Stomach Pain - Female

Causes of Acute Stomach Pain

• Eating Too Much. Eating too much can cause an upset stomach and mild stomach pain.
• Hunger Pains. Younger children may complain of stomach pain when they are hungry.
• GI Virus (such as Rotavirus). A GI virus can cause stomach cramps as well as vomiting and/or diarrhea.
• Food Poisoning. This causes sudden vomiting and/or diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
• Constipation. The need to pass a stool may cause cramps in the lower abdomen.
• Strep Throat. A strep throat infection causes 10% of new onset stomach pain with fever.
• Bladder Infection. Bladder infections usually present with painful urination, urgency and bad smelling urine. Sometimes the only symptom is pain in the lower abdomen.
• Appendicitis (Serious). Suspect appendicitis if pain is low on the right side and walks bent over. Other signs are the child won't hop and wants to lie still.
• Intussusception (Serious). Sudden attacks of severe pain that switch back and forth with periods of calm. Caused by one segment of bowel telescoping into a lower piece of bowel. Peak age is 6 months to 2 years.

Causes of Recurrent Stomach Pains

• Stress or Worries. The most common cause of frequent stomach pains is stress. Over 10% of children have a "worried stomach." These children tend to be sensitive and too serious. They often are model children. This can make them more at risk to the normal stresses of life. Examples of these events are changing schools, moving or family fights. The pain is in the pit of the stomach or near the belly button. The pain is real.
• Abdominal Migraine. Attacks of stomach pain and vomiting with sudden onset and offset. Often occur in children who later develop migraine headaches. Strongly genetic.
• Functional Abdominal Pains. Functional means the stomach pains are due to a sensitive GI tract. The GI tract is free of any disease.
• School Avoidance. Stomach pains that mainly occur in the morning on school days. They keep the child from going to school.

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

When to Call for Stomach Pain - Female

Care Advice for Stomach Pain

1. What You Should Know About Stomach Pain:
   • Mild stomach pain can be caused by something simple. It could be from gas pains or eating too much.
   • Sometimes, stomach pain signals the start of a viral infection. This will lead to vomiting or loose stools.
   • Watching your child for 2 hours will help tell you the cause.
   • Here is some care advice that should help.
2. Lie Down:
   • Have your child lie down and rest until feeling better.
3. Clear Fluids:
   • Offer clear fluids only (such as water, flat soft drinks or half-strength Gatorade).
   • For mild pain, offer a regular diet.
4. Prepare for Vomiting:
   • Keep a vomiting pan handy.
   • Younger children often talk about stomach pain when they have nausea. Nausea is the sick stomach feeling that comes before they throw up.
5. Pass a Stool:
   • Have your child sit on the toilet and try to pass a stool.
   • This may help if the pain is from constipation or diarrhea.
   • Note: For constipation, moving a warm wet cotton ball on the anus may help.
6. Do Not Give Medicines:
   • Any drug (like ibuprofen) could upset the stomach and make the pain worse.
   • Do not give any pain medicines or laxatives for stomach cramps.
   • For fever over 102° F (39° C), acetaminophen (such as Tylenol) can be given.
7. What to Expect:
   • With harmless causes, the pain is most often better or gone in 2 hours.
   • With stomach flu, belly cramps may happen before each bout of vomiting or diarrhea. These cramps may come and go for a few days.
   • With serious causes (such as appendicitis), the pain worsens and becomes constant.
8. Call Your Doctor If:
   • Pain becomes severe
   • Constant pain lasts more than 2 hours
   • Mild pain that comes and goes lasts more than 24 hours
   • You think your child needs to be seen
   • Your child becomes worse
9. Extra Help: Worried Stomach:
   • Help your child talk about events that trigger the stomach pain. Talk to your child about how to cope with these the next time around.
   • Help your child worry less about things she can't control.
   • To treat the pain, help your child get very relaxed. Lying down in a quiet place and taking slow deep breaths may help. Make the belly go up and down with each breath. Then try to relax all the muscles in the body. Think about something pleasant. Listening to audios that teach how to relax might also help.
   • Make sure your child gets enough sleep.
   • Make sure that your child doesn't miss any school because of stomach pains. Stressed children tend to want to stay home when the going gets rough.
   • Caution: Your child should see her doctor for an exam. Do this before concluding frequent stomach pains are from worrying too much.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Stomach Pain - Male

Causes of Acute Stomach Pain

• Eating Too Much. Eating too much can cause an upset stomach and mild stomach pain.
• Hunger Pains. Younger children may complain of stomach pain when they are hungry.
• GI Virus (such as Rotavirus). A GI virus can cause stomach cramps as well as vomiting and/or diarrhea.
• Food Poisoning. This causes sudden vomiting and/or diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
• Constipation. The need to pass a stool may cause cramps in the lower abdomen.
• Strep Throat. A strep throat infection causes 10% of new onset stomach pain with fever.
• Bladder Infection. Bladder infections usually present with painful urination, urgency and bad smelling urine. Sometimes the only symptom is pain in the lower abdomen.
• Appendicitis (Serious). Suspect appendicitis if pain is low on the right side and walks bent over. Other signs are the child won't hop and wants to lie still.
• Intussusception (Serious). Sudden attacks of severe pain that switch back and forth with periods of calm. Caused by one segment of bowel telescoping into a lower piece of bowel. Peak age is 6 months to 2 years.

Causes of Recurrent Stomach Pains

• Stress or Worries. The most common cause of frequent stomach pains is stress. Over 10% of children have a "worried stomach." These children tend to be sensitive and too serious. They often are model children. This can make them more at risk to the normal stresses of life. Examples of these events are changing schools, moving or family fights. The pain is in the pit of the stomach or near the belly button. The pain is real.
• Abdominal Migraine. Attacks of stomach pain and vomiting with sudden onset and offset. Often occur in children who later develop migraine headaches. Strongly genetic.
• Functional Abdominal Pains. Functional means the stomach pains are due to a sensitive GI tract. The GI tract is free of any disease.
• School Avoidance. Stomach pains that mainly occur in the morning on school days. They keep the child from going to school.

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

When to Call for Stomach Pain - Male

Care Advice for Stomach Pain

1. What You Should Know About Stomach Pain:
   • Mild stomach pain can be caused by something simple. It could be from gas pains or eating too much.
   • Sometimes, stomach pain signals the start of a viral infection. This will lead to vomiting or loose stools.
   • Watching your child for 2 hours will help tell you the cause.
   • Here is some care advice that should help.
2. Lie Down:
   • Have your child lie down and rest until feeling better.
3. Clear Fluids:
   • Offer clear fluids only (such as water, flat soft drinks or half-strength Gatorade).
   • For mild pain, offer a regular diet.
4. Prepare for Vomiting:
   • Keep a vomiting pan handy.
   • Younger children often talk about stomach pain when they have nausea. Nausea is the sick stomach feeling that comes before they throw up.
5. Pass a Stool:
   • Have your child sit on the toilet and try to pass a stool.
   • This may help if the pain is from constipation or diarrhea.
   • Note: For constipation, moving a warm wet cotton ball on the anus may help.
6. Do Not Give Medicines:
   • Any drug (like ibuprofen) could upset the stomach and make the pain worse.
   • Do not give any pain medicines or laxatives for stomach cramps.
   • For fever over 102° F (39° C), acetaminophen (such as Tylenol) can be given.
7. What to Expect:
   • With harmless causes, the pain is most often better or gone in 2 hours.
   • With stomach flu, belly cramps may happen before each bout of vomiting or diarrhea. These cramps may come and go for a few days.
   • With serious causes (such as appendicitis), the pain worsens and becomes constant.
8. Call Your Doctor If:
   • Pain becomes severe
   • Constant pain lasts more than 2 hours
   • Mild pain that comes and goes lasts more than 24 hours
   • You think your child needs to be seen
   • Your child becomes worse
9. Extra Help: Worried Stomach:
   • Help your child talk about events that trigger the stomach pain. Talk to your child about how to cope with these the next time around.
   • Help your child worry less about things he can't control.
   • To treat the pain, help your child get very relaxed. Lying down in a quiet place and taking slow deep breaths may help. Make the belly go up and down with each breath. Then try to relax all the muscles in the body. Think about something pleasant. Listening to audios that teach how to relax might also help.
   • Make sure your child gets enough sleep.
   • Make sure that your child doesn't miss any school because of stomach pains. Stressed children tend to want to stay home when the going gets rough.
   • Caution: Your child should see his doctor for an exam. Do this before concluding frequent stomach pains are from worrying too much.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Acne

Symptoms of Acne

• Whiteheads (pimples) are plugged oil glands that are closed.
• Blackheads are plugged oil glands that are open. Reason: The oil turns black when it is exposed to air.
• Whiteheads and blackheads are also called "zits."
• Red bumps are from blocked oil glands that have leaked oil. This causes irritation in the skin around them. Larger red bumps can be quite painful.
• Acne mainly appears on your face, neck, and shoulders

Causes of Acne

• Acne skin changes are from plugged oil glands. Acne has several causes.
• Increased levels of hormones during puberty have a part. Heredity also plays an important role.
• Some skin bacteria can make it worse.
• Acne is not caused by diet. You do not need to avoid eating fried foods, chocolate, or any other food.
• Acne is not caused by dirt or by not washing your face often enough.

When to Call for Acne

Care Advice for Acne

1. What You Should Know About Acne:
   • More than 90% of teenagers have some acne. Acne is a normal part of the teen years.
   • There is no medicine at this time that will cure acne.
   • However, good skin care can keep acne under control and at a mild level.
   • Here is some care advice that should help.
2. Benzoyl Peroxide Gel:
   • Benzoyl Peroxide (BP) is the best OTC medicine for bringing acne under control. Use a Benzoyl Peroxide 5% gel product (such as the store brand). OTC means no prescription is needed.
   • It helps to open pimples and to unplug blackheads. It also kills bacteria.
   • Apply the lotion once a day at bedtime to the area with acne. Redheads and blonds should apply it every other day for the first 2 weeks. Reason: More sensitive skin.
   • Use an amount of lotion the size of a pea. This should be enough to cover most of the acne.
   • If the skin becomes red or peels, use less of it. Other option: You can use it less often.
   • Caution: Avoid the corners of the eyes, nose and mouth. Reason: These areas are very sensitive.
   • Caution: Benzoyl Peroxide bleaches clothing, towels, blankets, etc. Apply it only at bedtime and put it on sparingly. Use a plain white pillowcase.
3. Antibiotics for Red Bumps:
   • Large red bumps mean the infection has spread beyond the oil gland. If you have several red bumps, your doctor may prescribe an antibiotic.
   • Antibiotics come as solutions for the skin or as pills.
   • The antibiotic will kill the bacteria that are causing the infection.
   • Give the antibiotic as directed.
4. Washing the Face:
   • Wash your skin twice a day. The most important time to wash is bedtime. Just use warm water or you can use a mild soap (such as Dove).
   • Shampoo your hair daily.
   • Avoid scrubbing your skin. Reason: Hard scrubbing of the skin irritates the openings of the oil glands. This causes them to close off even more tightly.
5. Pimple Opening:
   • Opening (popping) pimples is not advised by many doctors. But, most teens and adults do it anyway.
   • So, here's how to open a pimple safely without any squeezing.
   • Never open a pimple before it has come to a head.
   • Wash your face and hands first.
   • Use a sterile needle (cleaned with rubbing alcohol). Nick the surface of the yellow pimple with the tip of the needle. The pus should run out without squeezing.
   • Wipe away the pus and wash the area with soap and water.
   • Opening small pimples in this way will not cause skin damage.
6. Avoid Picking or Squeezing Acne:
   • Many young people pick at their acne when they are not thinking about it. Picking makes acne worse.
   • Try not to touch the face at all during the day.
   • Squeezing blackheads causes bleeding into the skin. The bleeding turns into brownish blotches on the skin. They can take 1 or 2 months to fade.
   • Squeezing red lumps can force bacteria into the skin. This too leaves blotches. It can also cause a serious face infection.
7. Prevention - Avoid Triggers of Acne:
   • Avoid putting any oily or greasy substances on your face. Reason: They block oil glands and make acne worse. If you use cosmetics, use water-based cosmetics.
   • Avoid hair tonics or hair creams (especially greasy ones). When you sweat, they will get on the face and irritate the acne.
8. What to Expect:
   • With treatment, new whiteheads and blackheads will decrease. But, it takes 6 to 8 weeks.
   • Acne usually lasts until age 20 or 25.
   • So, you will need to continue the treatment for several years.
   • You don't need to worry about scarring. It is very rare for acne to leave any scars.
9. Call Your Doctor If:
   • With treatment, the acne has not improved after 2 months
   • It looks infected (large, red, tender bumps)
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Animal or Human Bite

