Common Illness

Allergies (Allergic Rhinitis)
The Common Cold (Upper Respiratory Infections) | Ear Infections (Otitis Media) | Fever | Gastroesophageal Reflux (GER) | Rashes | Sore Throat (Pharyngitis) | Trauma, Burns, and Head Injuries | Vomiting and/or Diarrhea (Gastroenteritis) |

Allergies (Allergic Rhinitis)

Introduction:

Allergic rhinitis is very common and is also known as nasal allergies. If allergy symptoms occur only at certain times of the year, such as the spring or fall, this is known as seasonal nasal allergies or "hayfever." If allergy symptoms occur all year long, this is called perennial nasal allergies.

Causes/Triggers of Allergies:

Pollen
House-dust mites
Mold
Animals

Symptoms:

Runny nose
Nasal congestion or stuffy nose
Sneezing
Itchy nose
Watery, itchy eyes
Itchy throat
Red eyes
Darkening under the eyes (allergic shiners)
Swollen eyes
Dark crease below the bridge of the nose (allergic salute)

Treatment

Prevention

Prevention is very important. Try to avoid exposure to the avoid triggers.
Keep car and house windows closed during high pollen seasons and use air conditioning.
After playing outside, take a shower or bath and wash the hair. Pollen can collect on skin and hair.
Keep kitchens, bathrooms, and basements well ventilated to reduce humidity and mold.
Keep pets out of a child's bedroom, and wash cats/dogs weekly to limit pet dander.
Remove carpets and rugs from a child's room and replace them with hardwood floors or tiles.
Cover mattresses, box springs, and pillows in allergy-proof covers.
Wash sheets and blankets weekly in hot water.
Vacuum floors and dust surfaces weekly.

Medications

There are several possible medications that can be used.
Antihistamines (Claritin, Benadryl, Zyrtec, or Allegra) relieve symptoms of sneezing, runny nose, and itchy, watery eyes.
Leukotriene blockers (Singulair) relieve symptoms of sneezing and stuffy, runny, or itchy nose.
Nasal sprays (Flonase, Rhinocort, Nasonex) relieve nasal congestion, sneezing, and runny nose.
Decongestants relieve nasal congestion.
Some children receive allergy shots.

Call the office for the following:

If you want to make an allergy appointment to discuss your child's symptoms
If the above prevention methods are not working.
If you feel your child may benefit from daily medication.

Resources

The Common Cold (Upper Respiratory Infections)

General:

A cold or upper respiratory infection is a viral infection of the nose and throat. The cold is spread from person-to-person by hand contact, coughing, and sneezing. Colds are NOT caused by cold air or drafts. Most healthy children get at least six colds a year and sometimes up to 10-12 a year.

Symptoms:

Runny or stuffy nose
Cough
Possibly a fever or sore throat
Sometimes hoarseness, red eyes, and swollen lymph nodes

Expected Course:

Fever can occur as a cold is starting and usually lasts less than 3 days. Most nose and throat symptoms are gone in a week. A cough can last 2 to 3 weeks.
Watch for signs of secondary bacterial infection if a fever develops several days to a week after a cold begins. Bacterial infections can be signified by earaches (ear infections), yellow or green drainage from the eyes (conjunctivitis or pink eye), or difficulty breathing (pneumonia).

Home Care:

For a runny nose with a lot of clear discharge, blowing the nose or suctioning with a bulb syringe can help.
For a dry, stuffy, or blocked nose, use warm water or saline nasal drops to loosen up the dried mucus, followed by blowing or suctioning the nose with a bulb syringe. Instill 1-2 drops into each nostril and then suction or blow the nose after 30-60 seconds. Nasal washes can be done up to 3 times a day with nasal saline drops that can be purchased over-the-counter at your local drugstore. Little Noses and Ocean make nasal saline drops that can be found in the cold medication aisle.
Humidifier and hot mist showers help moisten the air and allow stuffy noses to drain and are soothing for children with colds.
Most cold medications are not helpful. Try to avoid giving cold medications to children under 9 months of age.
Keep in mind that oral decongestants can make a child jittery or keep him/her from sleeping at night. Vapor rubs can be used on the outer clothing of the chest in children over 3 months of age.
Antibiotics are not helpful for colds unless a secondary bacterial infection has developed.

