Pediatrix

Constipation

Constipation is difficult passage of hard tools or the inability to pass a bowel movement when the urge is felt. Normally, breast fed infants may not have a stool for several days. There’s no need for concern unless your baby is distressed. Constipation means hard stools not infrequent stools. Infant-sized glycerin suppositories may be used occasionally to soften hard fecal matter in the rectum.

If your child is bottle fed and is having small, very hard stools, Pediatrix may advise changing formulas, increasing water in the diet, or giving a mild stool softener. If constipation seems to be a continual problem, please call our office.

Diarrhea

Diarrhea is the passage of loose, watery stools and usually is caused by a viral infection of the intestinal tract. When children have diarrhea, it is a signal that there is something affecting the intestinal tract.

Pedialyte is an electrolyte solution which is made especially for infants. It may be purchased over the counter in the formula section of your drug store or supermarket. Your infant may take as much as he likes as long as there is no vomiting. Pediatrix normally reccomends Pedialyte for a short period to rest the stomach. Then the baby’s diet is gradually advanced.

If your child is having diarrhea but is happy, active, and has no blood or mucus in the stools, there’s not as much cause for concern. If diarrhea is associated with a high fever, listlessness, increased irritability and vomiting or decrease in urine output please contact the Pediatrix office.

Vomiting

Spitting up in infancy, should be differentiated from vomiting which is usually caused by a viral infection, or flu. When a child’s stomach is upset, all milk products be avoided. Only clear liquids should be given in very small amounts at a time. Here’s an excellent home remedy:

Home Remedy Mix

1. One quart of water.
2. Two tablespoons of sugar.
3. One teaspoon of salt.
4. Give one teaspoon every 2 min the first hour.
5. Give three to four tablespoons every 15-20 minutes during the next hour.
6. Gradually increase the amount as tolerated.

Pedialyte, or other rehydration mixtures may also be used in small amounts. No milk products or foods should be given until the vomiting is under control. Emetrol Syrup is an anti-emetic that can be bought over-the-counter for use with children more than age one. It acts like old-fashioned Coke syrup and may help to relieve the dry heaves. Be sure to call Pediatrix if:

• There is any kind of head injury associated with the vomiting.
• Your child or baby is still vomiting after you have given small amounts of clear fluids for four to six hours.
• There are any signs of dehydration such as no tears, dry diapers or not urinating, dry mouth, listlessness, blood in the vomit or severe abdominal pain.

Once your infant or child is holding down clear fluids then gradually increase his diet for 24 hours. Keep the selections bland, choosing from dry toast, crackers, soup, popsicles, JELLO, dry cereal, applesauce and other mild foods.

Colds and Nasal Congestion

Children often suffer from four to six upper respiratory infections each year. As a parent, you’ll probably become an expert on home treatment. Colds are invariably caused by viruses; they do not respond to antibiotic treatments. The only effective way to deal with a cold is to treat the symptoms. There is no need to worry about colored mucous unless it lasts more than 14 days call Pediatrix if you notice:

• Fast, heavy or labored breathing or retractions (pulling on chest muscles to breath).
• A persistent cough which keeps your infant or child from sleeping or eating.
• Any temperature (101°F and above) in a baby less then six months old or a persistent fever over 101°F. for more than 48 hours in an older child.
• Increased irritability or marked listlessness.
• Pulling, batting or tugging at the ears or refusing to suck on the bottle.
• Appetite may decrease, but refusal of all liquids is cause for concern. Encourage fluids, milk is fine.

Here are some time-tested home treatments you may wish to use:

• Salt Water Nose Drops: These work well for stuffy noses and are safe for infants. Mix a quarter teaspoon of salt and four ounces of water and place two to three drops in each nostril. Wait a few minutes then try to suction some of the congestion with a blue-bulb syringe. These drops are safe to use and can be given before naps, at bedtime or at mealtime. You may also buy salt water nose drops over the counter. Some brand names include OCEAN NOSE DROPS, AYR DROPS, or NASAL.
• Afrin Pediatric Nose Drops for Babies: These drops work very well and you can by them over the counter. They can be used twice a day but only for three days. If they are overused, they can irritate the lining of the nose and cause a rebound effect—i.e. even more congestion.
• Cool Mist Humidifier: This device moistens the air and may help to shrink the mucus membranes of the nose. Change the water in it daily. Do not use a humidifier if your child has asthma.
• Elevate the Head of the Crib: In small infants, sometimes propping the head of the crib up slightly may help them to breathe easier. Simply insert pillows beneath the mattress to build up the head.
• Over-The-Counter Products: Occasionally, Pediatrix will recommend a decongestant and antihistamine to dry up the congestion. for suggestions and dosages, please contact us.