Types of Wounds

• Bruise. There is no break in the skin. No risk of infection.
• Scrape (Abrasion) or Scratch. A wound that doesn't go all the way through the skin. Low chance of infection. Antibiotic drugs are not needed.
• Cut (Laceration). A wound that goes through the skin to the fat or muscle tissue. Some chance of infection. Most need to be seen. Cleaning the wound can help prevent this. Antibiotic drugs may be needed.
• Puncture Wound. These wounds break through the skin. Greater risk of infection. Puncture wounds from cat bites are more likely to get infected. Antibiotic drugs may be needed.
• Wound Infection. This is the main risk of an animal bite. The main finding is redness around the bite and pain. It starts 8 hours to 3 days after the bite. It can often be prevented by early, careful cleaning of the bite. This is why most animal bites need to be seen.

Types of Animal Bites

• Large Wild Animal Bites. Rabies is a disease that can kill people. Bites or scratches from any large wild animal can pass on rabies. Animals at highest risk are bats, skunks, raccoons, foxes, or coyotes. These animals may spread rabies even if they have no symptoms.
• Small Wild Animal Bites. Small animals such as mice, rats, moles, or gophers do not carry rabies. Chipmunks, prairie dogs, squirrels and rabbits also do not carry rabies. Exception: one of these small animals actually attacks a human (an unprovoked bite). Sometimes, their bites can get infected.
• Large Pet Animal Bites. Most bites from pets are from dogs or cats. Bites from other pets such as horses can be handled using this guide. Dogs and cats are free of rabies in most U.S. and Canadian cities. Stray animals are always at risk for rabies until proven otherwise. Cats and dogs that always stay indoors should be safe. The main risk in pet bites is wound infection, not rabies. Cat bites become infected more often than dog bites. Cat scratches can get infected just like a bite because cats lick their claws.
• Small Indoor Pet Animal Bites. Small indoor pets are not at risk for rabies. Examples of these pets are gerbils, hamsters, guinea pigs, or mice. Tiny puncture wounds from these small animals also don't need to be seen. They carry a small risk for wound infections.
• Human Bites. Most human bites occur during fights, especially in teenagers. Sometimes a fist is cut when it strikes a tooth. Human bites are more likely to become infected than animal bites. Bites on the hands are at higher risk. Many toddler bites are safe because they don't break the skin.
• Bat Bites and Rabies. In the U.S., 90% of cases of rabies in humans are caused by bats. Bats have spread rabies without a visible bite mark.

Animals at Risk for Rabies

• Bat, skunk, raccoon, fox, or coyote
• Other large wild animals
• Pets that have never had rabies shots and spend time outdoors
• In the U.S., rabies occurs 4 times more in cats than in dogs.
• Outdoor animals who are sick or stray
• Dogs or cats in countries that do not require rabies shots
• In the U.S. and Canada, bites from city dogs and cats are safe.
• In the U.S., there are 2 - 3 deaths from rabies per year in humans.

When to Call for Animal or Human Bite

Care Advice for Animal or Human Bite

1. What You Should Know About Bites:
   • Bites that don't break the skin can't become infected.
   • Cuts and punctures always are at risk for infection.
   • Here is some care advice that should help.
2. Clean the Bite:
   • Wash all wounds right now with soap and water for 5 minutes.
   • Also, flush well under running water for a few minutes. Reason: Can prevent many wound infections.
3. Bleeding - How to Stop:
   • For any bleeding, put pressure on the wound.
   • Use a gauze pad or clean cloth.
   • Press for 10 minutes or until the bleeding has stopped.
4. Antibiotic Ointment:
   • For small cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Put it on the cut 3 times a day.
   • Do this for 3 days.
5. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
6. Cold Pack for Pain:
   • For pain or bruising, use a cold pack. You can also use ice wrapped in a wet cloth. Apply it to the bruise once for 20 minutes. Reason: Helps with bleeding, pain and swelling.
7. What to Expect:
   • Most scratches, scrapes and other minor bites heal up fine in 5 to 7 days.
8. Call Your Doctor If:
   • Bite starts to look infected (pus, redness, red streaks)
   • Fever occurs
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Antibiotics: When Do They Help?

Antibiotics are strong medicines that can kill bacteria. They have saved many lives and prevented bad outcomes. These drugs do not kill viruses. They only work on bacteria. Every day, doctors must decide if a child's infection is viral or bacterial. Here's how they do it:

Bacterial Infections

Much less common than viral infections. Antibiotics can help. Bacteria cause:

• Most ear infections
• Most sinus infections (not sinus congestion)
• 20% of sore throats which are Strep throats
• 10% of pneumonia (a lung infection)

Viral Infections

Most infections in children are caused by a virus. Antibiotics do not help. Viruses cause:

• 100% of colds. (Note: unless they turn into an ear or sinus infection. This happens with 5 to 10% of colds.)
• 95% of new coughs. (Note: asthma can also start with a cough.)
• 95% of fevers
• 80% of sore throats
• 90% of pneumonia. (Note: most cases in children are caused by a virus.)
• 99% of diarrhea and vomiting
• Note: There are a few anti-viral drugs that can treat viral infections. An example is Tamiflu used for severe influenza.

Cold Symptoms that are Normal

Parents sometimes are worried about common cold symptoms. The symptoms below are not signs of bacterial infections. Nor, are they a reason to start antibiotics.

• Green or yellow nose discharge. This is a normal part of getting over a cold. It is not a clue to a sinus infection.
• Green or yellow coughed up phlegm. This is a normal part of getting over viral bronchitis. It is not a sign of pneumonia.
• High fevers. High fevers (more than 104° F or 40° C) can be caused by a virus or bacteria.

Side Effects of Antibiotics

All antibiotics have side effects. Some children taking these drugs can get side effects. Examples are diarrhea, nausea, vomiting, or a rash. Loose stools occur because the drug kills off the good bacteria in the gut. If your child gets a rash, it can be from the drug. Your doctor has to decide if the rash is an allergy or not. The biggest side effect of overuse is called antibiotic resistance. This is when the germs are no longer killed by the drug. That's why we only use antibiotics if your child really needs one.

Giving Antibiotics for Viral Infections: What Happens?

If your child has a virus, an antibiotic won't get rid of the fever. It will not help the other symptoms. The drug will not get your child back to school sooner. It will not get you back to work any faster. If your child has side effects from the drug, he will feel worse.

What You Can Do

• Save antibiotics for bacterial infections when your child really needs them
• Don't pressure your child's doctor for an antibiotic
• Treat your child's cold and cough symptoms with home treatment that works
• Keep in mind that fever is fighting the infection. It also boosts the immune system to prevent future infections.

Arm Injury

Types of Arm Injuries

• Fractures. Fractures are broken bones. A broken collarbone is the most common broken bone in children. It's easy to notice because the collar bone is tender to touch. Also, the child cannot raise the arm upward.
• Dislocations. This happens when a bone is pulled out of a joint. A dislocated elbow is the most common type of this injury in kids. It's caused by an adult quickly pulling or lifting a child by the arm. Mainly seen in 1 to 4 year olds. It's also easy to spot. The child will hold his arm as if it were in a sling. He will keep the elbow bent and the palm of the hand down.
• Sprains. Sprains are stretches and tears of ligaments.
• Strains. Strains are stretches and tears of muscles (such as a pulled muscle).
• Muscle Overuse. Muscle pain can occur without an injury. There is no fall or direct blow. Muscle overuse is from hard work or sports (such as a sore shoulder).
• Muscle bruise from a direct blow
• Bone bruise from a direct blow
• Skin Injury. Examples are a cut, scratch, scrape or bruise. All are common with arm injuries.

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Arm Injury

Care Advice for Minor Arm Injuries

1. What You Should Know About Minor Arm Injuries:
   • During sports, muscles and bones get bruised.
   • Muscles get stretched.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil). Ibuprofen works well for this type of pain.
   • Use as needed.
3. Small Cut or Scrape Treatment:
   • Use direct pressure to stop any bleeding. Do this for 10 minutes or until bleeding stops.
   • Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
   • Gently scrub out any dirt with a washcloth.
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage. Change daily.
4. Cold Pack for Pain:
   • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes.
   • Repeat 4 times on the first day, then as needed.
   • Reason: Helps the pain and helps stop any bleeding.
   • Caution: Avoid frostbite.
5. Use Heat After 48 Hours:
   • If pain lasts over 2 days, put heat on the sore muscle.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Reason: Increase blood flow and improve healing.
   • Caution: Avoid burns.
6. Rest the Arm:
   • Rest the injured arm as much as possible for 48 hours.
7. What to Expect:
   • Pain and swelling most often peak on day 2 or 3.
   • Swelling should be gone by 7 days.
   • Pain may take 2 weeks to fully go away.
8. Call Your Doctor If:
   • Pain becomes severe
   • Pain is not better after 3 days
   • Pain lasts more than 2 weeks
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Arm Pain

Causes of Arm Pain

• Muscle Overuse (Strained Muscles). Arm pains are often from hard muscle work or sports. Examples are too much throwing or swimming. They are most common in the shoulder. This type of pain can last from hours up to 7 days.
• Muscle Cramps. Brief pains that last 1 to 15 minutes are often due to muscle cramps. These occur in the hand after too much writing or typing.
• Viral Illness. Mild muscle aches in both arms also occur with many viral illnesses.
• Septic Arthritis (Serious). This is a bacterial infection of a joint space. Main symptoms are fever and severe pain with movement of the joint. Range of motion is limited or absent (a "frozen joint").

