Benadryl is a good medicine to give for mild allergic reactions, hives, insect stings, and itchy rashes in children over 6 months of age.  

The dose is 12.5 mg per 25 pounds of weight every 6 hours up to a max of 50mg.  It comes as a liquid (12.5mg/1 tsp.), a fast dissolving tablet (12.5mg/tablet), and tablets and soft gels (25mg each). Be aware that Benadryl may cause your child to be sleepy or, less commonly, agitated.

We do not recommend Benadryl lotion, gel, cream or spray on itchy rashes.  Benadryl should not be used on the skin.  1% Hydrocortisone cream may be used sparingly 2 -3 X/day on itchy rashes.

If your child has a more serious reaction (trouble breathing, wheezing, collapse, etc), use your Epipen as previously instructed if prescribed, or call 911.  If you administer your Epipen, proceed to the nearest emergency room if your child responds, or call 911.

RECOMMENDATIONS FOR THE CARE OF "COLDS"

In spite of the best care that we give our children, many of them will get "colds"  four to six times a year.  Children who attend pre-school or are enrolled in daycare may get even more.  These are most often due to viruses and do not require the use of antibiotics.  Cold symptoms such as stuffy nose and cough can take up to two weeks to resolve.  If symptoms have not improved by then or they develop a new fever, worsening cough, or ear pain, an appointment should be made.

STUFFY, RUNNY NOSES

Infants normally breathe through their noses, so they have trouble breathing when their noses are congested.  It is helpful to buy a bulb syringe (sometimes called an ear syringe) to suction the mucus from the baby's nose.  If you have a bulb syringe from the hospital, even better.  If necessary, salt water nose drops (such as Ayr, Ocean or Salinex brands) can be used in small infants: put 1 or 2 drops of this solution in each nostril, one drop at a time and one nostril at a time to avoid choking or aspiration. Wait a few seconds and then suction with a bulb syringe.

Yellow or green colored mucus is common with both viral and bacterial infections. It is not a specific indication for treating with antibiotics.

If an infant or child is feeding adequately, sleeping well, and happy, there is no reason to treat a runny or stuffy nose.  However, if this is not the case, there are medicines or treatments available at certain ages. These medicines will not cure a cold but may lessen the symptoms.  They are not as effective as we would wish.  Time is the eventual healer for viral infections.

For safety reasons, decongestants, antihistamines, and cough suppressants are not recommended for treatment of colds in children under 6 years of age. Definitive studies have not been done yet for effectiveness.

Deaths have been reported from overdoses of cold medicines. Do not give more than one prescribed or over-the-counter medicine unless directed by a doctor. This will prevent giving the same ingredients twice and causing an overdose. Give only the recommended dose at the recommended time intervals.

Do NOT use "Cold" medicines which combine aspirin, acetaminophen or ibuprofen with decongestants (Tylenol Cold and Cough, Advil Cold and Sinus, etc.)  If medication is needed for fever or pain,  it should be given separate­ly in the proper dosage for fever or pain.  Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin) should be given rather than aspirin. See buttons above for dosages based on weight; there is also a separate section with more information on fever, as well.

Be aware that cough and cold medications may have undesirable side effects such as insomnia, hyperactivity, or drowsiness.

COUGH

We do not need to "stop" all coughs. Coughing is essential to maintain adequate ventilation of the lungs.  It also helps to clear mucus from the lungs.  Cough medicines, including narcotic cough medicines, have not been proven to be effective in reducing coughs.  Warnings have been published about possible side effects from cough medicines, especially in infants and younger children.  We are no longer providing “recommended” doses of these products.  Honey, alone or in herbal tea, has been found to be as effective as any cough medicine with dextromethorphan (“DM”) without the possible side effects.  Honey cannot be given to an infant under 1 year old. There are commercially available honey-based products such as Chestal or Zarbee’s if that is easier.  It can be sometimes be helpful to use a decongestant (Sudafed) in children 6 years of age and older, to help control the mucus and postnasal drip that contributes to many coughs.  Use of medicines that contain guaifenisin may help thin the mucus and aid in comfort with cough and congestion.

OVERLAP OF MEDICINES

It is okay to give cold medicines, antibiotics, asthma medicines and fever or pain medicines (i.e. Tylenol, Motrin/Advil) at the same time, if necessary.

If  medication is desired, these would be possible ones to try if your child is at least 6 years of age.

MUCINEX- multiple formulations  are available that contain guafenisin.  Follow instructions on the package for dosing based on age.

DELSYM - a 12 hour cough suppressant with "DM".

