29 USEFUL HINTS

The following information is taken from our "Patient Information Booklet”

1. Bathing - The child may play in the clear water first. Then, if you use soap, soap her up and rinse her off quickly. Sitting in soapy water can cause dry skin and genital irritation. Use a mild soap or bar; Ivory Soap and deodorant soaps are very harsh and should usually be avoided. Bubble bath should be avoided for the same reason. Ear wax can often be softened or flushed out by rinsing clear water into the ear canal on a daily basis.

2. Burns - Immediately rinse off the hot substance, if any; then apply ice or cold water compresses for 30 minutes, or immerse in cool water. Then call the office for further advice. Blistering burns, especially on the face or hands, should be seen in the office. (Try not to pop the blister.) Never apply butter to the burn. We will sometimes recommend antibiotic ointment to avoid infection.

3. Colds - Children can have up to 12 colds a year. They may last from 7 to 10 days, and are generally caused by viruses, which are not sensitive to antibiotics. Colds are very frequent the first year a child is in a school or day care. Ordinary colds do not give a high or prolonged fever. If the cold lasts over 10 days, or if fever develops after the child has had the cold for several days, please call for an appointment.

To care for a cold, plenty of fluids and a vaporizer are all that are needed. For congestion, any oral decongestant (for children over 4 months) or salt water nose drops may provide comfort. Elevating the head may help. If a cough keeps the child up a night, discuss the need for a cough medicine with the nurse during telephone hours. We do not normally prescribe antibiotics unless an examination in the office reveals a bacterial infection. You can expect the appetite to be quite diminished; this is of no concern as long as the child is taking fluids well.

4. Dentist - We recommend that your child see a dentist for the first visit between the 3rd and 4th birthday.

5. Diaper Rash - Change the diaper promptly. At each change, cleanse with mild soap and water, and rinse well. Dry thoroughly by exposing the area to the air; you may gently use a hair dryer on low setting. Diaper creams such as Balmex, Desitin, A&D, or Vaseline may be useful. If the rash lasts longer than 1 week or is very red, try Lotrimin cream 2-3 times per day. Avoid chemically treated "baby wipes;" they may further irritate the rash. If the rash persists, call for advice.

6. Diarrhea - Dehydration is very unlikely from diarrhea alone, as long as adequate fluids are given. For children with severe diarrhea, start with clear liquids, bananas, rice, applesauce, crackers and toast; advance to a regular diet within a day. Continue with a regular diet after the initial treatment, even if the diarrhea persists. Avoid juices and punches.

If the diarrhea persists beyond 7-10 days, call the office during telephone hours. We do not recommend medicine to stop diarrhea in young children.

Children with diarrhea frequently have a small amount of blood-streaked stool; this is normal and requires only Vaseline to the rectum if the child is otherwise well. However, if the diarrhea is associated with a high fever, or large amounts of blood in the stool, please call the office.

7. Earache – Infants and toddlers are not good at localizing pain; if you see him pulling at the ears with no cold symptoms, teething is as likely as an ear infection. If you are concerned or the infant seems excessively cranky, you may give acetaminophen and schedule an appointment.

If an older child has a severe earache in association with cold symptoms, call us. Never put oil or other drops in a painful ear unless it is medication specifically for earaches.

8. Eczema - Infants often develop dry patches on their skin. Usually this is not due to food allergies in these young children, but is due simply to the skin drying out. Sometimes there is a family tendency toward eczema. If you notice these dry patches, there are several steps you might take.

a. Apply a fragrance-free moisturizing cream (such as Eucerin or Nivea), especially just after a bath onto moist skin.
b. Keep the bath water lukewarm, and keep bath time short.
c. Soap, if used at all, should be a mild type such as a Dove bar.
d. Avoid fabric-softener sheets on the clothes.

If the above does not alleviate the eczema quickly, 1% hydrocortisone cream or ointment may be applied to the dry patches up to 3-4 times a day for 5 days. If the eczema persists, please call the office to make an appointment.

9. Fluoride - If there is no fluoride in your tap water, we will prescribe supplements for your child from 6 months to 12 years of age. Most towns in southern New Jersey, Pennsylvania or Maryland do not fluoridate their water, but check with your Water Company or Public Health Department to determine the fluoride level in the water. If you have well water, you probably need fluoride, but you may wish to have the water tested for fluoride before we prescribe it. We do not recommend fluoride supplements if your tap water is fluoridated, even if your child drinks little of it or is nursing.

10. Guns - 30% of all Delaware homes have a gun. However, if not stored properly, guns pose a clear hazard to all children in the home. All firearms should be stored unloaded, in a locked cabinet, with the ammunition in a separate locked cabinet.

11. Head Injuries - Children often fall and bump their heads. Frequently, there will be dramatic swelling; this does not necessarily indicate serious injury. Simply apply ice; you may also give acetaminophen. Symptoms to call the office for include: loss of consciousness, discharge from the ear, severe headache, persistent vomiting, increasing sleepiness, difficulty walking or talking, or alteration of memory. It is not harmful to allow the child to fall asleep, but you may want to wake him periodically to check his mental state and the ability to wake him up easily. If acting sick, please take the temperature; an unrecognized fever may cause the same symptoms.