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Arm Pain

Care Advice for Strained Arm Muscles

1. What You Should Know About Mild Arm Pain:
   • Strained muscles are common after using them too much during sports.
   • An example is throwing a ball over and over again.
   • Weekend warriors who are out of shape get the most muscle pains.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
3. Cold Pack for Pain:
   • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes.
   • Repeat 4 times on the first day, then as needed.
   • Caution: Avoid frostbite.
4. Use Heat After 48 Hours:
   • If pain lasts over 2 days, put heat on the sore muscle.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Reason: Increase blood flow and improve healing.
   • Caution: Avoid burns.
5. What to Expect:
   • A strained muscle hurts for 2 or 3 days.
   • The pain often peaks on day 2.
   • After severe overuse, the pain may last a week.
6. Call Your Doctor If:
   • Fever or swollen joint occurs
   • Pain caused by work or sports lasts over 7 days
   • You think your child needs to be seen
   • Pain gets worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Asthma Attack

Symptoms of Asthma

• Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
• Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out.
• The diagnosis of asthma requires attacks of wheezing that recur. The diagnosis is rarely made before 1 year of age.

Causes (Triggers) of Asthma Attacks

• Infections that affect breathing (like colds or the flu)
• Pollens (trees, grass and weeds)
• Animals (like cats or rabbits)
• Tobacco smoke
• Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
• Food Allergy (Serious). Asthma attacks caused by food allergy can be life-threatening (anaphylaxis). Examples are nuts or fish.

Asthma Attack Scale

• Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard or mild. (Green Zone: Peak Flow Rate 80-100% of normal rate)
• Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Wheezing can be heard. Retractions are present (ribs pull in with each breath). (Yellow Zone: Peak Flow Rate 50-80% of normal rate)
• Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. Rarely, wheezing is absent due to poor air movement. Retractions may be severe. (Red Zone: Peak Flow Rate less than 50% of normal rate)
• Peak Flow Meter: a peak flow meter measures Peak Flow Rates (PFR). It tells us how well a person can move air out of the lungs. A PFR can be used in children 6 years and older.

When to Call for Asthma Attack

Care Advice for Asthma Attack

1. What You Should Know About Asthma:
   • Over 10% of children have asthma.
   • Your child's asthma can flare up at any time.
   • When you are away from your home, always take your child's medicines with you.
   • The sooner you start treatment, the faster your child will feel better.
   • Here is some care advice that should help.
2. Asthma Quick-Relief Medicine:
   • Your child's quick-relief (rescue) medicine is albuterol or xopenex.
   • Start it at the first sign of any wheezing, shortness of breath or hard coughing.
   • Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
   • Repeat it every 4 hours if your child is having any asthma symptoms.
   • Never give it more often than 4 hours without talking with your child's doctor.
   • Coughing. The best "cough med" for a child with asthma is always the asthma medicine. Caution: Don't use cough suppressants. If over 6 years old, cough drops may help a tickly cough.
   • Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
   • Use the medicine until your child has not wheezed or coughed for 48 hours.
   • Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
3. Asthma Controller Medicine:
   • Your child may have been told to use a controller drug. An example is an inhaled steroid.
   • It's for preventing attacks and must be used daily.
   • During asthma attacks, keep giving this medicine to your child as ordered.
4. Allergy Medicine for Hay Fever:
   • For signs of nasal allergies (hay fever), it's okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.
5. Fluids - Offer More:
   • Try to get your child to drink lots of fluids.
   • Goal: Keep your child well hydrated.
   • Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up.
6. Humidifier:
   • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
7. Avoid Tobacco Smoke:
   • Tobacco smoke makes asthma much worse.
   • Don't let anyone smoke around your child.
8. Avoid or Remove Triggers:
   • Shower to remove pollens or other allergens from the body and hair.
   • Avoid known causes of asthma attacks (such as smoke or cats).
   • During attacks, reduce exercise or sports if it makes your child's asthma worse.
9. What to Expect:
   • If treatment is started early, most asthma attacks are quickly brought under control.
   • All wheezing should be gone by 5 days.
10. Inhaler With a Spacer: How to Use
    • Step 1. Shake the inhaler well. Then attach it to the spacer (holding chamber).
    • Step 2. Breathe out completely and empty the lungs.
    • Step 3. Close the lips and teeth around the spacer mouthpiece.
    • Step 4. Press down on the inhaler. This will put one puff of the medicine in the spacer.
    • Step 5. Breathe in slowly until the lungs are full.
    • Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
    • If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
11. Metered Dose Inhaler (MDI): How to Use Without a Spacer (if you don't have one)
    • Step 1. Shake the inhaler well.
    • Step 2. Breathe out completely and empty the lungs.
    • Step 3. Close the lips and teeth around the inhaler mouthpiece.
    • Step 4. Press down on the inhaler to release a puff. Do this just as your child starts to breathe in.
    • Step 5. Breathe in slowly until the lungs are full.
    • Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
    • If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
    • Ask your doctor for a spacer if you don't have one. It will help send more medicine into the lungs.
    • Older children who don't like a spacer can be prescribed an albuterol dry powder device.
12. Home Nebulizer: How to Use:
    • A nebulizer machine changes a liquid medicine (med) into a fine mist. The fine mist can carry the med deep into the lungs. This is called a nebulizer (neb) treatment.
    • Step 1. Prepare the medicine. First, wash your hands with soap and water. For pre-mixed single dose vials, just add one vial to the neb holding cup. For multi-dose vials, you need to do the mixing. First, add the correct amount of normal saline to the neb cup. Then carefully measure and add the correct amount of medicine to the saline.
    • Step 2. Connect the nebulizer to the air compressor tubing. The air compressor is run by electricity. Portable ones run on a battery. Compressors make the jet of air that turns the medicine into a fine mist.
    • Step 3. Turn on the air compressor. It will start making the fine mist that your child needs.
    • Step 4 for an Older Child. Place the mouthpiece between your child's teeth and seal with the lips. Ask your child to breathe slowly and deeply. Ask your child to hold a deep breath for 10 seconds once a minute.
    • Step 4 for a Younger Child. If your child refuses the mouthpiece, use a face mask. It should cover the nose and mouth. It should fit snugly.
    • Step 5. Continue the treatment until the med is gone. If the med sticks to the side of the cup, shake it a little. An average neb treatment takes 10 minutes.
    • Step 6. After each treatment, take the nebulizer apart. Rinse and clean it as directed. Reason: It can't produce mist if it becomes clogged up.
    • Caution: Closely follow your doctor's instructions. Use the exact amount of med your doctor ordered. Don't give a neb treatment more often than every 4 hours.
13. Call Your Doctor If:
    • Trouble breathing occurs
    • Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
    • Wheezing lasts over 24 hours
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Back Pain

Causes of Back Pain

• Strained Back Muscles. New backaches in teens are mostly from strained back muscles (muscle overuse). The pain is mostly in the lower back and near the center. There are 200 muscles in the back that allow us to stand upright.
• Work Triggers. Carrying something too heavy or lifting from an awkward position can cause back pain. Bending too far backward or sideways can cause back pain. Digging in the garden for too long causes overuse of back muscles.
• Exercise. New exercises or changes in an exercise routine can cause back pain. This is also called muscle overuse.
• Back Packs. In school-age children, heavy backpacks have become a common cause. They also can cause shoulder and neck pains. Children who have not gone into puberty are at greater risk. Reason: They lack the muscle mass.
• Kidney Infection (Serious). Pain is on one side in the middle of the back. Other symptoms are fever and pain when passing urine.
• Kidney Stone (Serious). Pain is on one side of the mid-back and shoots into the lower belly. The pain is extremely severe. The urine has blood in it.
• Sciatic Nerve Pain (Serious). Sciatica is pain caused by a pinched nerve in the lower back. Sciatica gives a burning pain in one buttock. The pain shoots into the back of the leg on that side. The most intense pain can be in the lower leg and foot. Leg weakness, numbness or tingling can also occur. A ruptured disk causes the pressure on the nerve. Sciatica is rare in children but common in adults.

Symptoms of Back Pain

• Strained back muscles cause most of these symptoms:
• The pain is in the middle or lower back
• The pain is made worse by bending
• The muscles near the spine are tender to the touch
• The muscles may be tight (in spasm)

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

When to Call for Back Pain

Care Advice for Strained Back Muscles

1. What You Should Know About Back Pain:
   • Most new lower back pain is caused by lifting heavy objects. Lifting while the back is twisted is a common cause. Muscle overuse from exercise also causes strained back muscles.
   • Pain is not the only symptom. Walking a little bent over or stiff may occur for a few days.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
   • Reason: Helps back pain and muscle spasms.
3. Cold Pack for Pain:
   • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes.
   • Repeat 4 times on the first day, then as needed.
   • Reason: Helps with the pain and muscle spasms.
   • Caution: Avoid frostbite.
4. Use Heat After 48 Hours:
   • If pain lasts over 2 days, put heat on the sore muscle.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Reason: Increase blood flow and improve healing.
   • Caution: Avoid burns.
5. Sleep on the Side:
   • Sleep on the side with a pillow between the knees.
   • If your child only sleeps on the back, put a pillow under the knees.
   • Avoid sleeping on the stomach.
   • The mattress should be firm. Do not sleep on a waterbed.
6. Activity:
   • Avoid any sports or work that increase the pain.
   • Avoid lifting or jumping until well.
   • After 48 hours, start gentle back stretching exercises.
   • Complete bed rest is not needed.
7. Prevent Backpack Pain:
   • Limit the weight of what is carried. It needs to less than 15% of body weight. That means a 100-pound (45 kg) child should not carry more than 15 pounds (7 kg).
   • A sign of carrying too much weight is having to lean forward when walking.
   • Buy a well-made backpack with wide, padded shoulder straps.
   • Never carry the pack on just one shoulder. Reason: causes shoulder and neck pain.
8. What to Expect:
   • New back pain without a reason most often goes away in a few days.
   • Back pain from muscle overuse (strained back muscles) goes away in 1 to 2 weeks.
9. Call Your Doctor If:
   • Pain becomes severe
   • Walks different than normal for more than 3 days
   • Pain starts to shoot into the leg
   • Fever occurs
   • Pain lasts more than 2 weeks
   • You think your child needs to be seen
   • Pain gets worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Bed Bug Bite

Symptoms of Bed Bug Bites

• Usually cause itchy, red bumps in a group or line
• Often they look like a hive or mosquito bite
• Bite may have a red dot (puncture) in the center. This is where the bed bug bit through the skin.
• Occasionally, a small blister can occur in the center
• Bites are usually on exposed skin (arms, legs and face)
• Bites are usually first noted in the morning

Diagnosis of Bed Bug Bites

• Live bed bugs hide and are not usually seen. Close inspection of the mattress may find some.
• They are ¼ inch (6 mm), flat, oval shaped, reddish-brown bugs.
• Suspect bed bugs if over 3 red bumps in a row are on exposed skin. The bumps or bites are very itchy.
• Bed bug waste is found on bedding or mattress seams. It looks like dark brown flecks or coffee grounds.
• A blood stain on the sheet may sometimes be found. This is from a bug smashed after feeding.