  6 -11 years:  5 ml every 12 hrs

  12 and older:  10 ml  every 12 hrs

CHILDREN'S SUDAFED

   6 -11 years:  10 ml every 4 - 6 hrs

SUDAFED TABLETS

  6 - 11 years: 1 tab every 4 - 6 hours

  12 and older: 2 tabs every 4 -6 hours

HUMIDIFIERS

Cool mist humidifiers may be helpful when children have croup, with dry barky coughs.  We do not generally find them useful if children have loose runny noses or moist coughs.

DURATION

If your child's "cold" does not seem to improve after 10 days, please call for an appointment.  Be aware that coughs, runny noses, and congestion can persist for two weeks or longer.  If your child is improving, it is unlikely we will need to see him or her.

CONSTIPATION PROTOCOL

1.     BOWEL TRAINING:

Sit on the toilet for 10 minutes after a meal with a glass of water.  Pick a time of day when the household is not in  “Rush Mode”.  Do not insist that the patient has a bowel movement; this is a time to allow the body to relax. If this sitting time is done every day for 1 week, eventually the bowels will be conditioned to relax and pass a stool at that time.

2.     DIET for Infants  < 1yr of age:

·      Infants >1mo of age who are fed breast milk or formula exclusively:  add fruit juices* – 1oz/month of age/day to a max of 4 oz

·      Infants >4mo of age:  add baby foods with high fiber content 2 times/day, (see food list below).

*Prune, apple and pear juices are beneficial to give because they contain carbohydrates which are poorly absorbed by the body, causing soft stool.

3.     DIET for Children >1yr of age:

·      Increase fruit juice (apple, pear, prune, cherry grape); citrus juices are usually not very helpful.

·      Add fruits,vegetables and whole grain foods which are high in fiber content (see food list below).

·      Decrease milk products to 3 servings/day

·      Increase water consumption

4.     FIBER REQUIREMENTS per age per day:

·      2 -3 yrs = 19 grams

·      4 – 8 yrs = 25 grams

·      9 – 11 yrs:  female = 26 grams; male = 31 grams

5.      FIBER FOOD SOURCES (if age appropriate):

Bran flakes

Shredded wheat

Figs

Dates

Prunes

Raisins

Raw Carrots

Other Raw Vegetables

Dried Apricots

Peaches

Pears

Peas

Beans

Broccoli

Cauliflower

Cabbage

Popcorn (>4yrs of age)

Oatmeal

Brown rice

Whole wheat bread

6.      Foods to decrease:

Milk

Ice cream

Yogurt

Cheese

Rice

Cooked carrots

MEDICATIONS FOR CONSTIPATION:

Over The Counter:

CITRUCEL  (Bulk forming fiber laxative)

Promotes elimination by providing additional bulk (fiber) to the diet. The patient will usually have a bowel movement in 12-72 hours. Your child must have a good liquid intake.

Dose: 1 tsp-1 Tbsp 1-3 times a day as directed by your physician.

MIRALAX:

  Dose: 1 capful in 8 ounce beverage 2-3 times a day over a weekend until fecal excretion is clear. Miralax usually works within a few days.  Typical maintenance dosing is 1 capful/8 ounces of any beverage once/day, though the amount may be adjusted to produce a soft stool every day.

DIAPER RASH

Diaper rash is very common, and can often be prevented.  It usually occurs when the skin breaks down from prolonged contact with the chemicals in urine and bowel movements, if the skin stays wet too long, or if wipes are used.

NO WIPES

Wipes are a common cause of diaper rash. We do not in general recommend using wipes. The fragrances and additives in the wipes often can irritate your child’s diaper area and lead to rashes.  If wipes are used, we recommending fragrance-free products that have been rinsed.  If your child already has a diaper rash, returning to water only is a good first step.

Water is the best cleansing agent.  We want you to wash your baby with water as soon as possible after a wet or dirty diaper.  Dry well and, if possible, leave the baby without a diaper for exposure to the air before diapering again.

TREATING A DIAPER RASH

Discontinue using diaper wipes, if you are still using them.  Water washing, air exposure, and frequent changing help prevent and treat diaper rashes.  A barrier-type ointment or cream, such as A&D or Desitin or other infant-safe product may be helpful.  Call us to make an appointment if these measures aren't helping. 

RECOMMENDATIONS FOR EAR ACHES

Earaches often, but not always, mean ear infections.  If the pain can be controlled, you can wait to make an appointment until the office is open.