12. Kerosene Heaters and Wood Stoves - Small children frequently burn themselves on these heaters. Also, their use is associated with eye irritation, nasal congestion, sore throats, and headaches. We recommend against their use if the home can be heated a safer way.

13. Lead Paint - Homes built before the 1960’s may contain lead paint, posing a poisoning hazard to small children. Paint should be kept in good condition, with no flaking or chipping. Cleaning floors routinely with high phosphate dishwasher detergent can help control lead paint dust. Only a trained certified contractor should remove lead paint; unsafe lead paint removal can cause poisoning. For further information, contact Delaware’s Childhood Lead Poisoning Prevention Office at 995-8693.

14. Nose Bleeds - These are common and often spontaneous, or caused by trauma, nose picking, colds, cigarette smoke, allergies, or dry home heat. Nose bleeds can be very alarming, but are rarely dangerous.

To prevent recurrent nose bleeds: run a vaporizer in the child's room, avoid any cigarette smoke in the house, and avoid giving decongestants and aspirin or aspirin-containing products. You may also apply Vaseline or saline drops to the nostril opening.

If a child has a nose bleed that does not stop spontaneously: Have the patient sit up, with the head tilted slightly forward, and squeeze the nasal passages for 5-7 minutes. If the bleeding does not stop in 15 minutes, dip a cotton ball in hydrogen peroxide, and squeeze until almost dry. Stuff the cotton ball (or a portion of it) into the bleeding nostril and squeeze the nostrils as above. Leave in place several hours or overnight, keeping moist with peroxide. Then rewet cotton ball, and gently remove with tweezers. If re-bleeding occurs, repeat this process, and call the office.

15. Poisoning - Call immediately! Either call our sick line, or call Poison Control 1-800-222-1222.

16. Q-Tips - Never use them to clean ears. They can cause injury, or push the wax further in. A better way to clean ears is to make sure that clean water gets into the ear canals at each bath (even in infants). This softens the wax, and does not cause ear infections or other problems.

17. Rashes - Please do not expect us to diagnose most rashes over the phone. If you are not sure what the cause is, we are happy to schedule an appointment during office hours. There is no harm in trying most non-prescription remedies. (Avoid cortisone cream in young infants unless prescribed by your doctor.)

18. Salt Water Nose Drops - Helpful for infants with stuffy noses who are having trouble sleeping or eating, or are uncomfortable. Dissolve 1 pinch (1/4 tsp.) of salt in 1 cup of tepid water. Have the child lie face up, and place 2-3 drops in one nostril. After several seconds, sit the child up, and clean the nose with a warm washcloth using a milking action. Then repeat with the other nostril. Do not use nasal aspiration bulbs; constant use can worsen the stuffiness.

19. Seizure - If you think your child is having a convulsion:

a. Turn on the lights!
b. Note the time.
c. Lie the child on the floor or rug face up away from other objects.
d. Turn the head to the side.
e. Be sure the airway is clear.
f. If the child begins to vomit, roll him to his side.
g. Do not put anything in his mouth. He will not swallow his tongue.
h. Do not try to restrain the shaking.
i. Wait until the seizure is over.
j. Note how long the seizure lasts, which parts of his body are twitching, and his color in his face.
k. If the seizure lasts over 5 minutes, call the ambulance.
l. When the seizure is over, the child will be very sleepy. Let him sleep.
m. Call us immediately!
n. While you are waiting for our call back, take the temperature.
20. Sleep Position for Infants - We agree with the American Academy of Pediatrics that all infants should be laid down to sleep on their backs, unless a medical condition requires otherwise. The face-up sleep position is clearly associated with a reduction in SIDS. The side position is no longer recommended for routine use. If your child has reflux or another medical condition, this should be discussed with your doctor. Once the infant is old enough to roll over (about 4-5 months), the sleep position becomes less imperative.

21. Smoking - We strongly recommend against smoking around your children. Any smokers should take their cigarettes outside, since the smoke will settle in your heating system, carpets and upholstery, and affect the children at a later time. If a nursing mother smokes, the nicotine and other byproducts can be found in the milk. Parental smoking is associated with SIDS, as well as cough, congestion, sore throats, asthma, bronchitis, pneumonia, and ear infections in children. Children also tend to imitate their parents' habits, and take up smoking themselves as they get older.

22. Strep Throats - We can only diagnose strep throat with an examination and a positive throat culture; call during office hours for an appointment. If the culture is positive, the child must be treated with antibiotics for a full 10 days to prevent rheumatic fever.

23. Sunburn - Keep the child cool and out of the sun. Push lots of fluids to drink. Acetaminophen or ibuprofen is fine for pain. A cool shower may also help. Noxema or Nivea cream may help keep the skin from drying too much. Next time, remember to apply sun block (number 15 or higher) every two hours, for infants over 6 months; keep as much of the body lightly clothed as possible. We advise minimal exposure to sun for children under 6 months; also, sun block is not recommended for this age group.