Cause of Bed Bug Bite Reactions

• The skin bumps are the body's reaction to the bug's saliva.
• While the bug is sucking blood, some of its secretions get mixed in.
• Bed bugs are small visible blood-sucking bugs. They are about ¼ inch (6 mm) in length.
• During the day, bed bugs hide in the corners of mattresses. They may also be found in bed crevices, floors, and walls.
• At night, the bed bugs come out of hiding. They feed on humans for about 5 minutes.

Prevention of Getting Bed Bugs

• Over half of bed bug infestations within homes start after recent travel.
• Avoid hotels and hostels where bed bugs have been reported.
• When you check into a hotel room, look for signs of bed bugs. Look for flecks of their waste (like coffee grounds) in the bedding and mattress. If present, ask for another room.
• Keep your luggage and clothing on a luggage rack off the floor.
• When you return from a trip, place all travel clothing into the clothes dryer. Run the dryer for 20 minutes. (Reason: The heat will kill any bed bugs or their eggs that are present). One pregnant bed bug can spread bed bugs to an entire house.

Frequent Questions (FAQs)

• Can bed bugs transmit HIV or hepatitis? This is highly unlikely. It has never been reported.
• Do bed bugs like dirt? Not really. What bed bugs like is the warmth of the human body. Dirty and cluttered spaces just give bed bugs a place to hide.
• Are bed bugs too small to be seen? No. You can see adult bed bugs. They are about the size of an apple seed (4-7 mm; ¼ inch).
• Are bed bugs scared of the light? They do prefer darkness. But keeping the light on will not stop bed bugs from biting you.

When to Call for Bed Bug Bite

Care Advice for Bed Bug Bites

1. What You Should Know About Bed Bug Bites:
   • Bed bug bites cause itchy red bumps.
   • They are usually less than ½ inch (12 mm) in size.
   • Some are larger (like a hive). These are normal reactions to a bed bug.
   • A large hive does not mean your child has an allergy.
   • The redness does not mean the bite is infected.
   • Bed bugs do not carry any infectious diseases.
   • Don't panic: You can get rid of bed bugs from your home.
   • Here is some care advice that should help.
2. Steroid Cream for Itching:
   • To reduce the itching, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
   • Apply 3 times a day until the itch is gone.
   • If you don't have, apply a baking soda paste until you can get some.
3. Allergy Medicine For Itching:
   • If the bite is still itchy, try an allergy medicine by mouth.
   • Benadryl is a good one. No prescription is needed.
4. Try Not to Scratch:
   • Cut the fingernails short.
   • Help your child not to scratch.
   • Reason: Prevent a skin infection at the bite site.
5. Bed Bug Repellents - Not Helpful:
   • Insect repellents do not keep bed bugs from biting.
   • Repellents containing DEET (used on skin) and permethrin (used on clothing) do not help.
6. Removing Bed Bugs from Your Home:
   • Getting rid of bed bugs requires a licensed pest control service.
   • Look in the phone book or on the internet under Pest Control.
7. What to Expect:
   • Any pinkness or redness usually lasts 3 days.
   • The swelling may last 7 days.
   • The itch may last for 2 weeks.
8. Call Your Doctor If:
   • Bite looks infected (redness gets larger after 48 hours)
   • Large red bumps last more than 7 days
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Bee or Yellow Jacket Sting

Cause of Bee Sting Reactions

• The bee's stinger injects venom into the skin.
• The venom is what causes the symptoms.

Local Skin Reactions to the Sting

• The main symptoms are pain, itching, swelling and redness at the sting site.
• Pain. Severe pain or burning at the site lasts 1 to 2 hours. Itching often follows the pain.
• Swelling. The bee sting may swell for 48 hours after the sting. The swelling can be small or large. Stings on the face can cause a lot of swelling around the eye. It looks bad, but this is not serious. The swelling may last for 7 days.
• Redness. Bee stings are often red. That doesn't mean they are infected. Infections rarely happen with stings. The redness can last 3 days.

Anaphylactic Reaction to the Sting

• A severe life-threatening allergic reaction is called anaphylaxis.
• The main symptoms are hives with trouble breathing and swallowing. It starts within 2 hours of the sting.
• This severe reaction to bee stings happens in 4 out of a 1,000 children.
• Hives. After a bee sting, some children just develop hives all over or face swelling. Hives or face swelling alone may be able to be treated at home. But, at times, these symptoms can also lead to anaphylaxis. Be sure to call your doctor now to help decide.

Prevention of Bee Stings

• Don't go barefoot if bees are around.
• Be careful in gardens and orchards.
• Insect repellents do not work against these stinging insects.

When to Call for Bee or Yellow Jacket Sting

Care Advice for Bee or Yellow Jacket Sting

1. What You Should Know About Bee Stings:
   • Bee stings are common.
   • The main symptoms are pain and redness.
   • The swelling can be large. This does not mean it's an allergy.
   • Here is some care advice that should help.
2. Try to Remove the Stinger (if present):
   • Only honey bees leave a stinger.
   • The stinger looks like a tiny black dot in the sting.
   • Use a fingernail or credit card edge to scrape it off.
   • If the stinger is below the skin surface, leave it alone. It will come out with normal skin shedding.
3. Meat Tenderizer for Pain Relief:
   • Make a meat tenderizer paste with a little water. Use a cotton ball to rub it on the sting. Do this once for 20 minutes. Reason: This may neutralize the venom and reduce the pain and swelling. Caution: Do not use near the eye.
   • If you don't have any, use an aluminum-based deodorant. You can also put a baking soda paste on the sting. Do this for 20 minutes.
4. Cold Pack for Pain:
   • If pain does not improve after using the meat tenderizer paste, rub with an ice cube.
   • Do this for 20 minutes.
5. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
6. Steroid Cream for Itching:
   • For itching or swelling, put 1% hydrocortisone cream (such as Cortaid) on the sting.
   • No prescription is needed.
   • Use 3 times per day.
7. Allergy Medicine for Itching:
   • For hives or severe itching, give a dose of Benadryl.
8. What to Expect:
   • Severe pain or burning at the site lasts 1 to 2 hours.
   • Normal swelling from venom can increase for 48 hours after the sting.
   • The redness can last 3 days.
   • The swelling can last 7 days.
9. Call Your Doctor If:
   • Trouble breathing or swallowing occurs (mainly during the 2 hours after the sting). Call 911.
   • Redness gets larger after 2 days
   • Swelling becomes huge
   • Sting starts to look infected
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Blisters

Causes of Blisters

• Friction Blisters. Friction is the most common cause of blisters.
• Burns - Chemical (Second-degree)
• Burns - Thermal (Second-degree)
• Frostbite (Second-degree)
• Hand-Foot-and-Mouth Disease. Viral rash from Coxsackie virus gives tiny blisters on palms and soles.
• Impetigo. Staph bacteria can cause impetigo with blisters.
• Insect Bites. In young children, insect bites (such as fleas) can cause small blisters.
• Poison Ivy, Poison Oak, Poison Sumac
• Sunburn (Second-degree)
• Staph Scalded Skin Syndrome (Serious). SSSS is caused by the Staph bacteria. The main finding is widespread large blisters.

Friction Blisters - Hands and Feet

• Friction causes most blisters on the hands and feet.
• A friction blister is a raised pocket of clear fluid covered by skin.
• Cause. A friction blister is the result of forces on the skin. Shear forces separate the top layer of the skin from the lower layer. This forms a cushion (blister) of fluid over the spot of friction or pressure.
• Common Sites. Fingers, palm, back of heel, top of toes, side of foot.
• Hand Friction Blisters. Hand blisters are often due to friction from using a tool too much. Examples are a shovel, pick, or rake. They can also be caused by sports equipment. Examples are a tennis racquet or boat oars. Gymnastics equipment (such as high bars) may also cause hand blisters.
• Foot Friction Blisters. Foot blisters are likely due to friction from an activity. Examples are hiking or running. Usually, a child has new shoes or poorly-fitting shoes. Children starting a new sport may develop blisters. Also, a risk factor to forming blisters is recently increasing the activity time.
• Prevention. There are two general approaches to prevent friction blisters. These are toughening the skin and lowering the friction force.
• Complications. Pain or infection.
• Treatment. Painless or mildly painful small blisters can be treated at home. Use moleskin or tape that has a hole cut in the center. Larger or very painful blisters sometimes need to be drained. This can be done by making a small hole in the blister. Use a clean needle or pin. Let all the blister fluid drain out. Then the blister can be covered with antibiotic ointment and a dressing.

When to Call for Blisters

Care Advice

Treatment of Normal Friction Blister

1. What You Should Know - Friction Blister:
   • A friction blister is a raised pocket of clear fluid, covered by skin.
   • Most blisters should not be opened. Reason: It increases the risk of infection.
   • However, large or severely painful blisters often need to be drained. This is done by poking a small hole in the blister with a needle. (See #4 below)
   • Here is some care advice that should help.
2. Protect the Blister:
   • Goal: Protect the blister from any more rubbing.
   • Surround it with a "donut" made from moleskin. Ask for this product at your drug store.
   • Using scissors, cut a moleskin piece to a shape larger than the blister.
   • Next cut a hole the size of the blister in the center. Do this by folding the moleskin in half and cut along the fold.
   • Remove the covering from the sticky side. Then, put the moleskin on with the blister in the center.
   • If the blister is taller than the moleskin, add one more layer of moleskin.
   • Hold the "donut" in place with a large strip of duct tape.
   • Other option. If you don't have moleskin, use a bandage (such as Band-Aid). Fold it and cut the center out to the size of the blister.
   • For foot blisters, also switch to shoes that don't rub the blister.
3. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
4. Severe Pain - Drain the Blister:
   • Draining a large blister can help make the pain go away.
   • Wash the skin with warm water and soap.
   • Clean a needle or straight pin with rubbing alcohol.
   • Gently press the fluid to one side of the blister to create a bulge.
   • Pass the needle sideways through the fluid making 2 puncture holes. Gently wiggle the needle to make the holes larger.
   • Remove the needle.
   • Press the fluid out through the holes.
   • Leave the roof of the blister in place to protect the raw skin underneath.
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Put it on twice per day after cleansing.
   • Cover the drained blister with a bandage (such as Band-Aid).
5. Broken Blister Treatment:
   • If the blister breaks open, let it drain.
   • Leave the roof of the blister in place to protect the raw skin underneath.
   • If there are any loose flaps of skin, trim them with a fine scissors.
   • Wash it with warm water and soap.
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Put it on twice a day.
   • Cover it with a bandage (such as Band-Aid).
6. What to Expect:
   • Most often, they dry up and peel off without any treatment.
   • This may take 1 to 2 weeks.
7. Call Your Doctor If:
   • Blister looks infected
   • Severe pain and you want your child's doctor to drain the blister
   • You think your child needs to be seen
   • Your child becomes worse

Treatment of Normal Blood Blister

1. What You Should Know - Blood Blister:
   • A blood blister can happen when the skin gets pinched. Examples are a finger caught in a hinge or a closing door.
   • It forms a tiny pocket of bloody fluid covered by skin. It is dark red or purple in color.
   • A blood blister is not harmful.
   • No treatment is needed. You do not need to drain it.
   • It will slowly dry up and peel off over 1-2 weeks.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
3. Call Your Doctor If:
   • You think your child needs to be seen
   • Your child becomes worse