Conjunctivitis

Conjunctivitis is an eye infection that causes redness on the white part of the eye together with a yellow discharge in the corner. Infants often have a blocked lacrimal duct, the passage from the eye into the nose. If the duct is blocked, the baby’s eyes will water and may form some discharge off and on. Massaging the area between the eye and the nose with your finger several times a day may help to open the tear duct. If there is a consistent discharge, Pediatrix may prescribe an antibiotic solution to be placed in the eye and alert you to watch for these signs:

• No improvement after being on eye drops after 24-24 hours.
• Increased redness or swelling of the eyelid, or skin around the eye.
• High fever or irritability.

If you’re aware of any accidents or injuries to the eye, please notify Pediatrix.

Ear Infections

At least one episode of otitis media will be experienced by 85 percent of all children during their first five years of life. Otitis media means inflammation of eustachian tube, the narrow passageway from behind the eardrum to the nose and throat area. It’s purpose is to equalize air pressure between the middle ear and the air outside the ear.

With a cold, allergies or even teething, the eustachian tube may become blocked. Fluid builds up behind the eardrum and leads to infection, causing pain. The buildup of fluid causes hearing to become muffled. A feeling of blockage in the ear, persistent pain and temporary loss of hearing are symptoms of otitis media.

An ear infection may be treated with antibiotics. Pediatrix will ask you to return after the treatment to make sure your child has responded well to the medicine and to insure that all of the infection is gone. Some thought is being given to keep using antibiotics for the first 2 days in an ear infection.

Persistence of pus or fluid behind the eardrum can cause impaired hearing and may lead to permanent damage. At the time of the checkup, Pediatrix may perform a TYMPANOGRAM on your child. This is a simple, non-painful test to measure the air pressure in the middle ear. It tells us if the eustachian tube is functioning properly.

Can you prevent ear infections? Probably not. There seems to be a genetic tendency toward getting them. Some studies have shown that babies who have chronic otitis media should not be fed a bottle lying down. There is an increase incidence of otitis in children who are exposed to smoke from tobacco.

In an effort to prevent the buildup of fluid behind the eardrum, an antihistamine/decongestant may be recommended as soon as nasal congestion begins. Occasionally, Pediatrix may leave your child on a maintenance dose of antibiotics to prevent an ear infection from developing during teething or the flu season. Each child is treated individually. The most important things to remember are to give the medication as directed and to get adequate follow-up.

Teething

Children’s teeth begin forming before birth, early in the fetal stage. Your diet during pregnancy provided the essential nutrients for your baby’s tooth development. Most children begin teething at four to six months of age. Indicators include drooling, biting and chewing.

The first to appear are usually the front teeth, or incisors on the lower jaw. They’re normally followed by the four upper central and lateral incisors. Then the lower lateral incisors and the molars appear. Before the child’s second birthday, the pointed teeth known as canines usually come through. After age two, the remaining molars erupt.

Teething can cause many symptoms including low grade fever, irritability, waking up at night. But at Pediatrix we hesitate to attribute symptoms to teething until other possible causes have been ruled out.

To soothe a teething child, try having him chew on something cold such as wet wash cloth which has been placed in the freezer for a few minutes. Tylenol can be effective in relieving symptoms. Solutions placed directly on the gums don’t last long enough to be very effective, but may help.

Brushing should begin as soon as the teeth come in. Remember that bottles in bed cause rotting of the teeth. No bottles in bed is a good rule to follow.

Thumbsucking and Pacifiers

All babies are born with a sucking reflex. Because of this they will suck on a fist, finger, nipple or anything else that comes in contact with their mouths. Because sucking is necessary for feeding, your baby soon comes to associate it with feelings of satisfaction and security.

As a child grows older, it’s normal for him to suck on fingers, pacifiers or favorite objects. You may notice an increase in sucking activity if your child is anxious, tired, hungry or stressed.

Simple Croup

Simple croup is an acute infection, which involves the vocal cords, the windpipe and the bronchial tubes. It is usually caused by a virus and will last form 5-7 days.

Croup, like a cold in the nose, causes swelling and increased mucus production in the lining of the windpipe, bronchial tubes, and of the vocal cords. The typical barking cough and noisey breathing of croup is caused by your child breathing through narrowed passages due to the swelling and mucus production.

Use the humidifier, give plenty of fluids, and keep the environment cool. A cool humid environment helps keep the swelling of the vocal cords, windpipe and bronchial tubes down, and helps to make the mucus thinner and easier to handle. You may also take your child into a steamy bathroom for 20 minutes to help loosen the mucus. Taking your child outside for 20-50 minutes may help, (the cold air shrinks the swelling).