EAR PAIN RELIEF

Acetaminophen (Tylenol) or Ibuprofen can be helpful in relieving ear pain (see buttons for dosing above)

You can also make an anesthetic solution with vinegar, water, and ice.  Mix 1 teaspoon of vinegar with 2 teaspoons of water and add ice to make it ice cold.  Then, with a dropper or spoon, drip some in the painful ear, leave it in for about 30 seconds, turn the head so it drains out, and then put more in.  Do this five times.  If both ears hurt, you can alternate putting the ice cold solution in each ear every 30 seconds. Do this five times in each ear.  Expect that your child will not like having the ice-cold solution in his or her ear (this is an understatement),  but will be much happier when the pain is relieved in 10-15 minutes or so.  You can repeat the treatment in 30-60 minutes or later if necessary. If you suspect a “swimmer’s ear”, or if there is drainage from the ear, do not use this treatment.

RECOMMENDATIONS FOR THE CARE OF FEVER

In most cases, you do not need to worry about fever.  It is more important to assess how your child is acting (listless, lack of appetite etc.),  not just the temperature.  Fever is a symptom of disease, just like a cough or runny nose. A child who looks very ill even without a fever should be checked.  We should evaluate any infant less than 2 months of age who has a temperature over 100.4 degrees.  In certain circumstanc­es, serious illness may be present in small babies without a fever, especially if chest congestion is present or they seem very listless or weak.  In such situations, we urge you to call the office for an appointment.

Some fever is actually helpful. Your child's body is better able to defend itself against viral infection (the cause of most colds and "flu") at above normal temperature. We do not recommend treating fever until the temperature reaches 101.4° - 102°. The only reason for “treating” fever is to make the child more comfortable.

The temperature may or may not come down to the absolute “normal” temperature with treatment or may come down and then go up again.  This is okay.  Our concern is with the child, not fever.  If your child looks or acts significantly ill, he or she should be seen.

Normal body temperature is not a single temperature, but a range of temperatures influenced by age, time of day and the measurement site. Temperatures should be taken rectally in all children under 4 weeks of age, and can usually be taken orally in older children.  Other means of assessing your older child’s temperature are: the earscan thermometer (set for the “Oral Equivalent”) or the temporal artery thermometer.

If you need directions on how to use a digital rectal thermometer, please ask for our handout called “Fever and Your Child”.  Mercury thermometers should not be used. The AAP encourages parents to remove mercury thermometers from their homes to prevent accidental exposure to this toxin.

Children with fever should not be covered or dressed warmly.  The extra heat must be allowed to escape from the body.  With any fever, extra amounts of liquids such as juices, water, Jell-O, broth, or even popsicles and ice chips should be given to replace the extra liquids the body uses up with fever.  If the child is not eating, the fluids should be Pedialyte or Pedialyte popsicles.

ASPIRIN, ACETAMINOPHEN (Tylenol) AND IBUPROFEN (Motrin/Advil)

Do not use aspirin at all unless directed by a doctor.  It has been associated with Reye's Syndrome, a potentially fatal condition. We recommend that acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) be used instead of aspirin.

Ibuprofen and acetaminophen (Tylenol) are available without prescription. One advantage of ibuprofen is that it has a longer duration of effectiveness. Ibuprofen is not recommended under 6 months of age.

The doses for ibuprofen and acetaminophen are on the buttons above.

COMBINATION FEVER, SORE THROAT, COLD MEDICINES

Do not use acetaminophen or ibuprofen indiscriminately as a general treatment for colds or other illnesses.  Acetaminophen overdosage can cause severe problems, including destruction of the liver and death.  Ibuprofen overdose can be toxic to the kidney and can also cause severe or fatal problems.  We recommend giving acetaminophen or ibuprofen separately from cough and cold medicines (do not buy the combination product) and only if needed for fever or pain/discomfort.

CONTROL OF FEVER

Control of the fever should always begin by removing most of the child's clothing.  This allows heat to escape from the body.  Then give acetaminophen or ibuprofen, according to the dosage tables.  Sponging with water or alcohol is not recommended.

“CURE” OF FEVER

It is important to realize that treating the fever will not "cure" the fever.  It will probably lower the temperature somewhat but will not permanently return the body's temperature to normal.  It gives only partial, temporary relief of the fever.  This is okay.  Our reason for treating fever is to try to make the child more comfortable.

HIGH FEVER

High fever may often signify diseases such as strep throat, pneumonia, urinary tract infection, ear infection, or more serious conditions which would require specific medication and care.  Call us to make an appointment if your child has a recurrent very high fever (over 104 degrees) or one that won't come down below 104 degrees.  Remember that a child can be very sick without having a high fever.  Evaluate how the child is acting, not just the tempera­ture.

Always use a proper measuring device – a device is included in the package. Kitchen spoons are not accurate measures. Always dose by weight if known, otherwise, dose by your child’s age.