Prevention of Foot Blisters

1. Prevention - General:
   • Shoes. Buy shoes that fit. Do not wear shoes that are too tight or too loose. New hiking boots are often somewhat stiff. It is wise to first wear them around the house and on short walks. Wear them in before wearing them on a long hike.
   • Socks. Do not use cotton socks. They tend to stay damp when wearing. Instead use synthetic (acrylic) or wool socks. Some people prefer to wear two socks at a time. You can wear a thin inner liner ('wicking') sock and a thicker outer sock.
   • Lubricants. If your child often gets blisters at the same spot, use a lubricant. You can use petroleum jelly (such as Vaseline). Cover the area with a small amount of the lubricant before sports. This will help to reduce friction on the spot.
   • Callus. If blisters usually occur under a callus, file the callus down. Then, lubricate it. This way it won't add to the friction.
   • Taping Pressure Points. If a lubricant doesn't stop blisters, taping is the next step. Taping is a very good way to treat hot spots for friction blisters. Many hikers and runners use taping. Follow the instructions listed down below.
2. Prevention - Taping:
   • Option 1 - Moleskin
   • You can get moleskin at your drug store. It is a good way to stop friction blisters. Here are some instructions on how to use moleskin.
   • Using scissors, cut the moleskin to a shape slightly larger than the pressure point.
   • Remove the backing from the moleskin. Put it on the pressure point. Smooth it from the center outward so that there are no wrinkles.
   • Put on a clean and dry sock.
   • Option 2 - Taping with Duct Tape
   • Duct tape is available at your hardware store. It is also good at stopping friction blisters. Many hikers and runners use it. Here are some instructions on how to use duct tape.
   • Using scissors, cut out a piece of duct tape into a shape slightly larger than the pressure point.
   • Apply the piece of duct tape to the pressure point. Smooth it from the center outward so that there are no wrinkles.
   • Put on a clean and dry sock.
3. Prevention - Toughening the Skin:
   • This mainly applies to walkers, hikers, and runners.
   • Slowly add to the distance you hike or run over days to weeks. This will increase the toughness of the skin. It will lower the risk of blisters forming.
4. Call Your Doctor If:
   • You have other questions or concerns

Prevention of Hand Blisters

1. Prevention:
   • Gloves. Wear heavy-duty work gloves when working with the hands. Also, use gloves when working with tools. Examples are shovels, picks, and rakes. Sports gloves can be used for rowing, paddling, weight lifting or cycling.
   • Lubricants. Lower friction at pressure points by covering them with a lubricant. You can use petroleum jelly (such as Vaseline).
2. Call Your Doctor If:
   • You have other questions or concerns

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Bottle-Feeding (Formula) Questions

Topics Covered for Formula Feeding

If your baby is healthy, skip the "What to Do" section. Go directly to the topic number that relates to your question for advice:

1. Types of formulas
2. Switching formulas and milk allergies
3. Powdered versus liquid formulas
4. Whole cow's milk, 2%, 1% and skim milk
5. Vitamins and iron
6. Water to mix with the formula
7. Extra water
8. Amounts: how much per feeding?
9. Schedules or frequency of feedings
10. Length of feedings
11. Night feedings: how to eliminate?
12. Formula temperature
13. Formula storage
14. Cereals and other solids
15. Burping
16. Baby bottle tooth decay
17. Traveling
18. Nipples and bottles
19. Normal stools
20. Breast discomfort

When to Call for Bottle-Feeding (Formula) Questions

Care Advice for Bottle (Formula) Feeding

1. Types of Formulas:
   • Milk-protein formulas, soy-protein formulas, and hydrolysate formulas
   • Soy formulas don't contain lactose or cow's milk protein. Currently, 20% of infants in the U.S. are fed soy formula. Often, switching to soy is not done with a valid reason.
   • Hydrolysate formulas mean the protein is broken down. These are advised when children are sensitive to both soy and milk protein.
2. Switching Formulas and Milk Allergies:
   • Switching from one milk-based formula to another is not helpful for any symptom. It is also not harmful.
   • Switching from milk formula to soy formula is sometimes helpful for severe diarrhea. This may occur from temporary low lactase levels. It may also be used for those families who are vegetarian.
   • Switching from milk formula to soy is sometimes helpful for cow's milk allergy. A cow's milk allergy occurs in 1-2% of infants. Most often, protein hydrolysate formulas (such as Alimentum) are advised. This is because 15% of these infants are also allergic to soy protein.
   • Switching formulas for frequent crying, spitting up or gas is rarely helpful.
   • Don't switch formulas without talking with your child's doctor.
3. Powdered versus Liquid Formulas:
   • Formulas come in 3 forms: powder, concentrated liquid and ready-to-feed liquid.
   • Concentrated formulas are mixed 1:1 with water.
   • Ready-to-feed formulas do not need any added water.
   • Powdered formulas are mixed 2 ounces (60 mL) of water per each level scoop of powder. Never add extra water because dilute formula can cause a seizure.
   • Powdered formula costs the least. Ready-to-feed formula costs the most.
   • Powdered formula is the easiest to use to supplement breastfeeding.
   • Ready-to-feed formula is the easiest to use for traveling.
4. Whole Cow's Milk, 1%, 2% and Skim Milk:
   • Cow's milk should not be given to babies before 12 months of age. Reason: Raises risk of iron deficiency anemia.
   • Skim milk (fat free milk), 1% low fat milk or 2% milk should not be used before 2 years. Reason: The fat content of whole cow's milk (3.5%) is required. It is needed for rapid brain growth.
5. Vitamins and Iron:
   • For all infants, use a formula that has iron in it. This helps to prevent iron deficiency anemia.
   • The iron amount in iron-fortified formulas is too small to cause any symptoms. Iron in formulas does not cause constipation or diarrhea.
   • Iron-fortified formulas contain all the vitamins and minerals needed.
   • Extra vitamins are therefore not needed for infants taking formula.
   • Fluoride. Babies no longer need to take fluoride drops. Reason: the fluoride in toothpaste works very well. For children at high risk for tooth decay, your dentist may use fluoride varnish.
6. Water to Mix With the Formula:
   • Most city water supplies are safe for making 1 bottle at a time. Run the cold tap water for 1 minute. Don't use warm tap water. (Reason: To avoid potential lead exposure). Heat cold water to desired temperature. Add this to powder or formula concentrate.
   • Exceptions:
     • Untested well water or
     • City water with recent contamination or
     • Developing countries with unsafe water supply or
     • Your child has decreased immunity.
     • For these conditions, use distilled water, bottled water, or filtered tap water.
     • Another option is to use city water or well water that has been boiled. Boil for 10 minutes. Add 1 extra minute per each 1,000 feet (305 meters) of elevation.
     • Bottled water costs more than distilled water.
     • If making a batch of formula, distilled, bottled or boiled water is needed.
7. Extra Water:
   • Babies usually do not need extra water. (Reason: regular formula is 85% water)
   • Too much water can cause seizures.
   • You can offer some water if weather is very hot.
   • Don't give more than 4 ounces (120 mL) of extra water per day. Limit extra water during the first 6 months of life. Exception: Don't give any during the first month.
   • After starting solid foods, babies need more water.
8. Amounts - How Much Per Feeding:
   • The average amount of formula that babies take per feeding is:
   • Newborn: 2-3 ounces (60-90 mL) per feeding
   • 1 month old: 4 ounces (120 mL) per feeding
   • 2 months old: 5 ounces (150 mL) per feeding
   • 4 months old: 6 ounces (180 mL) per feeding
   • 6 months old: 7-8 ounces (210-240 mL) per feeding
   • The amount can vary depending on the baby's weight and if the baby is going through a growth spurt.
   • A baby's appetite varies throughout the day. If the infant stops feeding or loses interest, the feeding should be stopped.
   • If healthy babies are not hungry at several feedings, increase the feeding interval.
   • The most amount of formula advised per day is 32 ounces (1 liter).
   • Over-feeding can cause vomiting, diarrhea or too much weight gain.
   • If your baby needs over 32 ounces (1 liter), talk to your doctor about starting solids.
   • Get rid of any formula left in bottle at end of each feeding. Do not reuse this leftover formula. Reason: Contains germs that can grow.
9. Frequency of Feedings (Schedules): Babies mainly need to be fed when they are hungry. If your baby is fussy and it's been more than 2 hours, feed him. Some guidelines are listed below:
   • From birth to 3 months of age, feed every 2 to 3 hours.
   • From 3 to 9 months of age, feed every 3 to 4 hours.
   • Infants often set their own schedule by 1 to 2 months of age.
10. Length of Feedings:
    • Feedings shouldn't take more than 20 minutes.
    • If the feeding is prolonged, check the nipple to be sure it isn't clogged.
    • A clean nipple should drip about 1 drop per second. Check this when the bottle of formula is turned upside down.
11. Night Feedings - How to Get Rid of Them:
    • Most newborns need to be fed at least twice each night.
    • Most formula-fed babies give up night feedings by 4 months of age. The tips below can help your baby sleep for longer stretches during the night:
    • Keep daytime feeding intervals to at least 2 hours. Slowly stretch them to 3 hours.
    • During daytime, your baby shouldn't sleep for more than 3 hours at a time. If your baby naps longer than that, wake him for a feeding.
    • Place your baby in the crib drowsy but awake. Don't bottle-feed or rock until asleep.
    • Make middle-of-the-night feedings brief and boring compared to daytime feedings. Don't turn on the lights or talk to your child. Feed him rather quickly.
12. Formula Temperature:
    • Most babies like formula at body temperature.
    • In the summertime, some infants prefer formula that's cooler.
    • In the wintertime, some prefer warm formula.
    • The best temperature is the one your infant prefers. Either way, there's no health risk involved.
    • Just make sure the formula is not too hot. Reason: It can burn your baby's mouth.
13. Formula Storage:
    • If you can, make your child's formula fresh for each feed. However, if formula needs to be made ahead of time:
    • Prepared formula should be stored in the refrigerator. It must be used within 24 hours.
    • Open cans of formula should also be kept in the refrigerator. They should be covered and used within 24 hours.
    • Prepared formula left at room temperature for more than 1 hour should be discarded.
    • Leftover used formula should always be tossed. Reason: Contains germs that can grow.
14. Cereals and Other Solids:
    • Bottle-fed infants should be started on baby foods between 4 and 6 months. First baby foods can be cereals and/or fruit.
    • Starting before 4 months is not needed. Starting before 4 months makes feedings messier and longer. Early use of solids can also cause gagging.
    • Solids don't increase sleeping through the night for bottle-fed infants.
    • Delaying solids past 9 months of age is not advised. The delay runs the risk that your infant will refuse solids.
15. Burping:
    • It is not harmful if a baby doesn't burp.
    • Burping is an option, but not required.
    • It can decrease spitting up, but it doesn't lessen crying.
    • Burping can be done twice per feeding, once midway and once at the end.
    • If your baby does not burp after 1 minute of patting, it can be stopped.
16. Baby Bottle Tooth Decay:
    • Some older infants and toddlers are used to a bottle before sleeping.
    • Falling asleep with a bottle of milk or juice can cause severe tooth decay.
    • Prevent this bad habit by not using the bottle as a pacifier. Also, do not use the bottle as a security object.
    • If you cannot stop the bottles, fill it with water. Use water instead of formula or milk at bedtime.
17. Traveling:
    • Use bottles of ready-to-feed formula (most expensive).
    • Or mix formula ahead of travel and carry in a cold insulated container.
    • Or use powered formula. Put the required number of scoops in a bottle. Carry clean water in a separate bottle. Mix before each feeding.
18. Nipples and Bottles:
    • Any nipple/bottle products are fine.
    • It is not necessary to sterilize bottles or nipples. Wash them with soap and water. Rinse them thoroughly.
    • It is also safe to wash bottles and nipples in the dishwasher.
19. Formula-fed Stools, Normal:
    • Meconium Stools are dark greenish-black, thick and sticky. They normally are passed during the first 3 days of life.
    • Transitional Stools are a mix of meconium and milk stools. They are greenish-brown and looser. They are passed day 4 to 5 of life.
    • Normal Milk Stools without any meconium are seen from day 6 on.
    • Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.
    • The stools are yellow in color and thick like peanut butter. Green stools are also normal (usually caused by bile).
    • After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They are soft and solid.
20. Breast Discomfort in Bottle-feeding Mothers:
    • Even though you chose not to breastfeed, your breasts will make milk. Breast milk comes in on day 2 or 3. Swollen breasts can be painful for a few days. Here is what to do:
    • Ibuprofen. Take 400 mg of ibuprofen (such as Advil) 3 times per day. This will help to lessen pain and swelling. There's no special prescription medicine for this.
    • Cold Pack. Use a cold pack or ice bag wrapped in a wet cloth. Put it on your breasts for 20 minutes. Do this as often as needed. This will decrease milk production. Do not use heat. Heat will increase milk production.
    • Pumping. For moderate pain, hand express or pump off a little breast milk. This will help to reduce your pain. Pumping breast milk can increase milk production. But, doing this to take the edge off your discomfort is not harmful.
    • Bra. Wear a bra that offers good breast support or a sports bra. Wear it 24 hours a day.
    • Binding. Binding the breasts by wearing a tight bra is no longer advised. Binding by using an elastic wrap is also not advised. Binding can increase the risk of breast infections (mastitis).