Call the office for the following:

Fever > 100.4°F in a baby less than 90 days
Fever > 105°F
Fever that lasts longer than 3 days
Difficulty breathing (the child's chest is moving heavily, pulling of muscles between the rib cage can be seen, or the nostrils are flaring)
Eyes develop a yellow or green discharge
Concerns for ear pain
Severe sore throat that lasts longer than 24 hours
Cough that lasts longer than 3 weeks
Fever goes away for more than 24 hours and then returns
Child looks or becomes worse

Ear Infections (Otitis Media)

Introduction

Otitis media is an infection of the middle ear that usually occurs after children have had a cold for several days. Next to the common cold, an ear infection is the most common childhood illness. Most children have at least 1 ear infection by the time they are 3-years-old.

Risk Factors:

Age: the size and shape of an infant's ear makes it easier for an infection to develop. Ear infections occur most often in children between 3 months and 3 years of age.
Family history: children are more likely to have repeated ear infections if a parent or sibling also had repeated ear infections.
Colds/allergies: colds often lead to ear infections, and children in group child care settings are likely to get more colds. Allergies that cause stuffy noses can also lead to ear infections.
Tobacco smoke: children exposed to secondhand tobacco smoke are at increased risk for ear infections.
Bottle-feeding: babies who are bottle-fed, especially while lying down, get more ear infections than breastfed babies. When feeding, try to hold a baby's head above the stomach level to keep the ear tubes from being blocked.

Symptoms:

Pain/unusual irritability: an older child can report that the ear hurts. Younger children may only be irritable or cry, especially during feedings, because sucking and swallowing may cause painful pressure changes in the middle ear.
Difficulty sleeping: this is likely due to the ear pain and may involve frequent wakings at night.
Fever: anything above 101°F.
Tugging or pulling at one or both ears.
Ear drainage: yellow or white fluid may drain from one or both ears. This is a sign that the eardrum has opened up and the pus behind it is draining. Pain and pressure usually decrease after this drainage occurs.
Trouble hearing: during and after an ear infection, a child may have difficulty hearing because fluid behind the eardrum gets in the way of sound being transmitted.

Other Causes of Ear Pain:

Infection of the skin of the ear canal, often called "swimmer's ear"
Pressure from blocked or plugged Eustachian tubes from colds or allergies
A sore throat
Teething or sore gums

Treatment:

To determine whether your child has an ear infection, the health care provider will need to look in the ears.
Not all ear infections require antibiotics. Some children who don't have a high fever or who aren't severely ill may be observed without antibiotics.
Ear pain and fever should go away within 2 to 3 days of starting treatment.
Pain medications (Tylenol and/or Ibuprofen) and heat to the ear can be given for pain relief.
If your child is receiving an antibiotic, be sure to finish the entire course of treatment.
Most children should have their ears checked in 2-3 weeks after starting treatment to make sure the ear infection has cleared. Once the infection clears, fluid may still remain in the middle ear for several weeks to months but usually disappears on its own.

FEVER

Introduction:

Fever is a source of considerable concern among parents. Is a fever bad? What does it mean? Will the fever harm my child? Will it cause a seizure? The answers are no, no, no, and no (unless your child is pre-disposed to febrile seizures), respectively. In fact, fever is usually a good indicator that the immune system of your child is responding appropriately to some foreign invader, usually viral or bacterial. The following will help you manage fever appropriately at home, and provide parameters for when to call for advice or an appointment.

Practical definition of a fever:

Rectal temperature of 100.4°F (38.0°C) in an infant up to 90 days old
Rectal temperature of 101°F (38.3°C) in children older than 90 days

Rectal temperatures are preferable in newborns and infants. Tympanic thermometers are considered reliable after 12 months of age. It is not advisable to take your child's temperature daily, and he/she won't appreciate it. Research has shown that a parent can detect fever by touch over 80% of the time. Wait until you have a reason, trust your judgment, and then take a temperature.