24. Teething - Allow the infant to chew on a cool washcloth, chilled teething ring, teething biscuit, or cold bagel. Teething gels such as Oragel can be useful, but may also dull the taste buds, which is uncomfortable. You may use acetaminophen or ibuprofen (see "fever" for dosage) every 4 hours as often as the infant needs relief.

25. Tick Removal - There are many methods; here is one: Moisten a cotton ball with a little water, and rub it on a bar of soap. Cover the tick with the soapy cotton ball, and rub gently counterclockwise. After 1 or 2 circles you should find the tick intact on the cotton ball. Another technique is to gently grasp the head of the tick with a tweezers, carefully flip it belly-up over its head, and gently pull until it lets go of the skin. If part of the tick remains embedded, remove as much as you can, but don’t be concerned if some remains; it will come out eventually. When the tick is out, wash the skin with soap and water and apply antibiotic ointment. If a half-inch area of redness appears around the site over the next few days, this is of no concern. However, if a large red circle or blotch appears over 3-7 days, the child needs to be examined in the office.

26. Tooth Brushing - Start brushing teeth with a soft toothbrush or cloth and water as soon as they appear. Do not use fluoridated toothpaste until you are sure your child is not swallowing the toothpaste. Regular visits to a dentist should start between the 3rd and 4th birthday or sooner if the child has dental problems.

27. Vaporizers and Humidifiers - These are very useful for anyone with a runny nose, cough or congestion. The warm mist type works fine, but care must be taken so that a curious small child does not get scalded. Plain tap water (no Vicks or other medicine) is fine for warm or cool types, but the ultrasonic type may require distilled water. Furnace humidifiers are fine but do not moisturize the air as well as the room types, and some models may breed mold if not cleaned regularly.

28. Vomiting -

a. If your child is 1 year or older:
Give your child clear fluids, but no solids, for eight hours. Offer your child clear fluids (such as Gatorade, fruit juice, Pedialyte or Infalyte; no milk or plain water) until he/she has gone eight hours without vomiting.
Start with one tablespoon for children between 1 and 6 years of age and one ounce for school-age children, every 10 minutes for four consecutive hours.
After four hours without vomiting, double the amount each hour for another four consecutive hours.
If your child vomits using this treatment, rest the stomach completely for one hour and then start over but with 1/2 the amount. The one-swallow-at-a-time approach rarely fails.
Give bland foods after eight hours without vomiting. After your child has gone for eight hours without vomiting, he/she can gradually return to a normal diet. For older children, start with foods such as saltine crackers, honey on white bread, bland soups (such as chicken with rice or noodles), rice, and mashed potatoes.
Your child usually can be back on a normal diet within 24 hours after he/she stops vomiting, even if the diarrhea persists. It won't hurt him/her not to eat much for a few days as long as he/she drinks.

b. For bottle-fed infants under 1 year of age:
Offer an oral electrolyte solution such as Infalyte or Pedialyte for eight hours.
If your child has vomited only once, dilute the usual formula with equal amounts of plain water.
If he/she vomits two or more times, wait one hour, then offer Infalyte or Pedialyte in small amounts (one teaspoon) every 10 minutes for four consecutive hours.
After four hours without vomiting, double the amount given every 10 minutes for an additional four hours.
After eight hours without vomiting, return to formula.
Infants over 4 months can also return to eating cereal and strained bananas after eight hours and go back to a normal diet in 24 to 48 hours after vomiting stops.

c. For breastfed babies under 1 year of age:
Reduce the amount per feeding. The key to treating vomiting in breastfed babies is to provide breast milk in smaller amounts than usual.
If your baby has vomited twice, continue breastfeeding but nurse on only one side each time for 10 minutes.
After your baby has gone for eight hours without vomiting, return to nursing on both sides. If your baby vomits three or more times, nurse him/her four or five minutes every 30 to 60 minutes.
If vomiting continues, put him/her on an oral electrolyte solution (Infalyte or Pedialyte).
As soon as four hours have passed without vomiting, return to nursing, but again giving smaller-than-usual amounts of breast milk for eight hours.

d. Avoid these common mistakes:
A common error is to give as much clear fluid as the child wants rather than gradually increasing the amount. This almost always leads to continued vomiting.
Keep in mind that there is no effective drug for vomiting caused by a virus or irritated stomach lining and that diet therapy is the answer. Call our office if the child is still holding down no fluids by the next morning, or if he looks dramatically worse.

29. Water: There is no need to drink a certain amount of water per day, as long as other fluids are taken in the usual amounts. Plain tap water is fine for most uses; there is rarely an advantage to store-bought bottled water. There is usually no need to boil water for infants if the water is taken straight from the tap. If you have a well, the water should be tested periodically for organisms and chemical contaminants, and you should ask us about fluoride supplements.