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Breast-Feeding Questions

Topics Covered for Breast-Feeding

If your baby is healthy, skip the "What to Do" section. Go directly to the topic number that relates to your question for advice:

1. How often to feed to bring in the milk supply
2. Length of feedings to bring in the milk supply
3. Length of feedings after milk supply is in
4. Signs of adequate milk supply (Do I have enough milk?)
5. How to increase milk supply
6. Supplemental formula
7. When to introduce a bottle
8. Extra water
9. Severe engorgement (generalized swelling and pain) of both breasts
10. Blocked milk ducts (1 or more tender lumps in the breast)
11. Sore or cracked nipples
12. Mother's medicines
13. Mother's smoking or tobacco use
14. Mother's diet
15. Sick infants
16. Sick mother (with illness)
17. Normal stools during the first weeks of life
18. Normal infrequent breast milk stools after 1 month of age
19. Leaking breast milk
20. Vitamin D for breastfed baby
21. Storage of pumped milk
22. Burping
23. Milk letdown that causes pulling away, coughing or choking
24. Cereals and other solids (baby foods)
25. When to Call Your Doctor

Expert Reviewers:

Maya Bunik, M.D., Lisbeth Gabrielski, RN, and Marianne Neifert, M.D., Lactation specialists

When to Call for Breast-Feeding Questions

Care Advice for Breastfeeding

1. How Often to Feed to Bring in the Milk Supply:
   • Every 1½ to 3 hours for the first month (8 to 12 times per day).
   • During the day, wake your baby up if more than 3 hours have passed since the last feeding.
   • During the night, wake your baby if more than 4 hours pass without a feeding.
   • After 1 month of age, allow your baby to sleep longer. If your baby is gaining weight well, feed on demand and do not awaken for feedings.
2. Length of Feedings to Bring in the Milk Supply:
   • Offer both breasts with each feeding
   • Nurse 10 minutes on the first breast. Then, nurse up to 15 minutes on second breast if your baby is actively sucking.
   • For each feeding, switch which breast you start on.
   • Needing to stimulate your baby to take the second breast is normal.
3. Length of Feedings After Milk Supply is in: (by day 8 at the latest)
   • On the first breast, allow your baby to nurse up to 20 minutes. Reason: To get the high-fat, calorie-rich hind milk.
   • You can tell your baby has finished when the sucking slows down. Your breast should feel soft. Then offer the 2nd breast if your baby is interested.
   • For each feeding, switch which breast you start on.
4. Signs of Good Milk Supply: (Is your baby getting enough breast milk?)
   • Stools: 3 or more yellow seedy stools per day. Exception: 1 or 2 can be normal while the milk is coming in. Stools should start increasing by day 5 of life. See Care Advice #15 on Breastfed Stools for more information. Caution: Once the milk is in, infrequent stools are not normal. However, it can become normal after 4 weeks of age.
   • Urine: 6 or more wet diapers per day. Exception: 3 wet diapers per day can be normal while milk is coming in. Wet diapers should start increasing by day 5 of life. Note: If you aren't sure about the diaper being wet, place a tissue in the diaper.
   • Satisfied (not hungry) after feedings
   • Breasts feel full before feedings and soft after feedings
   • It is very important that your baby is latched on right. This way she can get enough milk. Look and listen for regular swallowing. This shows that your milk has letdown. Letdown is the release of breastmilk into the milk ducts just before a feeding. It starts after 2 to 3 weeks of nursing. At first, milk letdown may take 60 to 90 seconds of sucking before it starts.
5. How to Increase Milk Supply:
   • Enough sleep (extra naps), reduced stress (ask for help), relaxed environment, good fluid intake
   • Drink enough fluids to keep your urine pale yellow in color.
   • Usually that means drinking at least 2 quarts (2 liters) of fluid per day.
   • Increase how often you nurse. Limit the use of the pacifier.
   • Pump the breasts for 10 minutes after each feeding. Do this for a few days (see lactation consultant). Electric breast pumps that are double-sided give the best results.
6. Supplemental Formula:
   • Don't offer your baby any bottles of formula before 3 to 4 weeks old. Reason: It will interfere with creating a good milk supply.
   • You should be nursing your baby every 2 hours (start to start). Reason: so your baby can get colostrum after birth.
   • There are some exceptions. Medical indications to prevent dehydration or severe jaundice include the following:
   • The milk is not in (day 3 - 4) and your baby is very hungry (especially preterms)
   • Not enough wet or soiled diapers or
   • Your baby is quite jaundiced. Reason: Prevents dehydration.
   • After every breastfeeding for 1 or 2 days, give expressed breastmilk or formula. Give 1 ounce (30 mL) at a time. Also, see your child's doctor within 24 hours for a weight check.
7. When to Introduce a Bottle:
   • When your baby is 4 weeks old, if your baby is nursing well, offer a bottle of pumped breastmilk (1 ounce or 30 mL). Do this once a day. This allows him to get used to a bottle and the nipple.
   • If you wait too long (such as 8 weeks), many babies will reject bottle feedings.
   • Once your baby accepts bottle feedings, use them at least once every 3 days. This insures that he will continue to accept them.
   • Bottle acceptance allows you to leave your baby with a sitter. It's also essential if you plan on going back to work outside the home.
   • You can use formula or pumped breast milk that has been refrigerated or frozen.
8. Extra Water:
   • Never give extra water to infants younger than 6 months. Reason: Too much water can cause a seizure.
   • It's not needed. Reason: Breast milk contains 88% water.
   • If your baby gets enough breast milk, extra fluids are not needed. They may decrease your baby's interest and ability to breastfeed.
9. Engorgement (Generalized swelling and pain of both breasts):
   • Engorgement usually begins 2 or 3 days after your baby's birth.
   • Also, can start at any time when breasts are not emptied regularly.
   • Breastfeed your baby more often. Do not use pacifiers.
   • Remove a little milk before feeding your baby. Hand express or briefly use a breast pump.
   • Gently squeeze the areola with your fingers at the start of each feeding. This will soften the areola and help your baby latch on. Milk release won't occur if your baby only latches on to the nipple.
   • Pump your breasts when they hurt or when a feeding doesn't help discomfort. Also, pump when you must miss a feeding.
   • Use a cold pack on the breasts between feedings. Cold cabbage leaves or a bag of frozen peas works well.
   • Call your doctor or lactation consultant if: not better after 24 hours of this treatment.
10. Blocked Milk Ducts (tender lump in the breast):
    • Caused by the breast not being emptied all the way
    • Treatment goal: Open up the blocked milk ducts
    • Breastfeed your baby more often. Do not use pacifiers.
    • Before each breastfeeding session, use heat on the breast lump for 5 minutes. Do this with a hot shower, hot bath or heating pad.
    • While feeding or pumping, massage the swollen areas toward the nipple.
    • Try different breastfeeding positions which may drain the affected area (ducts) better.
    • Call Your Doctor If:
      • Lump becomes red and very painful
      • Fever occurs
      • Not better after 24 hours of treatment
      • Your baby starts acting sick
11. Sore or Cracked Nipples:
    • Most often, due to friction from not latching on right. Can also be due to a non-areolar grasp on the breast.
    • Clean with warm water once daily. Do not use soap which dries out the skin.
    • For sore nipples, coat and lubricate nipple and areola with breast milk.
    • For cracked nipples, use 100% lanolin after feedings. No prescription is needed. Exception: mother allergic to wool. Hydrogel pads are also good for healing.
    • Help your baby latch on to as much of the areola as possible. Do this by compressing the areola. Proper latching-on should prevent nipple injury.
    • Prevent the breast from pulling out of your baby's mouth. Support the breast from below during feedings.
    • Start feedings on the side that is least sore.
    • Limit feedings to less than 10 minutes on the sore side.
    • Don't pull your baby off the nipple until she has released her grip. You can break the seal by placing your finger in the mouth between gums.
    • Call your doctor if: not better after 24 hours of treatment.
12. Mother's Medicines:
    • It's best to take your medicine at the end of a feeding. Reason: It will be out of your system by the next feeding.
    • Most commonly used drugs are safe. Examples are penicillins, erythromycin, cephalosporins, stool softeners, cough drops, nose drops, eyedrops, and skin creams.
    • Pain Medicines: Acetaminophen (such as Tylenol) and ibuprofen (such as Advil) are safe. Aspirin (325 mg) should not be used. Reason: risk for bleeding. Baby aspirin (81 mg daily) is safe to use for mothers who need it for health problems.
    • Do not use decongestants. They can reduce milk production in some mothers. An example is Sudafed.
    • Do not use sulfa drugs (Septra and Bactrim) for the first month. They are okay after the baby is 4 weeks old.
    • Allergy medicines for allergy symptoms are OK during breastfeeding. Long-acting allergy medicines (such as Zyrtec) are preferred. They can be given as needed once per day at bedtime. Do not use combination products with decongestants.
    • Birth control pills can decrease your milk volume. Make sure that your milk supply is well established (6 weeks or more) before starting. If you decide to use birth control, consult your doctor first.
    • For all other drugs, call your doctor or check the LactMed Website (listed below).
    • LactMed is a drug/lactation website. It provides information regarding the safety of medicines while nursing. It's on Toxnet. Toxnet is the toxicology data website of the National Library of Medicine.
    • Infant Risk Call Center. Provides current information on the use of medications during pregnancy and breastfeeding. They answer calls Monday-Friday 8 am - 5 pm central time. (806)-352-2519. Website at Infant Risk Center.
13. Mother's Smoking or Tobacco Use:
    • It is best not to use tobacco. But, if you must smoke, you can also breastfeed. Generally, the benefit of giving your baby your milk outweighs tobacco risks.
    • The nicotine and its byproducts pass into the breast milk. This may cause your baby not to sleep well and increase the heart rate. It can also cause loose stools. Heavy tobacco use (over ½ pack per day) can decrease your milk supply. It may also affect letdown.
    • Smoking cessation aids pose no more problems for the breastfed baby than smoking. Use as directed.
    • If you smoke, do not smoke around your baby.
14. Mother's Diet:
    • Foods: Eat a diet that is varied and balanced. No special foods should be eaten or not eaten. The effect on the baby of foods in the mother's diet is overrated. Foods eaten in moderate amounts most often cause no effects.
    • Honey: Honey is safe for breastfeeding moms to eat. It is also safe to use to treat coughing in the mother. Botulism isn't transmitted through breast milk.
    • Caffeine: Caffeine is found in coffee, tea or soft drinks. Too much caffeine can cause your baby to not sleep well. It can also cause increased crying or even diarrhea. Limit caffeine drinks to two 8 ounce (240 mL) servings per day.