Expected course of a fever:

A fever associated with a virus can last from 1 to 3 days and vary in magnitude from 101° to 104°.
You may not see any other symptoms for up to 24 hours after the start of the fever.

Call the office immediately or go the Emergency Room if:

Your feverish child becomes jittery, shaky, or incoherent.
Your child's temperature is above 104.
Your child is less than 2-months-old.
Your child's temperature does not go down at least 1 degree ½ or 1 hour after he/she takes Tylenol or Motrin/Advil.
Your child is acting sick and doesn't perk up ½ to 1 hour after fever reducing medicine.

How to manage a fever at home:

You can give acetaminophen (Tylenol) to children to bring a fever down. Tylenol can be given every 4 to 6 hours as needed. However, call the office first with any fever of 100.4 or higher before giving Tylenol to children under 3 months.
Ibuprofen (Advil or Motrin) works two hours longer than Tylenol. It can be given every 6 to 8 hours as needed in children over age 6 months. Make sure your child eats something with Ibuprofen because it can cause stomach upset on an empty stomach.
Avoid aspirin. The American Academy of Pediatrics recommends not giving aspirin to children (through age 21 years).
You can give your child a lukewarm bath to bring the fever down faster.
Treatment for all fevers. Encourage your child to drink a lot of cold fluids. Have your child wear as little clothing as possible because this will help bring down the fever.

Acetaminophen (Tylenol) Dose: Give each dose every 4 to 6 hours as needed for fever or pain. Do not exceed 5 doses in 24 hours.

Ibuprofen (Motrin or Advil) Dose: Give one dose every 6-8 hours as needed for fever or pain. Do not exceed 4 doses in 24 hours. Do not give this medication on an empty stomach. NOT RECOMMENDED FOR USE UNDER AGE 6 MONTHS.

Download Tylenol/Motrin Dosing Chart PDF.

GASTROESOPHAGEAL REFLUX (GER)

Prevalence in Children:

Generally self-limited condition that gets better with time
Peak in symptoms occurs between four to six months of age

Presenting Signs and Symptoms in Infants:

Feeding refusal
Recurrent vomiting
Arching of the back
Poor weight gain
Irritability
Excessive crying
Sleep disturbance

Presenting Signs and Symptoms in Older Children/Adolescents:

Recurrent vomiting
Heartburn
Difficulty swallowing
Asthma
Recurrent pneumonia
Upper airway symptoms (chronic cough/hoarse voice)

Red Flags or Alarm Signals Not Suggestive of Reflux:

Bilious or forceful vomiting
Onset of persistent vomiting after 6 months of life
Bloody stools
Abdominal tenderness or distention
Fever, lethargy, enlarged liver
Large head, small head, seizures

Confirming Diagnosis of Reflux (will need an appointment in the office):

Comprehensive history and physical exam
No gold standard for diagnosis
Empiric therapy (trial of medication)
Appropriate testing and differential diagnosis to rule out other etiologies

Management of Reflux in Infants:

Decrease the feeding volume and increase the frequency
Consider thickening bottle feeds (breast milk or formula) with cereal
Positioning upright for 20-30 minutes after every feeding
Consider trial of hypoallergenic formula
Consider medication if conservative measures not working

Management of Reflux in Older Children:

Avoid large meals
Do not lie down immediately after eating
Lose weight, if overweight
Avoid caffeine, chocolate, and spicy foods that can make symptoms worse
Eliminate exposure to tobacco smoke
Consider medication if conservative measures not working

RASHES

Most infant and childhood rashes are not worrisome and need to be seen to be properly diagnosed. Please call during office hours to schedule an appointment for us to look at your child's rash.

Call the Office Immediately if:

A rash occurs suddenly and is accompanied by any facial swelling or difficulty breathing.
Your child has a red rash that will not fade when pressed on.
Fever greater than 101°F accompanies the rash.

