lethargy, dry mouth, no tears, and sunken eyes and/or soft spot.

  • the stools are bloody or very mucousy.

  • the diarrhea lasts longer than one week.

  • your child has over ten large liquid stools per day.

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Vomiting

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:

  • Give one teaspoon of Pedialyte or similar electrolyte solution every ten minutes for small babies and every five minutes for older children. If this provokes continued vomiting, you should wait until the vomiting has completely stopped for one hour before restarting Pedialyte. If the vomiting will not stop after a few hours, go ahead and give one teaspoonful (5 ml or cc) every 5 to 10 minutes.

  • After he or she holds down one teaspoonful 8 to 10 times, you can begin to give one tablespoonful every 25-30 minutes for infants and every 15 to 20 minutes for older children.

  • After he or she holds this down four times, very gradually give larger amounts of liquid. Don’t give more than two ounces at a time for the first day.

  • Start a bland and starchy diet slowly, such as described in the “Diarrhea” section. Gradually return to a normal diet over the next several days.

When to call

Call the doctor if:

  • your child appears to be dehydrated, with signs such as decreased urination, glassy eyes, lethargy, dry mouth, no tears, and sunken eyes and/or soft spot.

  • your child cannot stop vomiting or will not hold down even very small amounts of liquid at a time.

  • there is severe diarrhea (see “When to call” in the Diarrhea section).

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Diaper Rash

What causes it?

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:

  • Protect the skin with large amounts of Vaseline or a barrier ointment containing at least 25% zinc oxide.

  • Do not wipe the skin if it is very raw. Rinse the urine and stool off.

  • Air out the diaper area three times a day to help the rash heal.

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:

  • Apply athlete’s foot cream or vaginal yeast cream containing miconazole or clotrimazole three times daily until the rash has been clear for two days.

  • If the skin is very raw, cover the cream with diaper ointment.

  • Airing out the diaper area three times a day will help the rash heal.

When to call

Call during office hours if none of these measures work.

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Constipation

What is it?

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:

  • the stools are very firm, hard, or pellet-like.

  • your child has difficulty passing the stools.

  • he or she is bloated or having abdominal pain due to the constipation.

What you can do

Infants under Six Months

  • Changing to a different formula may help (some are less constipating).

  • Add one teaspoon of sugar to four ounces of formula.

  • Use one or two Pedialax liquid or glycerin suppositories. Note: This should only be done in very rare circumstances.

  • Babies over four months of age can take prune, plum or pear juice.

Older Infants and Children

  • Prune, plum or pear juice may help.

  • High-fiber cereals with 8 to 10 or more grams of fiber per serving will help.

  • Avoid starches, bananas and cheese—these foods are constipating

  • For toddlers in acute distress, give glycerin suppositories or Pedialax Liquid Glycerin Suppositories.  If this fails, try a Pedialax Enema. Note:  this should only be done in very rare circumstances.

  • In older children with distress, give one Pedialax Enema. If there are no results in 1 to 2 hours, repeat the enema. Note:  this should only be done in very rare circumstances. Do not give more than 2 enemas without consulting your pediatrician.

When to call

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.

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Bloody Noses

Bloody noses are common. They occur frequently when the weather is hot and dry, the heater is on, or during colds or allergy attacks.

What you can do

If your child has a nosebleed:

  • Have him or her sit up and lean forward. Squeeze the lower half of the nose together (the entire nose below the nasal bone that can be squeezed flat, not just the tip or the ends of the nostrils).

  • Hold this for five minutes (use a clock).

  • If the bleeding does not stop, hold it for ten minutes.

  • One or two hours after the nosebleed push a small amount of antibiotic ointment or Vaseline into each nostril, then gently squeeze the nostrils and wipe off the excess ointment.

When to call

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.

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Pink Eye (Conjunctivitis)

What is it?

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.

What you can do

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.

When to call

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.

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Lice

What is it?

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.

What you can do

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.

Cetaphil option

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

Nit Picking Option

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.

Cleaning

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

When to call

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

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Hives

What is it?

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.

What you can do

  • Oral Benadryl will usually stop the itch and diminish or clear the rash temporarily. This can be repeated every 6 hours.

  • Make note of and stop any new or possibly offending foods or medicines.

When to call

Call immediately if:

  • the hives are associated with hoarseness, difficulty breathing, generalized swelling or weakness.

  • there are water-filled blisters with them.

Call during the day, preferably in the morning, if:

  • your child is on an antibiotic or other prescription medication that you stopped because of the development of hives.

Call the office if:

  • the hives are lasting for days or are associated with other worrisome symptoms.

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Burns

What are they?

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.

What you can do

Thermal burns

  • Immediately remove any overlying clothing and diaper and run cold tap water on the burn.

  • Cooling the burn immediately and for 15-30 minutes continuously can decrease the pain as well as the depth of the burn. Even if the burn looks terrible, start cooling first prior to making a decision about if you need to call us or 911.

  • Immediately remove any overlying clothing and run cold tap water on the burn.

  • Put wash cloths or gauze into ice water and rotate those cloths onto the burn over and over for a very long time.

  • After the cooling, if blisters are not broken, gently wash them and apply antibiotic ointment and a dressing to protect the blisters.

  • If the blisters are open, wash the area gently, carefully remove the cover of the blister, apply antibiotic ointment and a sterile gauze and covering.  Re-dress every 2-3 days, unless the burn was dirty (see below).

Friction burns (a.k.a. ‘road rash’)

  • Gently clean out all of the dirt and gravel and sand (failure to do so can result in a ‘tattoo’).

  • Apply antibiotic ointment and cover with a plain gauze.

  • Re-dress daily for 2 days then every 2-3 days, or if it gets dirty or wet.

When to call

Call 911 if:

  • the burn was the result of a large fire, is associated with coughing and/or breathing difficulty or smoke inhalation.

  • the burn covers a large area of the body. 

  • your child has other generalized symptoms, such as weakness or altered level of consciousness.

Call the doctor on call if:

  • the burn is large and you are unsure if you need to call 911.

  • your child is still in considerable pain despite 40-60 minutes of cooling and a dose of ibuprofen.

Call the office if:

  • the burn is moderately large with either open or intact blisters.

  • the skin around the burn is becoming increasingly red and/or tender in the days after the burn.

  • the burn is not healing.

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Head Injuries

What is it?

Minor head injuries are frequent and common. Most only require close parental observation.

What you can do

  • Observe your child
  • Use cool packs to reduce swelling
  • Wake your child every 2 to 2.1/2 hours for the next 24 hours and see if they react normally to you (as normal as possible in the middle of the night). 

Go To ER if your child:

  • loses consciousness
  • is persistently dazed
  • has repeated vomiting
  • is persistently crying
  • if the skull is dented in (not a bump)

When To Call

If you are unsure what to do.

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A word about antibiotics

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.

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Dosage Chart

 

During 2011 and 2012, the pharmaceutical industry is planning to discontinue the 80 mg/0.8 mL concentration of acetaminophen infant’s drops.
Eventually, all acetaminophen will be in the labeled as “infant’s acetaminophen” on the shelf.
Be sure to check which concentration you have before giving a dose to your child.
If you have any questions regarding which strength you have and how to dose it, please speak with your pharmacist or call our office.

 

dosing12-15-2011

See package directions for larger children.

* Avoid multisymptom medications.
** Avoid those containing antihistimines.

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