    • Alcohol: It is best not to use alcohol during breastfeeding. Too much alcohol can cause your baby to be sleepy. It can also affect your milk letdown. If you must drink, limit to an occasional drink of beer or wine. Max: no more than 1 per day. Nurse your baby before you drink. Wait at least 2 hours before nursing again.
15. Sick Infants:
    • Do not stop breastfeeding for vomiting, spitting up, diarrhea, cough, or jaundice. See the care guide for that symptom.
    • Keep breastfeeding when possible.
16. The Mother is Sick (has an acute illness):
    • Continue breastfeeding, even if you have a fever.
    • Reason: Breast milk carries your antibodies. These can protect your baby from the full-blown infection.
    • Try to prevent the spread of infection by good hand washing. Do this after blowing your nose (for colds) or after stools (for diarrhea).
    • There are few medical conditions in the mother when breastfeeding is not advised. Some of these are AIDS, Herpes simplex rash (fever blisters) on the nipple/areola, drug abuse and tuberculosis. Talk with your doctor.
    • Fever Blisters on Mom's Mouth. Fever blisters (cold sores) on the lips are caused by the herpes virus. Herpes can cause serious infections in young babies. It's safe to continue breastfeeding if they are on your (mom's) lips. But avoid kissing or nuzzling your baby until fever blisters are completely dried up.
17. Breastfed Stools During the First Weeks of Life:
    • Meconium Stools are dark greenish-black, thick and sticky. They are passed during the first 2 days of life.
    • Transitional Stools (a mix of meconium and milk stools) are greenish-brown and loose. They are passed day 3 to 4 of life. While breast milk is coming in, babies have about one stool per day. This is usually from day 1 to 4. By day 5, passing black or dark green stools is not normal. Your baby should be seen to make sure your baby is getting enough milk.
    • Normal Breastmilk Stools without any meconium present are seen from day 5 on. The stools are runny, mustard-colored and can contain seedy particles. Normal breastfed stools can also be green (caused by bile) or have a water-ring around them, especially during the first month. Reason: rapid transit. Normal breastfed stools are loose (often runny and seedy). Stools are yellow, but sometimes can be green. The green color is from bile. Runny stools can even be bordered by a water ring. This is normal.
    • Normal stool size is about half to 1 tablespoon (8 to 15 mL).
    • Number of Stools: The number of stools is the best marker for how much breastmilk the baby is getting. On day of life 2 and 3, the baby should pass 1 or 2 stools per day. By day of life 4 or 5, the baby should be passing 3 or more breastmilk stools per day. Once breast-feeding is established, babies normally pass 4 stools per day to 1 after each feeding during the first month of life.
    • If breastfed babies get any formula, their stools become greener. They also become more frequent, more formed and odorous.
    • Diarrhea. Breastfed stools have changed to true diarrhea if:
      • They have blood or mucus
      • Smell bad or have a sudden increase in number
      • Your baby feeds poorly, acts sick, or a fever occurs
18. Normal Infrequent Breastfed Stools After 1 Month of Age:
    • Between 4 and 8 weeks of age, some breastfed babies change to normal infrequent stools.
    • They can pass 1 large soft stool every 4 to 7 days.
    • Reason: Complete absorption of breastmilk.
    • The longer they go without a stool, the larger the volume that is passed.
    • There is no pain or crying with stool passage.
19. Leaking Breast Milk:
    • Leaking milk is a common problem that nursing mothers experience during the first months. Usually, the leaking lessens as supply starts to equal demand. A balance is established between what the baby drinks and what the breasts make. Here's what you can do:
    • Keep a regular nursing pattern. Try to not skip or postpone feedings. Reason: More milk leaks from over-full breast.
    • Use nursing pads under your bra. You can use pads that can be thrown away or washable pads. Change pads often to keep your nipples dry.
    • Shirts with patterns hide milk spots better.
    • If this advice doesn't help, ask a lactation consultant for more tips.
20. Vitamin D for the Baby:
    • Breast milk contains all the needed vitamins and minerals except Vitamin D.
    • Vitamin D. Starting the first week of life, all breastfed babies need Vitamin D. The dose is 400 IU per day. (AAP Committee on Nutrition 2009). You can use separate Vitamin D drops. Or, you can use Vitamin ADC drops in a dose of 1 mL per day. (No prescription is needed).
    • Your child needs Vitamin D drops until he drinks enough cow's milk or formula. This is at least 32 ounces (1000 mL) of milk or formula per day. Each 8 ounces (250 mL) contains 100 IU of Vitamin D.
21. Storage of Breast Milk:
    • Freshly expressed breast milk can be kept at room temp for 6 hours.
    • Freshly pumped breast milk can be stored for 5 days in a refrigerator.
    • Frozen breast milk can be kept 6 months in a refrigerator freezer. Do not store milk in the freezer door (side) shelves. Milk can be kept up to 12 months in a deep freezer. If your ice cream is solidly frozen, the temperature is fine.
    • To thaw frozen milk, put the bag of breast milk in the refrigerator. It will take a few hours to thaw.
    • For quicker thawing, place it in a pan of warm water. Do this until it has warmed up to the temperature your baby likes. Never warm it up in a microwave or boiling water. This would destroy the protective antibodies.
    • After thawing, breast milk can be kept safely in the refrigerator for 24 hours. Do not refreeze.
    • After feeding your baby, throw out any remaining milk in the bottle. This milk should be discarded after 1 hour.
22. Burping:
    • You do not have to burp your baby. Burping is an option, but not needed.
    • It is not harmful if a baby doesn't burp.
    • Burping can lessen spitting up, but it doesn't decrease crying.
    • Burping can be done twice per feeding, once midway and once at the end.
    • If the baby does not burp after 1 minute of patting, it can be stopped.
23. Milk Letdown that Causes Pulling Away, Coughing or Choking:
    • Sometimes, a milk surge will be more than your baby can keep up with.
    • Your baby's reaction will be to pull away from the breast. She may cry, cough or even choke.
    • Stop the feeding and let your baby recover.
    • Wait until the letdown spray stops before putting her back to the breast.
    • Pausing and burping more often may help.
    • Prevention: The overactive letdown often occurs in mothers who pump often. So, finish one side all the way. Then only pump the other side enough to get rid of any pain.
24. Cereals and Other Solids (Baby Foods):
    • Breast-fed infants should be started on baby foods at 6 months. First baby foods can be cereals and/or fruit.
    • Starting before 6 months is not needed. Starting before 6 months makes feedings messier and longer. Early use of solids can also cause gagging.
    • Solids don't increase sleeping through the night for breast-fed infants.
    • Caution: Delaying solids past 9 months of age is not advised. The delay runs the risk that your infant will refuse solids.
25. Call Your Doctor If:
    • Your baby has trouble latching on
    • Your baby does not have a strong suck
    • Your baby acts hungry after most feeds
    • Your baby is not acting normal
    • Breastfeeding is painful
    • You think your child needs to be seen
    • You have other questions about breastfeeding

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Burn

Causes of Burns

• Hot Liquids. Hot liquids (such as coffee) are the most common cause of burns. They cause a scald.
• Hot Surfaces. Examples are ovens, stoves, space heaters and curling irons.
• Chemical Burns (Serious). Examples are acids or lye splashed on the skin. They continue to damage the skin until they are removed.
• Electrical Burns (Serious). They can be much deeper than they first appear.
• Flame Burns (Serious). Flammable liquid burns are mainly seen in teen boys.
• Friction Burns. Treadmill burns are a common example.
• Sunburn is not covered here. See the Sunburn care guide.
  

Degrees of Burns

• 1st degree. Red skin without blisters. These burns don't need to be seen.
• 2nd degree. Red skin with blisters. Heals from the bottom up, not from the edges. Takes 2 to 3 weeks. Small closed blisters decrease pain and act as a natural bandage.
• 3rd degree. Deep burns with white or charred skin. There are no blisters. Skin feeling is lost. Heals in from the edges. Grafts are often needed if it is larger than a quarter in size. These are burns over 1 inch or 2.5 cm. Skin grafts help limit scarring.

When to Call for Burn

Care Advice for 1st Degree Burns or Small Blisters

1. What You Should Know About Burns :
   • Minor burns can be treated at home.
   • This includes some small blisters.
   • Here is some care advice that should help.
2. Cold Pack for Pain:
   • For pain, put a cold wet washcloth on the burn.
   • Repeat as needed.
3. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
4. Clean the Burn:
   • Wash the burn gently with warm water.
   • Do not use soap unless the burn is dirty. Reason: Soaps can slow healing.
5. Closed Blisters - Don't Open:
   • Don't open any small closed blisters.
   • The outer skin protects the burn from infection.
6. Antibiotic Ointment for Open Blisters:
   • For any broken blisters, use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Then cover it with a bandage (such as Band-Aid). Change the dressing every other day.
   • Each time, clean the area. Use warm water and 1 or 2 gentle wipes with a wet washcloth.
7. What to Expect:
   • Most often, burns hurt for about 2 days.
   • It will peel like a sunburn in about a week.
   • First- and second-degree burns don't leave scars.
8. Call Your Doctor If:
   • Severe pain lasts over 2 hours after taking pain medicine
   • Burn starts to look infected (spreading redness, pus)
   • Burn not healed after 10 days
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Chest Pain

Causes of Chest Pain

• Muscle Overuse. Chest pain can follow hard sports (such as throwing a baseball). Lifting (such as weights) or upper body work (such as digging) can also cause it. This type of muscle soreness often increases with movement of the shoulders.
• Muscle Cramps. Most brief chest pain lasting seconds to minutes is from muscle cramps. The ribs are separated by muscles. These fleeting pains can also be caused by a pinched nerve. These chest wall pains are harmless. Brief muscle cramps are also the most common cause of recurrent chest pains. The medical name is precordial catch syndrome.
• Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.
• Asthma. Children with asthma often have a tight chest. They may refer to this as chest pain. They also get chest pain when they have lots of coughing.
• Heartburn. Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone).
• Caffeine. A rapid and pounding heart beat may be reported as chest pain. Too much caffeine as found in energy drinks is a common cause. Drugs prescribed for ADHD also can cause a fast heartbeat. Illegal drugs, such as cocaine, can cause a high heart rate as well.
• Chest Wall Injury. Blunt trauma usually just causes a bruised rib. Sometimes, it causes a rib fracture.
• Heart Disease (Serious). Heart disease is hardly ever the cause of chest pain in children. Chest pain that only occurs with exercise could have a cardiac cause.
• Pleurisy (Serious). Pleurisy is another problem of pneumonia. If the infection involves the lung's surface, that area of the chest will hurt.