Sore Throat (Pharyngitis)

Introduction:

Sore throat (or pharyngitis) involves pain, discomfort, or a raw feeling of the throat, especially with swallowing. Children under age 2 usually are unable to complain about a sore throat and may refuse to eat or drink or cry during feedings

Causes:

Most sore throats are part of a cold and therefore are caused by viruses.
The presence of a cough, hoarseness, or nasal symptoms usually means a viral infection.
Of severe sore throats, about 20% are caused by strep bacteria.

Treatment:

Local pain relief
- Children older than age 1 can sip warm chicken broth or apple juice.
- Children older than age 4 can suck on hard candy or lollipops.
- Children older than age 6 can gargle warm water with a little table salt.
Pain medication
- Give acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) for severe throat discomfort or fever > 102°F.
Soft diet
- Cold drinks and milk shakes are good
If strep throat is suspected, your child will need a throat culture done.
If strep throat is diagnosed, then an antibiotic will be prescribed.

Call the office for the following:

Great difficulty swallowing fluids or saliva
Difficulty breathing or stiff neck
Unable to open the mouth completely
Fever > 105°F
Signs of dehydration (very dry mouth, no tears with crying, and no urine for > 8 hours)
Sore throat pain that is severe
Rash that is widespread and/or spreading
Earache
Sore throat is the main symptom and lasts longer than 24 hours
Sore throat with cough/cold symptoms is present more than 3 days
Your child becomes worse

Trauma, Burns, and Head Injuries

The size of a lump on the head does not indicate the severity of an injury; often there will be an immediate "goose egg." Ice or cold compresses will help control any swelling. The usual treatment for trauma to any part of the body is RICE: Rest, Ice, Compression (an ace bandage) and Elevation. A child can be burned by liquids that wouldn't hurt an adult. Constant vigilance around hot liquids is imperative.

Go to the Emergency Room Immediately and/or Call the Office Immediately If:

Your child is knocked out, even for a short time.
Your child becomes disoriented or has balance problems.
Your child vomits more than once after a head injury, or there is bleeding from the ear.
There is a cut that won't stop bleeding, or it gapes open.

VOMITING AND/OR DIARRHEA (GASTROENTERITIS)

Gastroenteritis:

Gastroenteritis is also known as a stomach bug. It is most likely caused by a virus. Some children experience vomiting and diarrhea, some experience just vomiting, and some experience just diarrhea. Most episodes of gastroenteritis resolve over a couple of days. However, occasionally it can last as long as a week. Fever may or may not accompany gastroenteritis.
Vomiting = forceful emptying (throwing up) of a large portion of the stomach's contents through the mouth.
Diarrhea = sudden increase in the frequency and looseness of bowel movements (BMs) which are usually watery in nature.

Treatment: The main goal is to prevent dehydration.

For breast-fed infants, continue to nurse with shorter, more frequent feeds.
For bottle-fed infants, give Pedialyte 1 teaspoon every 5 minutes. After 4 hours without vomiting, increase the amount. After 8 hours without vomiting, return to regular formula.
For children older than 1 year, give Pedialyte, Gatorade, or popsicles in amounts of 1 teaspoon every 5 minutes. After 4 hours without vomiting, increase the amount. After 8 hours without vomiting, add solids.
For children on solid foods, bananas, rice cereal, applesauce, white bread, and saltine crackers are good foods to combat diarrhea. However, children may not have an appetite for several days with the illness. It is more important to give fluids than solids.
Avoid giving medications and fruit juices. Children should not be given anti-diarrhea medications, and the sugar in juice can make diarrhea worse.

Call the office for the following:

Signs of dehydration (no urine in > 8 hours, no tears with crying, and very dry mouth or no saliva)
Blood in stool or vomit
Fever > 105°F
Bilious (yellow or green) in the vomit
Continuous abdominal pain or crying for > 2 hours (especially if the abdomen is swollen)

***Barton Schmitt's pediatric triage advice and the American Academy of Pediatrics' guidelines were referenced to compile the above advice.

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