Medical Topics

On the Pinwheel Pediatrics website you will find remedies and advice related to the most common illnesses and problems that affect children. This information is meant to be useful in conveying general information and it may or may not be applicable to your child. Readers should always consult a physician or his/her office before implementing any treatment plan. This information, without specific, express instructions from one of the physicians of Pinwheel Pediatrics, should not be relied upon as medical advice. If you have a life threatening emergency, please dial 9-1-1.

    • ADHD
    • Anxiety
    • Abdominal Pain
    • Asthma and Wheezing
    • Back Pain
    • Burns
    • Chest Pain
    • Colic
    • Constipation
    • Coughing
    • Croup
    • Crying
    • Diarrhea
    • Difficulty Breathing
    • Earache
    • Fever
    • Headache
    • Hives
    • Lymph Nodes
    • Lice
    • Neck Pain
    • Nosebleed
    • Pink Eye or Eye Discharge
      (Conjunctivitis)
    • Poisoning
    • Rashes
    • Seizure
    • Sore Mouth
    • Sore throat
    • Stuffy or runny noses, colds, and
       nasal congestion
    • Teething
    • Thrush
    • Urination Pain
    • Vomiting

ADHD

Children are naturally more active, more exuberant, less attentive, and more impulsive than adults. Usually children outgrow these behaviors and they do not impact how they function at school and home. In some cases a child's attention span is so short, activity level so high, and impulse control so limited that his or her behavior is clearly extreme and negatively impacting his or her quality of life. If you feel that this description fits your child, you may wish to consider an evaluation for ADHD or Attention-Deficit/Hyperactivity Disorder. Below you will find useful information and our standardized evaluation forms.

1.General Information
   • Does my child have ADHD?
   • Information for parents with children with ADHD

2.Evaluation - These evaluation forms may be printed in advance and completed by
   both parents and the child's teacher prior to a consultation with the doctor.
   It is helpful for the doctor to have time assessing these forms prior to your visit.
   • Evaluation form for parents
   • Evaluation form for teachers
   • Evaluation form for doctor
   • Follow-up evaluation for parents during treatment
   • Follow-up evaluation for teacher during treatment

3.Treatment
   • About Medications
   • Behavioral techniques parents may institute


ANXIETY

Anxiety disorders are among the most common childhood psychiatric illnesses. Children and adolescents who are afflicted with anxiety often experience considerable distress and impairment in their day to day functioning. They may avoid situations that are important for their optimal development, such as school, peer involvement and functioning independently from parents. Anxious children/teens are also more likely to experience problems with their mood, conduct and overall functioning with family and peers.

If you are concerned that your child is suffering from anxiety, you should set up an appointment to discuss the possibility with your pediatrician. Prior to attending this meeting it can be helpful if you fill out one of the below forms and fax them or email them to info@pinwheelpediatrics.com in advance of the appointment.

    1.Questionairre to be answered by child
    2.Questionairre to be answered by parent

ABDOMINAL PAIN

Indicates any stomach ache, pain or discomfort located between the bottom of the rib cage and the groin area. During infancy, six or more severe short-lived painful episodes of stomachache that occur regularly every 10 to 60 minutes accompanied by severe screaming may indicate an intestinal obstruction. Abdominal pain plus yellow or green vomiting may also indicate a serious problem and you should go to your local emergency room. Abdominal pain in the lower abdomen, increasing in intensity and lasting six or more hours may also be serious and you should see your pediatrician or call the physician on-call for guidance. Severe abdominal pain one hour after a major injury to the abdomen (auto accident, sports injury, sledding injury) may also be important and we should be notified promptly.

Home Treatment: Lying down can sometimes relieve stomach pains. Offer clear fluids and keep a vomiting pan close by. Encourage your child to have a bowel movement or use a glycerin suppository; this may relieve pain due to constipation. Avoid using medicines like Advil/Motrin/Iboprofen as these could irritate the stomach lining and make the pain worse. One or two doses of Tylenol® may be used. Persistent, nonremitting pain for longer than six hours should prompt a call to the pediatrician. Also see colic instructions.