Do not use cold and cough preparations, unless instructed to do so, they make the mucous thicker and harder to handle. You should contact us and let us know that your child is ill with the croup. We may want to see your child to make sure that there are no other problems.

“What goes up must come down.”

Fever itself is not a disease but is a symptom of an illness. A fever is part of the body’s natural defense mechanisms for overcoming disease. The infection fighting systems are more effective at elevated temperatures. When your child has an elevated temperature we are more concerned about what is causing the fever, the symptoms associated with the fever, and how the child looks and acts. The height of the temperature is not a reliable indicator of the seriousness of the underlying condition. Some children may have a minor illness and run high temperatures, while others may be very sick and have little or no fever.

Unlike the oral temperature of a healthy adult which remains fairly constant at 98.6° Fahrenheit, the normal body temperature of infants and young children ranges form 97.1° to 100° depending on the time of day, the child’s activity level and the site at which the temperature is measured. As a rule, rectal temperature is one degree higher and axillary temperature one degree lower than oral temperature. Any temperature 101° or higher indicates a child has a fever.

How to Take a Temperature

There are several different types of thermometers:

• Traditional glass mercury thermometers(oral & rectal styles)
• Electronic digital thermometers (more expensive)
• Liquid crystal thermometers (not as accurate)

To take an axillary temperature, place the bulb of an oral thermometer in the armpit and hold the arm against the chest for at least three minutes. To take a rectal temperature, use a rectal thermometer. Make sure that the thermometer bulb is lubricated and that the baby is lying on its stomach. Gently guide the thermometer about one inch into there rectum, but never force it. Hold the thermometer in place by gently pinching the baby’s buttocks together with one hand. When you use this method, the mercury will reach its maximum level within one to two minutes.

To take an accurate oral temperature, the child must cooperate. Place the thermometer under the tongue with the child’s lips closed. If the child’s nose is stuffy or if the child is mouth breathing, the temperature will be lower. There is the danger of biting of breaking a glass thermometer. An oral temperature can be affected by hot or cold foods taken beforehand.

Parents frequently ask what temperature should be considered dangerous or when you should consult Pediatrix. In general, use your own instincts on how your child looks and acts. Call us if you notice any of the following conditions:

1. Any infant with fever of 101° or higher between birth and 6 months.
2. Any fever of 101° or higher that lasts more than 48 hours without an obvious cause or location of infection.
3. Associated symptoms such as a stiff neck, confusion, delirium, difficulty with arousal from sleep, convulsions, whimpering, increased irritability, obvious pain, painful urination or difficulty breathing. The main reason for treatment of fever is to make your child more comfortable. Avoid overdressing or using heavy covers and keep room temperature comfortable, but not overheated. Encourage fluids. Acetaminophen can be used as directed, as well as Ibuprofen.

If giving acetaminophen, fluids and undressing the child do not result in lowering the fever, try sponging the child with lukewarm water, not alcohol.

In some children a sudden rise in a temperature may cause convulsions. There appears to be a genetic predisposition to this. While a fever-associated convulsion is frightening, remember that it is not life-threatening and is usually of short duration.

Chicken Pox

Chicken Pox is a highly contagious childhood disease. It is known for a blister-like rash and itching. Chicken Pox is caused by a virus and the only treatment is to help relieve the symptoms. Once a child is exposed, the incubation period is 14-21 days. The typical rash goes through these stages:

• A prodrome of cold-like symptoms 24 hours before the rash appears which consists of a low-grade temperature, mild congestion and possibly a cough.
• The rash appears as small blisters on a red base, usually first on the trunk and then moving to the extremities and face. The vesicles tend to appear in “crops” with two to four crops appearing within two to five days. As the vesicles break, scabs appear.
• Your child remains contagious until all of the vesicles are scabbed. This takes 10 days.

To treat Chicken Pox

1. Keep your child cool and comfortable, and avoid close contact with other children.
2. Acetaminophen is okay, but never use aspirin or ibuprofen (Advil, Motrin).
3. Cool or tepid baths with baking soda or Aveeno’s Oatmeal Bath may be used for itching.
4. Benadryl Elixir also may be taken orally for the itching. You can purchase it over the counter as well as Caladryl lotion which can be used topically.
5. Keep the child’s fingernails short.

Call Pediatrix if your child gets Chicken Pox, so we can document it in the chart. We would be concerned about:

• A persistent fever of 101° or higher lasting longer than four or five days.
• Persistent cough or labored, fast, or heavy breathing.
• Severe headache, stiff neck or persistent vomiting.
• Sore ears.
• If the chicken pox lesions start to look infected or if you see any streaking form any of the lesions.

There is now an immunization to prevent Chicken Pox (Varivax).