CARE OF HEAD INJURIES

All children fall and hit their heads at some time or other.  The bones of the head are very strong, and serious problems following head trauma are rare. However, sometimes problems do occur immediately or many hours or days later.  If your child is over 12 months, a “goose egg” or swelling without other significant symptoms is common but usually not indicative of serious injury.  Intermittent cold packs can help control further swelling.

If you are concerned that your child has suffered a concussion,  please call the office, and make an appointment.  Recovery from concussions require "brain rest", and there are specific recommendations that we follow in regards to return to activities and sports, depending your child's situation.

Call the office  or 911, or proceed directly to the emergency room immediately if:

1.     The child was unconscious or cannot remember the details of the accident.

2.     Headache continues or becomes more severe, especially after 4-24 hours (It is okay to give Tylenol for a headache).

3.     Vomiting occurs more than twice within 6 hours of injury or vomiting persists after 12 hours.

4. Drowsiness develops more than normal sleepiness should produce.  Sleeping itself is not a problem, but sleep must be differenti­ated from unconsciousness.  After a significant injury, the child should be checked for responsiveness every 1-2 hours during naps and nighttime sleep for the 24 hours after the accident.                                              

5. Blood or other fluid drains from ears or nose.

6. Convulsions occur.

7. Staggering or increased clumsiness occurs.

8. Behavior or speech becomes unusual.

9. One pupil is a different size than the other

10. Resting pulse is less than 80 beats per minute for infants less than 5 years of age, or less than 60 beats per minute for children 5 years and older.                                                                                                

11. You are very suspicious or very concerned about the child's general condition, or if he/she   “just does not look right”.

NOTE:  An athlete with any degree of concussion following head trauma should not participate in sports again until he or she has no more symptoms of concussion, and we have examined him or her.

Many families have questions about lice -  while not a serious health problem, they drive us all crazy!

 Head Lice

Head lice only live on human beings and can be spread quickly by using the hat, comb, brush, bike helmet or headphones of an infected person or simply by close contact. Lice do not hop or jump. Anyone can get lice despite good health habits and frequent hair washing. Nits (white eggs) firmly attach to hairs. Nits usually hatch into lice within 7-10 days. Nits found on hair more than ½ inch from the scalp have usually hatched or have died (if patient was treated). Lice are tiny, brown bugs about the size of a sesame seed. Lice are most visible at the back of the neck, along the hairline and behind the ears. Examine your child’s head using a magnifying glass. Lice can not live for more than 3 days off of the human body. The most common symptom of head lice is itching of the scalp.  Pets do not transmit head lice to humans or vice versa.

Over-the-Counter Treatment: Use an over the counter cream rinse (such as Nix) or shampoo (such as RID). Follow the package directions for use carefully.  If using Nix Crème Rinse make sure the shampoo you use does not contain conditioner. It is preferable to use a detergent type of shampoo such as Johnson’s Baby shampoo or Prell Shampoo.

Do not retreat with any of these medicated shampoos or cream rinse before the specified time indicated on the package directions (usually 7-10 days- the time it would take for a nit to hatch).   Typically re-treatment is needed on Day 9 and occasionally on Day 18 if symptoms have not resolved.

Prescription Treatment:  You may call the office for a prescription pediculocide if OTC treatment fails.  This is rarely necessary.

Nit Removal:  Nit removal is very important.  Manual nit picking is a necessary part of any lice treatment program.  No comb alone will get rid of head lice. Part the hair into sections with clips and select a section to work on. Start at the top of the head, close to the scalp, using a fine-toothed nit-removal comb (such as a “Licemeister” comb), comb downward. Clean the comb with a tissue as you go. Dispose of the tissues in a sealed bag to prevent reinfestation.

Cleaning:  Clean the house once and then concentrate on heads.  Thoroughly vacuum everywhere (rugs, carpets, mattresses, upholstered furniture and car seats). Dispose of the vacuum cleaner bag after use.

Personal items such as hats, hair ribbons, scarves, coats, towels, and bed linens, should be cleansed in the washing machine in hot water. After cleaning, these items should be dried by using the hot cycle of a dryer for 20 minutes. Bedspreads, blankets, pillows and stuffed animals that cannot be washed should be dry cleaned or sealed in a plastic bag for a period of 2 weeks.

You’ll need to clean every item that has come in contact with your child’s head and shoulders. Soak all hair clips and combs/brushes in hot soapy water for 5-10 minutes, rinse, then dry.