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ASTHMA AND WHEEZING

Wheezing is a high-pitched sound usually heard when you are breathing out. It may also be accompanied by signs of respiratory distress such as fast breathing (>60 breaths per minute in an infant, >40 breaths per minute in a child), retractions (pulling in of the abdominal or neck muscles or muscles around the ribs), feeling of shortness of breath or difficulty in taking in a deep breath. Children in moderate respiratory distress may also appear anxious and be unable to talk in complete sentences.

Home Treatment: If your child is wheezing , but not having difficulty breathing, then keep him or her comfortable, and make sure he or she drinks plenty of fluids. Treat any associated fever with Tylenol® or Motrin® and call the office in the morning. If your child has been diagnosed with asthma and you have medications at home, you should use them as instructed. Albuterol, Proventil, Ventolin, or Xopenex is your child's "rescue medicine" and should be given during an acute wheezing attack and every 4 hours as needed. Your child should also continue to take his or her prescribed steroid inhaler. If your child is having any serious breathing difficulty or needs the rescue medicine more often than every 4 hours then call your pediatrician or go to the emergency room.

Relevant Links:
Recognizing an Asthma Attack

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BACK PAIN

Back pain caused by an auto accident or other injury can often wait until the office opens. However, if the accident was serious and the child has weakness, loss of feeling in one or both legs, or is experiencing severe pain, contact the emergency department. Back pain associated with fever or vomiting may be caused by a kidney infection (rarely a kidney stone) or a generalized flu-like illness. If the pain is truly severe and not relieved by Tylenol® or Motrin®, and is associated with fever call your pediatrician.

Home Treatment: Back pain can be reduced by a warm heating pad, a warm bath, and administration of Tylenol® or Motrin®. Collect a urine specimen in a clear jar and examine it for red color. Save the specimen for us to examine even if it appears clear. Refrigerate specimen and call our office in the morning so that you may bring in the specimen.

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BURNS

Simple burns do not blister and remain red. Burns with large blisters or deep burns with dead white skin such as from a flame or hot lawn mower or motorcycle muffler should be medically attended to within 6-8 hours. Severe burns, that cause charring to the skin or cover more than 10% of the body, should be seen in the emergency department immediately. All burns involving electricity should go directly to the emergency room.

Home Treatment: As with many other pains, Tylenol® or Motrin® as well as the application of a heating pad may be helpful to get through the night. If your child's chest pain is severe, go straight to the closest Emergency Room.

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CHEST PAIN

Unlike adults, chest pain in children is rarely serious. Chest pain during a serious attack of asthma, or chest pain during an illness with high fever and constant coughing should be communicated to your pediatrician. Sharp chest pain with every breath is important enough to call the doctor, even after hours.

Home Treatment: As with many other pains, Tylenol® or Motrin® as well as the application of a heating pad may be helpful to get through the night. If your child's chest pain is severe, go straight to the closest Emergency Room.

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COLIC

Babies younger than three months can sometimes have painful episodes with prolonged crying and difficulty in being calmed or soothed. Crying can be intense and last for several hours without pause. There are several causes for such behavior including gas pains, reflux of stomach acid into the swallowing tube (esophagus), milk intolerance, infections, constipation, and obstruction of the intestinal tract. If your child is screaming for several hours and cannot be calmed after using the following ideas, please call your doctor or go to the Emergency Room.

Home Treatment: Before calling us try to calm the baby by rocking the baby, swaddling the baby with a sheet or blanket, playing soothing music, humming softly into the baby's ear, or letting the vacuum cleaner or ceiling fan run. Sometimes a ride in the family car does wonders. It is safe to offer Mylicon drops (1/2 dropper), Maalox (1/2 dropper), or Tylenol®. Sometimes the colic is caused by stool in the rectum and pain on its passage so the baby tries to squeeze the anus muscles to keep the stool from passing. This can be helped by insertion of an infant glycerin suppository into the baby's anus and keeping it there for five minutes (squeeze the buttocks together while the suppository is inside).

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CONSTIPATION

Constipation refers to the absence of a bowel movement for 4-5 days or the inability to pass an extremely hard stool. Breastfed babies and babies less than 1 month can have infrequent stools. Constipation problems can wait until the office opens the next morning.

Home Treatment: You may treat your child with a glycerin suppository available at your pharmacy. For children older than two years treat with an enema for children - see how to give an enema below. Often, taking a younger child's temperature with a rectal thermometer will also stimulate a bowel movement. Never give corn syrup or honey to infants because of the risk of botulinism.

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COUGHING

One of the most frequent reasons for after hour phone calls is coughing in children.
Call your pediatrician if the coughing is very frequent and is associated with a fast rate of breathing, a marked reduction (50%) in drinking or sleeping, and/or a temperature greater than 103° F. Unless breathing is very rapid or strained, even pneumonia can wait until the next day. Also call for children with asthma who have needed oral steroids like Orapred or Prelone in the past. If your child has asthma and is coughing, please give his or her asthma medication and call the doctor if there is major breathing difficulty or if the cough persists despite their medications. If your child has a cough with fever and also a moderate decrease in activity or appetite you should call the office in the morning to schedule an appointment.

Home Treatment: Some coughs MAY be helped temporarily by giving a cough suppressant like Robitussin DM, but given the potential side effects SHOULD NOT be used in those under 6 years of age. Bear in mind that all over-the-counter medications for cough and runny nose will not shorten the course of your child's illness and will only provide temporary symptom relief. Humidifiers and nasal saline rinses and sprays are particularly helpful in those with congestion and runny nose. If the child's cough is bothering you more than the child, it can usually wait until morning. If there is almost continuous coughing associated with difficulty in breathing you should contact the physician.

Relevant Links:
Common Questions about Over-the-Counter Medications

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CROUP

Croup is an upper respiratory infection caused by a virus, which usually results in barky (seal-like) cough, runny nose and fever. Signs of respiratory distress can occur which are indicated by fast breathing (> 60 breaths per minute in an infant, > 40 breaths per minute in a child), retractions (pulling in of the abdominal or neck muscles, or muscles around the ribs), and stridor when the child is at rest (high-pitched noise made when you are breathing in.

Home Treatment: Children often breath fast from fever alone. Therefore treat the fever with Tylenol® or Motrin® and make sure your child is drinking fluids. If signs of breathing difficulty are present or the child is having prolonged coughing attacks, then take the child in the bathroom, turn on the hot shower and sit outside the shower in the steam (do not put child into the hot water). Moist, cool air may also help. Try taking the child outside in the cool night air or standing in front of an open freezer door or window in the house. If signs of breathing difficulty persist or the child appears listless or dehydrated then call your doctor or go to the nearest emergency room.

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CRYING

Infants are too young to tell or show us the cause of crying. Most crying occurs in the first year of life, but can occur in older children. Crying can occur with pain, hunger, illness and tantrums. If your child is under 3 months of age and has been crying more than 2 hours, call our office. If your child (any age) has a high-pitched continuous scream after vaccinations, call our office. If your child is a newborn with persistent crying and has a temperature less than 98.6° F or higher than 100.4° F, please contact a physician. If your child has swallowed a foreign object and is now crying excessively, go to your local emergency room. If your child has a stiff neck or bulging soft spot (known as the fontanelle) accompanied by crying go to the emergency room. If your child has fallen, is very irritable or seems very sick or weak call your physician.