Alternative Treatment:  If after treatment with the lotion, medicated shampoo or cream rinse, any active lice are visible before 7 days, an alternate option is to coat the hair in olive oil, baby oil, mayonnaise or Vaseline, then cover the child’s coated hair with a shower cap over night. Shampoo hair in the morning with a detergent such as Dawn dishwashing detergent to remove the oil. This type of treatment kills the lice by suffocation. Again, do not repeat treatment with a medicated shampoo or rinse before 7 days or per manufacturer’s directions.

Please inform the school, and/or daycare and parents of playmates if you discover head lice on your child.  Head lice are not dangerous and can be eliminated with treatment.

Additional Lice information:  

HealthyChildren.org

DAYCARE AND COMMON INFECTIONS

According to the American Academy of Pediatrics, most children do not need to be excluded from their regular day care for common respiratory and gastrointestinal illnesses except in the following situations:

1.)  too ill to participate in the day care program

2.)  medical needs are too great for the staff to perform

3.)  communicable diseases such as: impetigo, whooping cough, chickenpox, strep throat, lice, or scabies.

4.)  undiagnosed fever of 101 degrees or above

5.)  diarrhea if stool not contained in diaper or blood/mucus in stools

6.)  vomiting two or more times in the previous 24 hours

7.)  significant abdominal or other pain

8.)  mouth sores that are contagious

9.)  progressive rash with fever or behavioral changes

10.) skin lesions that are contagious

CONJUNCTIVITIS (“Pink Eye”)

Conjunctivitis, or “pink eye” as it is commonly called, is an inflammation of the membrane of the eyelid and eyeball. It can be caused by irritation from the environment (smoke, dust, pollen, chemicals), alleriges,  as well as infections from viruses and bacteria.  “Pink eye” due to infection can be contagious and is the only kind treated with antibiotic eye drops. For first aid measures after hours, use warm water soaks with wet wash cloths for about 5 minutes, 3-4 times a day.  Please call for an appointment when the office opens or speak with the phone nurse to determine if it is appropriate to prescribe antibiotic eye drops without a visit.

Definition of a pinworm:  A pinworm is a tiny, white, very thin harmless worm about ¼ inch long that lives in the colon.  It is often seen in the anal and buttock area, especially at night or early in the morning.  The pinworm moves; if it doesn’t move it is probably lint, a thread or dead.

Symptoms:  Itching and irritation of the anal area and buttocks.  Occasionally, the pinworms migrate to the vagina and causes vaginal itching.

Infection is caused by swallowing pinworm eggs.  Your child can get pinworms no matter how carefully you keep them and your house clean.

If pinworms are seen, over-the-counter medicine for treatment of pinworms has a 90 – 95% cure rate.  We recommend the use of:  

REESE Pinworm Medication:  given 1 time with or without food; repeat the dose one time in 2 weeks.

          Liquid:  shake suspension well; may mix medication with milk or fruit juice

          Pregnancy:  Consult with your OB regarding treatment

          Weight:  <25lbs or < 2yrs of age, call our office for advice

REESE Dosing by weight:   25-37 lbs = ½ tsp

              38-62 lbs = 1 tsp

               63 – 87lbs = 1 ½ tsps

               88-112lbs = 2 tsps

               113-137lbs = 2 ½ tsps

               138 – 162lbs =   3 tsps

               163- 187lbs = 3 ½ tsps

               >187lbs = 4 tsps

Contagiousness:  

• Pinworms are mildly contagious within the home.  

• Family members should only be treated if they have symptoms or if they sleep with the infected child.

• Children with pinworms do not need to miss any child care or school.

• Pets don’t carry pinworms.

• If your child has had contact with a child who has pinworms but has no symptoms and more than a month has passed, your child probably won’t get them.

• The swallowed egg takes 3 – 4 weeks to mature into an adult pinworm and the pinworm is never present for very long without causing some anal itching.

Treatment for reducing reinfection or spread to others:  

• Each morning give your child a shower.  Always rinse the anal area.  Do this for 3 days after taking the pinworm medicine.

• Frequently changing the infected person's underclothes, bedclothes, and bed sheets may decrease the egg contamination of the local environment and risk of reinfection.

• Machine washing at hot temperature will kill any eggs that are present in the clothing or bedding.

• Vacuum or wet mop your child’s room once every week because any eggs scattered on the floor are infectious for 1 – 2 weeks.

• Scrub hands and fingernails before eating, preparing food and after each use of the toilet.

• Keep the fingernails short because eggs can collect there.

• Thumb sucking and fingernail biting should be discouraged.

• Avoid scratching of the anal area

Call our office:

• If your child’s anal itching is not resolved within 1 week after treatment  

• If the skin around the anus becomes red or tender

• If there has been a positive pinworm sighting after appropriate treatment

Poisonings are an all too frequent occurrence in the pediatric population. The best care for poisonings is preventing them in the first place.  Please go through your house carefully and place ALL possible toxic substances (medicines, vitamins, perfumes, cleaning solutions, gasoline, fertilizers, etc.) behind locked doors.  This cannot be stressed strongly enough.

The Poison Control Center number is 1-800-222-1222. Call Poison Control immediately if your child has ingested anything that may be poisonous.

PROBIOTICS

PROBIOTICS can be used to improve occasional digestive distress due to antibiotics or infectious illnesses.

FLORASTOR

250 MG capsules or kids packet

1-2 capsules or 1-2 packets 2 times a day

Capsules may be opened and sprinkled onto soft foods or fluids

ALIGN JR.

>6yrs of age               1 chewable daily

****CULTURELLE****

Infants Kids packet – 1 packet 2 times a day

25lbs-50lbs  Kids packets – 2 packets 2 times a day

50lbs-100lbs   Kids chewable – 2 chewables 2 times a day

>100lbs   Chewables (non “kids”)/capsules – 2 capsules 2 times a day

Side effects may include mild bloating, gas or digestive gurgling when first beginning Culturelle.

When using Culturelle do NOT mix with WARM food or drinks

****LACTINEX GRANULES****

< 1 year of age        ½ packet 3 times per day

> 1 year of age        1 packet 3 times per day

Mix packet of granules in with soft food

****TAKE PROBIOTIC 2 – 3 HRS BEFORE OR AFTER ANY ANTIBIOTIC****

Most sore throats are caused by viral infections. There is one bacteria, streptococcus pyogenes or “strep”, that will cause a sore throat with classic symptoms of a very red throat, swollen tonsils with or without pus, swollen lymph nodes in the neck, and fever.

If your child is complaining of a sore throat, especially when accompanied by nasal congestion or cough and without fever, it is less likely to be “strep”.   It is reasonable to wait at least 48 hours before making an appointment since viral sore throats usually resolve within a few days (though sometimes followed by persistent cold symptoms). If you are concerned that your child is becoming dehydrated because he/she is not drinking, please call for an appointment.

If your child has a sore throat and fever ONLY, we are happy to see them sooner to be certain that they don’t have a “strep throat”.   This is one of the very few throat infections that will respond to an antibiotic.

Viral throat infections will respond to rest, fluids and pain control. Cold, non-acidic fluids are frequently well tolerated (try a smoothie!). Acetaminophen or ibuprofen may also enable more fluid intake by lessening the pain and/or fever (see buttons above for dosing).

SUNSCREEN APPLICATION TIPS AND SUN PROTECTION

SPF (sun protection factor) is defined as the ratio of the time necessary to produce a minimal redness on the skin covered by sunscreen to the time necessary to produce the same degree of redness on skin not covered by sunscreen.  The SPF is not meant to imply that using a higher SPF product allows more prolonged, safe exposure to sunlight.  

Choose a sunscreen labeled “broad-spectrum” to screen out both UVA and UVB rays, with a SPF of 15 – 30; more research is needed to test if sunscreen with >SPF50 offers any extra protection.  

Avoid the ingredient OXYBENZONE due to concerns about hormonal changes.  

Apply an adequate amount (1 oz. quantity would be adequate for a young adult) and rub it in well, at least 30 minutes prior to sun exposure.  

Reapply every 2 hours or after swimming or sweating.

Those people with sun-sensitive dermatological conditions (light colored skin, blonde or red hair, history of one serious sunburn) or those people receiving potentially photosensitive drugs, (sulfa antibiotics, tetracycline antibiotics, some acne preparations), are at a higher risk for sunburn and should use higher SPF products (SPF 30).

Apply to all exposed skin surfaces (including feet, ears, nose, neck).  For sensitive areas of the body, such as the nose, cheeks, tops of ears, and the shoulders, choose a sunscreen or sunblock with zinc oxide or titanium dioxide.  If the sunscreen irritates your child’s face, try using a sunscreen stick.

Apply sunscreen even on cloudy days; 80% of the sun’s UV rays can get through the clouds.  In addition, UV rays can bounce back from water, sand, snow and concrete.

Use a daily moisturizer with SPF when you’re indoors near bright windows.  UVA penetrates windows and damages unprotected skin.

If using a bug repellant apply it 15 minutes after the sunscreen to cut down on the pesticide soaking into the skin.

Follow the expiration date on the bottle.  If the bottle is not dated, call the company or purchase a new bottle each year.

Extra precautions for young infants less than 6 months of age:

Keep the baby out of direct sunlight

Dress in light weight long pants and long-sleeved shirts

Apply a small amount of sunscreen to small areas of the body if clothing and shade are not available.