Home Treatment: Before calling us try to calm the baby by rocking the baby, swaddling the baby with a sheet or blanket, playing soothing music, humming softly into the baby's ear, or letting the vacuum cleaner or ceiling fan run. Sometimes a ride in the family car does wonders. It is safe to offer Mylicon drops (1/2 dropper), Maalox (1/2 dropper), or Tylenol® if your child is over 6 weeks of age. Sometimes the crying is caused by stool in the rectum causing pain as it passes. Often the child squeezes the anal muscles to keep the stool from passing. This can be helped by insertion of an infant glycerin suppository into the baby's anus and keeping it there for five minutes (squeeze the buttocks together to keep the suppository inside).

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DIARRHEA

Diarrhea means at least three loose, watery stools within 24 hours. After the first year of life, it takes at least 10-12 high volume watery stools before significant dehydration can occur. If a large amount of blood or stringy mucus presents in the stool or if there is severe continuous abdominal pain, then you should call your physician.

Home Treatment: As long as your child can keep food and liquids down, the rule of thumb is to feed through the diarrhea. This means formula or breastfeeding should continue in infants, and children can continue on their regular diet. We would advise you to minimize the juice intake of your child, as this can contribute to further loose stools, but otherwise there are no restrictions. Offer Pedialyte solution, or a similar product (no prescription necessary), or Pedialyte Popsicles, when your child is unable to tolerate (vomiting or nausea present) his or her regular diet. Do not give only water as this may lead to other complications. After each large watery stool, at least two more ounces (60cc) of fluids containing sugar and electrolytes (gatorade or pedialyte) should be given if possible.

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EARACHE

Ear pain may be caused by an infection, referred pain (as from a sore throat or dental problem) or Eustachian tube dysfunction (often in the presence of a cold). Most ear pain can be managed by you during the night and seen in the office the next day. Occasionally an eardrum may rupture during an infection. You may see yellow fluid with some blood in the ear canal or on your child's pillow or shirt. This actually relieves the pressure and pain that your child was experiencing. Do not be alarmed because most eardrums will repair themselves, but you should be seen in the office the next day. Approximately 50% of ear infections are either caused by a virus or will cure themselves without the need of antibiotics; therefore there is no advantage to starting an antibiotic in the middle of the night.

Home Treatment: Give your child an adequate dose of Tylenol® or Motrin® every 4-6 hours and consider using a heating pad on the lowest setting for brief periods. Also, a small amount of warmed (not hot) mineral or olive oil instilled into the ear may help relieve pain.

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FEVER

Fever is best defined as a temperature of 100.4° F or higher. For children under 2 years of age, the most reliable method of taking the temperature is with a rectal thermometer. If an elevated temperature in this age group is measured via the ear or under the arm, please verify it with a rectal temperature before contacting your pediatrician. If your child is under 1 month of age, please contact a doctor immediately regardless of the time of day if he or she has a rectal temperature higher than 100.4° F. Also contact your pediatrician for any child who has a temperature of 104° F or higher. Signs of possible serious illness include a 50% or greater decrease in liquid intake or a 50% or greater decrease in playful activities while taking Tylenol® or Motrin® to bring the temperature down. We also must be notified promptly for any fever accompanied by a dark red-purple rash and a very irritable or very sleepy child of any age.

Home Treatment: Dress your child lightly in cotton clothing. Give Tylenol® or Motrin® to bring down the fever. Warm sponge baths or sponging the child's head with warm water can also help to bring down high fevers. Offer frequent fluids. Keep in mind that fever is a normal response to infections that offers some protection against the rapid growth of organisms in the child's body. It is a symptom that need not be treated (except in young infants) if the fever is low grade (less than 102° F) and the child feels and behaves normally despite an obvious source for the fever like a viral cold. When nausea, vomiting or irritability make oral fever products too hard for your child to take, FeverAll® can help. FeverAll® is a suppository form of acetaminophen (Tylenol®).

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HEADACHE

Headache presents as pain or discomfort of the scalp or forehead area. Severe headaches that cause crying or extreme pain, persist longer than 1 hour, and cannot be relieved by Tylenol or Motrin in appropriate doses may be serious and should prompt a trip to the doctor. Headaches following a head injury should always be brought to the attention of your physician. Please contact a physician if the headaches is associated with confused thinking, unsteady walking, blurred vision or weakness. Children with headaches accompanied by high fever and vomiting should be brought to the Emergency Department to evaluate for meningitis.

Home Treatment: If none of the above signs are present you may try Tylenol® or Motrin®. Resting your child in a darkened, quiet room, and the application of a heating pad or cold compresses may also be of benefit.

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HIVES

Hives are raised itchy white bumps with surrounding redness of the skin. They can be dime sized or extend to several inches with a jigsaw puzzle shape. They may rapidly appear and disappear. Unless there is noticeable swelling of the lip(s)and tongue or breathing difficulty, generalized hives are usually not an emergency. Stinging insects, peanuts or tree nuts, and shellfish allergies are an exception to this rule and should prompt a visit to the physician

Home Treatment: First aid includes administration of an antihistamine medicine, Benadryl®, which can be purchased without a prescription.

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LYMPH NODES

Lymph nodes may increase in size with viral and bacterial infections. Minor throat infections and colds can cause the lymph nodes in the neck to double in size. Mild enlargement and tenderness represent the inflammatory response that is needed to defend against infections. You may notice that your child has a swollen node that is larger on one side of the neck, armpit or groin as compared to the opposite side. Normal nodes are usually less than 1/2 inch across which is about the size of a pea. Nodes seen with a viral infection are usually 1/2 to 1 inch across. Nodes seen with a bacterial infection are usually greater than 1 inch across. If the lymph node is in the neck and causes difficulty with breathing, see a physician immediately. If your child has a fever greater than 104° F or if the skin around the node is red and the node is increasing in size at a rapid rate call your pediatrician.

Home Treatment: Give Tylenol® or Motrin®. as needed for fever or pain relief. Avoid squeezing or touching the lymph node. After the infection is gone the node will slowly return to the normal size over the next 2-4 weeks. They often remain afterwards, but are very small and almost unnoticeable to the touch.

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LICE

Lice are not dangerous and more importantly are not an emergency. While it is adviseable you see your pediatrician, the visit can wait until the following day.

Home Treatment: Anti-lice shampoo such as Nix can be purchased without a prescription. Follow the directions on the box

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NECK PAIN

Persistent neck pain after a bad fall or neck pain in a young child with high fever, irritability, or excessive sleeping should be addressed by a physician. In particular, pain on flexing or extending the neck is suggestive of meningitis and can be an emergency.

Home Treatment: A simple stiff neck can be helped by pain medicine (Tylenol® or Motrin®) and application of heat. It may also be helpful to apply a towel roll around the child's neck.

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NOSEBLEED

Simple nosebleeds require only five minutes of direct pressure with the fingers over the soft flared out part of the nose. The child should be sitting or reclining in a chair or bed during this time. Do not have child tip head back, this will cause the blood to drip in the child's throat and could cause vomiting. If the bleeding stops, insert a Vaseline-coated, rolled up facial tissue or toilet tissue into the nostril to act as a tampon. If you cannot stop the bleeding after multiple attempts, go to the nearest emergency department.

Home Treatment: If the bleeding does not stop after direct pressure or recurs, clear out any large clots, then saturate a tissue roll with regular strength nose drops (0.5% phenylephrine or Afrin) and insert the roll into the nostril. Leave it in place for 15 minutes. Then insert a Vaseline-coated fresh tissue roll leave in place for 20 minutes. If unable to stop the bleeding or if multiple nosebleeds occur in conjunction with other sources of bleeding including from the urine, stool, or mouth please seek medical attention.

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PINK EYE OR EYE DISCHARGE (Conjunctivitis)

Conjunctivitis or pink eye has a number of causes, some which do not require antibiotics. Including among these is trauma, chemical irritants, allergy and viral causes. Painful and itchy eyes that excrete pus (yellow or green) represent the time when antibiotic drops are appropriate. Chemical injury and trauma represent the time when a timely visit to the doctor is in order. Unless vision is affected, most cases of pink eye can wait until the office is open.