Additional suggestions for sun protection:

Dress in fabrics with a tight weave or clothes with UPF label (UV Protection Factor)  

Wear sunglasses with at least 99% UV protection

Wear hats with a 3 inch brim

Avoid the strongest sun hours between 10 a.m. and 4 p.m. or play in the shade

Wear SPF lip balm to protect against sun damage.

Summer safety tips from the American Academy of Pediatrics: healthychildren.org

AAP Educational Handouts: “Fun in the Sun” 4/2014
(LRPMG 7/17) 

If you are planning international travel and would like specific medical advice or medications for your child, please call the office for an appointment at least 2 weeks before your trip - sooner may be better!

Resources for International Travel Information:

www.cdc.gov/travel

www.adventuremedicalkits.com

Resources for International Travel Inoculations:

Ventura County Public Health Department Immunization Clinics:  (805) 981-5221  

Burt’s Pharmacy N.P.:  (805) 498-6675

Medications and Supplies:

• Benadryl (antihistamine for allergic reactions)
• 1% Hydrocortisone Cream (topical steroid for skin reactions)
• Polysporin (topical antibiotic for wounds)
• Thermometer
• Acetominophen (Tylenol) and/or Ibuprofen (Motrin or Advil): (see buttons above for dosing)
• Oral electrolyte solution or powder, for symptoms of vomiting/diarrhea; (Example: Pedialyte)

Vitamin D supplementation may be recommended following lab test results which indicate a low level.  If the Vit D level is low, the Physician will be specific as to how much Vit D3 (cholecalciferol) is recommended; the following are a few choices:  

L’il Critters

• Vit D:   each gummy bear  = 400 IU vit D

• Calcium/Vit D:  each gummy bear=  120 IU Vit D and  100mg Calcium

Vitafusion

• Vit D:  each gummy vitamin = 1000 IU vit D

• Calcium/Vit D:  each  gummy vitamin = 500 IU vit D and 250mg calcium

Replesta

TREATMENT of Vit D DEFICIENCY:  50,000 IU per tablet or wafer once weekly for 6 weeks.

If deficient:  recheck Vit D level in 2 – 3 months

Maintenance dose of Vit D:   1,000 IU/day

RECOMMENDATIONS FOR THE CARE OF VOMITING AND DIARRHEA

Diarrhea and vomiting are very common problems during infancy and childhood.  Most often they are caused by viral infections and may be accompanied by fever. Diarrhea or vomiting may last for several days or may get better for 1-2 days and then recur.  If diarrhea persists beyond one week, please call for appointment (sooner if your child appears dehydrated, very sick or if there is blood or mucus in the stool).   Any neonate or young infant with bilious (yellow-green) vomiting should be examined.

Very often, several members of the family will be sick with the "stomach flu" at the same time.  It is very contagious.  Good hygiene, including careful hand washing and avoiding sharing germs by eating and drinking from the same food or liquids, will help prevent spreading in one's own family.  It is important to maintain as much reasonable isolation as possible. Proper treatment of vomiting and diarrhea is of paramount importance to the small child in order to prevent dehydration.

DEHYDRATION

One sign of dehydration is not urinating more than 3 - 4 times in 24 hours.  An infant who has not wet his or her diaper for over 8 hours should be seen.  Also, any child with severe, uncontrollable vomiting or listlessness should be examined.

THE MOST IMPORTANT ASPECT OF TREATMENT OF VOMITING AND DIARRHEA IS TO MAINTAIN HYDRATION.  By this, we mean for the child to drink enough for the body to function properly.  Solid foods are often very poorly tolerated during the initial period of gastrointestinal upset. If frequent vomiting is not stabilizing or improving after 24 hours, or if there is ever any doubt as to the seriousness of the problem, call the office.

VOMITING:

1.   Omit all solid foods until there has been no vomiting for 4-6 hours. The most intense period of vomiting in viral gastroenteritis is the first 12-18 hours.

2.   IT IS CRUCIAL TO GIVE ENOUGH OF THE PROPER TYPE OF FLUIDS TO PREVENT DEHYDRATION.  Especially with vomiting, you must find the amount of fluid your child can retain.  If you give too much, it may be vomited right back up.

You may have to give one teaspoonful or one swallow at a time, but then it must be given

every 5-10 minutes so your child will get enough. Very cold fluids seem to stay down better.

Once the vomiting becomes less frequent, you can give larger amounts, less often.