Home Treatment: In the case of a foreign body or chemical irritant affecting the eyes, flush the eyes out with water. Other causes of pink eye may be temporarily treated with warm water or saline eye compresses using a clean cloth handkerchief or face towel; apply for 5 to 10 minutes several times daily.

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POISONING

If you child ingests a substance or medication you are uncertain of, please call poison control immediately: 1-800-222-1222.

Home Treatment: Keep the product close by so that you may describe the contents to the poison control staff. Do not give ipecac or induce vomiting unless instructed to do so by a physician or poison control. The most dangerous poisons include: iron pills, prescriptions drugs and non-prescription drugs, Tylenol®, pesticides, windshield washer solution, antifreeze, all household cleaners, alcoholic beverages, furniture polish, lamp oil, gasoline, kerosene and paint thinners. If unsure of an ingestion, be cautious and contact poison control: 1-800-222-1222.

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RASHES

Rashes are very common and rarely require immediate evaluation. Many times the rash is associated with a virus. Often the child has had cold symptoms and fever for a couple of days and then breaks out into a rash. Theses rashes are usually red raised bumps (without pus or fluid in them) on the trunk and extremities. These require no treatment and will go away in a few days. Rashes that appear to have fluid or pus in them could be chickenpox, herpes or impetigo. These should be evaluated the next day. If you have a newborn with severe fluid/pus filled rash, please call your doctor promptly. Hives are red raised welts often with associated blotchiness. They are usually itchy and new lesions tend to come and go over a period of hours. These may be triggered by an allergic reaction or infection and may be treated with Benadryl®. If there is any associated breathing difficulty, wheezing or swelling of the lips or tongue then you should seek immediate medical attention. Hives can come and go over a period of weeks. If they are lasting longer than 4-6 weeks then schedule an appointment. Immediately call the doctor for any dark red or purple rash, especially if accompanied by fever, sleepiness or irritability.

Home Treatment: Benadryl® may be used for hives and allergic reactions. Soak child in a warm (not too hot) bath for itchy rashes. Add Aveeno oatmeal or one cup of baking soda (not Baking powder) to the bath water. Over the counter creams and lotions may be applied to dry itchy skin. Most rashes can go untreated.

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SEIZURE

An episode of brief loss of consciousness, often with the eyes rolling upward or deviating to one side or the other, in conjunction with rhythmic movements or stiffening of the arms or legs may represent a seizure. If lasting longer than 15 minutes, occurring after a bad fall or injury, or associated with blueness around the lips or face, call 9-1-1. In all other situations, call your physician for guidance. Check your child's room or surroundings for evidence of poisoning by pills, alcoholic beverages, cleaning solutions, or insect spray.

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SORE MOUTH

Mouth pain is sometimes caused by viral blisters and ulcers or thrush, (see under Thrush) which is a yeast infection. If there is any evidence of ingestion of poison, lye, or dishwashing powder as a reason for the mouth sores, call poison control or the INOVA Fairfax Emergency Department immediately. The major goal about blisters or ulcers in the mouth is the reduction of pain and prevention of dehydration.

Home Treatment: Administration of Tylenol® or Motrin®, or sucking on something cool like ice chips, Slurpees, or Popsicles will usually help the child to drink and get some sleep.

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SORE THROAT

A sore throat may be caused by a viral or bacterial infection. Sore throat along with fever, headache, stomachache or nausea may indicate a strep throat infection. Most throat pain can be managed by you during the night and seen in the office in the next day or so. Contact your doctor for any sore throat associated with breathing difficulty, drooling due to difficulty in handling secretions, or dehydration.

Home Treatment: Give your child an adequate dose of Tylenol® or Motrin® every 4-6 hours as needed. Offer cold drinks or Popsicles, gargling with salt water, throat lozenges, or trying an over-the-counter numbing spray (Chloraseptic). Even if your child has strep throat, they may be safely seen in the next 1-2 days.