3.   Best fluids to give:  Oral Replacement Solutions such as PEDIALYTE or PEDIALYTE  FREEZER POPS, or DRIP DROP.

These are examples of appropriate electrolyte replacement solutions that are available in drug stores and supermarkets. They contain a good combination of water, sugar, and minerals to replace what is  lost during the vomiting or diarrhea. This solution is more palatable when given cold.  Water may also be given if your child is at least 1 year of age, and there is no diarrhea.

4.   The Oral Replacement Solutions (ORS) should be given as follows:

Children less than the age of 4 years: Give 1 tsp of Pedialyte or a bite of Pedialyte popsicle every 5

minutes during the first hour. If the fluid is not vomited, double the quantity of fluid given during the next hour (ex.. Give 2 tsps every 5 minutes) and continue to double the quantity of fluid  

given over  each subsequent hour until the patient has not had any vomiting for 4-6 hours.

Children greater than 4 years of age: Give 2 tsps of Pedialyte or bites of Pedialyte popsicle every

5 minutes during the first hour. If the fluid is not vomited, double the quantity of fluid given during the next hour (ex. 4 tsps every 5 minutes) and continue to double the quantity of fluid given over each subsequent hour until the patient has not had any vomiting 4-6 hours. If the patient vomits when given the replacement fluids: withhold the oral fluids for 15-30 minutes, then restart at the initial amount of fluid for the patient’s age.

5.     Fluids that are NOT RECOMMENDED: Gatorade and other sports drinks are not recommended because of their improper sugar and mineral contents. Plain water, soda and Jell-O are not commended in children younger than 1 year old. They are also not recommended in children older than 1 year who have both vomiting and diarrhea because they do not have the proper amounts of sugar and minerals.

6.     Breast milk: If your child is nursing, frequent small feedings of breast milk are usually

tolerated. The breast milk can be given in quantities as described in #4 above.

7.     Formula: Formula should not be given initially if there is significant vomiting. In place of the formula give Pedialyte until there has been no vomiting for 4-6  hours.

8.     Alternative Fluids: Clear broth of any kind. Do not add salt. It is best to alternate broth with

other clear fluids such as Pedialyte. Ice chips or small amounts of water can be offered if your child is at least 1 year of age,  and there is no diarrhea. Fluids with proper sugar and minerals must be the main treatment (ex. Pedialyte). DO NOT GIVE JUICE.

DIARRHEA:

Severe diarrhea is the passage of many watery, sometimes malodorous, bowel movements more than 5-6 times per day. Diarrhea is often caused by a viral infection of the stomach and intestines. The treatment for severe diarrhea is as follows:

1.     If the patient is exclusively breast fed: continue with small, frequent feedings.

2.     If the patient is exclusively on formula: If the formula is milk based (e.g. Similac Advance

or Enfamil Lipil) then switch to a soy based formula (e. g. Isomil or Prosobee) if the diarrhea is severe. If the diarrhea is mild (less than 4 times per day) the milk based formula may usually be continued.

3.     If the patient drinks cow’s milk: discontinue until the child has no diarrhea for 1-2 days. A replacement fluid such as rice milk, soy milk or lactaid milk is usually better tolerated.

4.     DO NOT GIVE APPLE JUICE OR OTHER JUICES because they may cause the diarrhea to worsen. If the patient refuses breast milk, formula or cow’s milk give them the oral replacement solutions, such as Pedialyte. Water in combination with solid food is also acceptable.

5.     If the patient is on solid foods: change from their regular diet to bland types of foods for the initial 24 hours of the symptoms. Recent information suggests that it may be helpful to return to a relatively normal diet within 1-2 days, even if some diarrhea persists. Avoid any foods that normally encourage more frequent bowel movements or produce gas (prunes, beans, etc.) Also, foods high in sugar, fat or spices may not be well tolerated.

If the patient is still on baby foods and has had the following food items, you may give: rice cereal, applesauce and bananas in addition to breast milk or soy formula.

If the patient is on table foods, you may give: the BRAT diet which consists of banana, rice food items, applesauce, dry toast, dry cereal (i.e. Rice Krispies), chicken soup, crackers (i.e. Saltines).

6.     Probiotics: Diarrhea may occur with the use of antibiotics. Probiotics act to replenish the “good” bacteria that should be in the intestines and restore the intestinal balance that can be upset by some antibiotics.   See the section here on probiotics.

VOMITING AND DIARRHEA:  Follow the treatment protocol for vomiting by omitting solids and fluids (other than the oral replacement solutions such as Pedialyte), until no vomiting for 4-6 hours. Once the patient is able to retain the oral replacement solutions for 4-6 hours, follow the diarrhea protocol by beginning the BRAT/ bland food diet as tolerated. Return to the patient’s regular diet within 1-2 days, as tolerated.