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STUFFY OR RUNNY NOSES, COLDS, AND NASAL CONGESTION

During the first year of life, a stuffy nose may cause much difficulty breathing. Green or yellow color of nasal discharge does not mean your child has a sinus infection. In fact it is very unlikely unless it is present with high fever and has lasted longer than eight days without improvement. The child with runny nose does not require a visit to the doctor unless the child's day care center insists that the child be seen by a physician before return to day care or accompanied by ear pain suggestive of an ear infection.

Home Treatment: At any age, use of 2-3 drops of saline nose drops (Ocean, Nasal, or generic) into each nostril, repeated every 3 to 4 hours, may be helpful. If you have a room vaporizer or humidifier, fill it with fresh water and run it in the child's room. For children over the age of 6 years old, an oral decongestant such as Dimetapp, PediaCare, or Triaminic MAY alleviate some symptoms. If there is no obvious benefit from these medications, they should not be used. These medications WILL NOT shorten the course of the illness.

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TEETHING

Unless you can see or feel tooth swelling, the cause of the pain is not from teething. Teething should not cause a temperature greater than 101° F and if the temperature is higher, it probably is due to another reason.

Home Treatment: Babies who seem to have teething pain can improve with Tylenol® or Motrin®, sucking on Popsicles or ice chips, rubbing the babies gums with a finger, applying over the counter teething gel, or letting the baby bite down on a hard pretzel or bagel. Some dentists suggest application of a warm wet teabag against the painful erupting tooth for pain relief.

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THRUSH

Thrush is usually an annoying but non-serious disease of the first few months of life. It presents as cottage cheese-like patches in the mouth, on the child's cheeks, palate, and tongue. When the white patches are scrapped or rubbed away, there is often an angry red color under the patches. Thrush can always wait until the morning to be treated. Call the doctor's office during normal hours for instructions.

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URINATION PAIN

Pain on urination is not always due to infection. Irritants such as bubble bath or use of antistatic products such as Bounce or Cling-Free can also cause pain on urination.

Home Treatment: First aid includes orally administered Tylenol® or Motrin® and application of a Benzocaine-containing ointment over the urethra (the part of the private area where urine comes out). Such ointments are found as hemorrhoid ointments such as preparation H or Anusol. Do not force fluids until the pain is gone. Collect a clean urine specimen and refrigerate it until you can bring the child with the urine specimen into the office during normal office hours.

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VOMITING

Vomiting refers to forceful throwing up of stomach contents more than three separate times. Normally, vomiting contains only about a few teaspoonfuls after the stomach is empty of food. It takes at least 8 hours for dehydration to occur, unless there is also serious diarrhea (at least 6x/day) with the vomiting. Call your pediatrician if there is yellow or green-colored vomit in any child younger than two years old, especially in the first 30 days of life because this could mean an intestinal obstruction. Vomiting plus pain in the abdomen lasting at least six hours may be important and you should call the doctor promptly. Also call for persistent vomiting more than two hours after a bad head injury. Vomit containing only a small amount of blood can wait until daylight.

Home Treatment: For bottle fed infants offer Pedialyte in small amounts (1-2 teaspoons every 5-10 minutes), after four hours without vomiting increase the amount of fluid. After 8 hours without vomiting return to normal formula feeds. For Breastfed infants, nurse for 5 minutes every 30-60 minutes. Return to regular feeds after no vomiting for 8 hours. For older children, give small amounts of clear fluids frequently. Give 1-2 teaspoons of clear liquids (Pedialyte, water, ginger ale, Gatorade) or ice chips every 5-10 minutes. After 4 hours of no vomiting increase amounts slowly and after 8 hours of no vomiting, offer small amounts of bland solids. ("BRAT" diet: Bananas, Rice, Applesauce and Toast). Do not give only water.

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