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Chest Pain

Care Advice

Sore Muscle Pain Treatment

1. What You Should Know About Mild Chest Pain:
   • Chest pains in children lasting for a few minutes are usually harmless. The pain can be caused by muscle cramps. They need no treatment.
   • Chest pains that last longer can be from hard work or sports. The shoulders are usually involved. Sore muscles can start soon after the event.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
   • Continue this until 24 hours have passed without pain.
3. Cold Pack for Pain:
   • For the first 2 days, use a cold pack to help with the pain.
   • You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes, then as needed.
   • Caution: Avoid frostbite.
4. Use Heat After 48 Hours:
   • If pain lasts over 2 days, put heat on the sore muscle.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Reason: Increase blood flow and improve healing.
   • Caution: Avoid burns.
   • A hot shower may also help.
5. Stretching the Muscles:
   • Gentle stretching of the shoulders and chest wall may help.
   • Do sets of 10 twice daily.
   • This may prevent muscle cramps from coming back.
   • Stretching can be continued even during the chest pain. Do not do any exercises that increase the pain.
6. What to Expect:
   • For sore muscles, the pain most often peaks on day 2.
   • It can last up to 6 or 7 days.
7. Call Your Doctor If:
   • Pain becomes severe
   • Pain lasts over 7 days on treatment
   • You think your child needs to be seen
   • Your child becomes worse

Heartburn (Reflux) Pain Treatment

1. What You Should Know About Heartburn:
   • Heartburn is common.
   • It's due to stomach acid going up into the esophagus. The esophagus is the tube from the mouth to the stomach.
   • Heartburn causes a burning pain behind the lower part of the breastbone. It also causes a sour (acid) taste in the mouth and belching.
   • Here is some care advice that should help.
2. Antacids:
   • Heartburn is usually easily treated. Give a liquid antacid by mouth (such as Mylanta or the store brand). No prescription is needed.
   • Dose: Give 1 to 2 tablespoons (15 - 30 mL).
   • If you don't have an antacid, use 2 to 3 ounces (60 - 90 mL) of milk.
   • For heartburn that keeps coming back, give an antacid 1 hour before meals. Also, give a dose at bedtime. Do this for a few days.
3. Heartburn Prevention:
   • Do not eat too much at meals. This overfills the stomach.
   • Do not eat foods that make heartburn worse. Examples are chocolate, fatty foods, spicy foods, carbonated soda, and caffeine.
   • Do not bend over during the 3 hours after meals.
   • Do not wear tight clothing or belts around the waist.
4. What to Expect:
   • Most often, heartburn goes away with treatment.
   • But, heartburn also tends to come back. So, preventive measures are important.
5. Call Your Doctor If:
   • Heartburn doesn't go away after 2 days of treatment
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Chickenpox

Symptoms of Chickenpox

• Chickenpox starts with some small water blisters or pimples on the head and trunk.
• Chickenpox progress within 24 hours through the next 5 stages:
  1. Small red bumps
  2. Thin-walled water blisters
  3. Cloudy blisters
  4. Open sores, and finally
  5. Dry brown crusts.
• Rash is all over the body. Most often, starts on the head and back.
• Repeated crops of new chickenpox keep appearing for 4 to 5 days. Therefore, all 5 stages are present at same time.
• Sores (ulcers) can also occur in the mouth, on eyelids, and on genitals.
• Fever is most often present. The more the rash, the higher the fever.
• Known contact to a child with chickenpox or shingles 10 - 21 days earlier
• Main related problems: skin infections from scratching.

Cause of Chickenpox

• Chickenpox is caused by a virus. It is called Varicella.
• Chickenpox can be prevented by getting this vaccine against this virus.

When to Call for Chickenpox

Care Advice for Chickenpox

1. What You Should Know About Chickenpox:
   • Chickenpox is caused by the varicella virus.
   • It's now uncommon because of the chickenpox vaccine.
   • Your job is to keep your child comfortable and to limit the itching.
   • Here is some care advice that should help.
2. Cool Baths for Itching:
   • For itching, give cool or lukewarm baths for 10 minutes as often as needed.
   • Caution: Avoid any chill.
   • Can add baking soda 2 ounces (60 mL) per tub.
   • Baths don't spread the chickenpox.
   • Do not use soaps. Reason: Soaps cause dry skin and make the itch worse.
3. Calamine Lotion for Itching:
   • Put calamine lotion on the chickenpox that itch the most.
   • You can also use an ice cube on the itchy spots for 10 minutes.
   • Don't use any lotion containing Benadryl in it. Reason: It can be absorbed across the skin. This can cause side effects in kids.
4. Allergy Medicine for Itching:
   • If itching becomes severe or interferes with sleep, give Benadryl by mouth.
5. Try Not to Scratch:
   • Try not to let your child pick and scratch at the sores. This can lead to infected sores.
   • Trim fingernails.
   • Wash hands often with soap.
6. Fever Medicine:
   • Give acetaminophen (such as Tylenol) for fever above 102° F (39° C).
   • Never use aspirin. Reason: Risk of Reye syndrome.
   • Also, don't use ibuprofen products (such as Advil). Reason: May increase risk of bad strep skin infections.
7. Fluids and Soft Diet:
   • The mouth and throat ulcers are painful. Try to get your child to drink adequate fluids.
   • Goal: Keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids. Offer a soft diet. Also, avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
   • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
8. Liquid Antacid for Mouth Pain (Age 1 Year and Older):
   • For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
   • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
   • Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
   • Caution: Do not use regular mouth washes, because they sting.
9. Ointment For Pain With Passing Urine:
   • For girls with painful genital ulcers, use petroleum jelly (such as Vaseline).
   • Put on the sores as needed.
   • For males with painful pox on the tip of the penis, this also works.
10. Return to School:
    • Your child can go back to school after all the sores have crusted over.
    • Most often, this is day 6 or 7 of the rash.
11. What to Expect:
    • Expect new chickenpox every day for 4 or 5 days.
    • Most children get 400 to 500 chickenpox.
    • They get less pox if they've had the vaccine.
12. Prevent the Spread of Chickenpox in the Office:
    • If your child needs to be seen, call first to the office.
    • Try to bring another adult. Have one adult enter the office first for instructions.
    • For nonurgent problems, the doctor may do an exam in the car.
13. Call Your Doctor If:
    • Chickenpox look infected (draining pus, scabs become larger)
    • Gets any new chickenpox after day 6
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Circumcision Problems

Normal Circumcision Healing

• A circumcision is the removal of most of the male foreskin.
• The incision starts off red and tender. The tenderness should be much less by day 3.
• The scab at the incision line comes off in 7 to 10 days.
• If a Plastibell (plastic ring) was used, it should fall off by 14 days. 10 days is the average. While it can't fall off too early, pulling it off can cause bleeding.

Complications of Circumcision

• Wound Infection (Serious). This is the most common complication. It occurs in less than 1 out of 200 circumcised boys. The main finding is spreading redness up the shaft of the penis.
• Bleeding (Serious). Normal bleeding from the incision site should be a few drops. More than that suggests a bleeding problem. Very rare.
• Urine Retention (Serious). Can't pass urine or just dribbles urine. Defined as no urine in 8 hours. Very rare.

When to Call for Circumcision Problems

Care Advice for Circumcisions

1. What You Should Know About Circumcisions:
   • The tip (head) of the penis can be red after the foreskin is removed. This is normal.
   • The rest of the penis should not be red.
   • The penis will be swollen for a few days. There may be some bruises or dried blood on it.
   • Most circumcisions heal quickly.
   • Infections are rare.
   • Here is some care advice that should help.
2. Plastic Ring Type Circ:
   • Gently wash the area with warm water twice a day.
   • Also, do this if it becomes dirty with poop.
3. Incision (No Plastic Ring is Present) Type Circ:
   • The dressing is gauze with petroleum jelly. Take this off 24 hours later. Sometimes, it will fall off on its own. If you need to remove it, use a warm wet washcloth.
   • Gently wash the area with warm water twice a day. Also, do this if it becomes dirty with poop.
4. Ointment for Pain:
   • Put a layer of ointment on the incision line. This should lessen any pain and crying.
   • To prevent pain, use petroleum jelly (such as Vaseline). Put it on the incision line and head of the penis. Do this after each cleansing for the first 4 days. Other option: You can also use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Reason: Helps keep it soft and stops the diaper from sticking during healing.
5. Crying - Don't Give Pain Meds:
   • Circumcisions are usually not that painful.
   • Covering the wound with an ointment often is all that is needed.
   • Do not give pain medicine (such as Tylenol).
   • If your baby is crying a lot, he may need to be seen. Call your doctor if you think your baby is in pain.
   • Your baby's doctor will decide if pain meds are needed.
6. Bleeding - How to Stop:
   • The circumcision wound can normally bleed a few drops. Most often, this is caused by the diaper rubbing on the wound.
   • Will stop on its own or with a few minutes of direct pressure.
   • Can stop bleeding by keeping the area soft with an ointment.
7. What to Expect For A Plastic Ring:
   • The plastic ring will normally fall off between 7 and 14 days (average 10).
   • It often hangs by a small piece of tissue for a few days.
   • It will come off on its own.
   • Pulling it off can cause bleeding.
   • It can't fall off too early.
8. Prevent Infections:
   • Fasten the diaper loosely to prevent friction against the penis.
   • Avoid tub baths for 7 days after the circ. Just clean the penis with a wet cloth.
   • If the cord is still on, wait longer. Avoid tub baths until 2 days after cord falls off.
9. Call Your Doctor If:
   • Looks infected
   • Bleeding occurs
   • Plastic ring moves onto shaft of the penis
   • Plastic ring does not fall off by day 14
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Colds

Symptoms of a Cold

• Runny or stuffy nose
• The nasal discharge starts clear but changes to grey. It can also be yellow or green.
• Most children have a fever at the start.
• A sore throat can be the first sign
• At times, the child may also have a cough and hoarse voice. Sometimes, watery eyes and swollen lymph nodes in the neck also occur.

Cause of Colds

• Colds are caused by many respiratory viruses. Healthy children get about 6 colds a year.
• Influenza virus causes a bad cold with more fever and muscle aches.
• Colds are not serious. With a cold, about 5 and 10% of children develop another health problem. Most often, this is an ear or sinus infection. These are caused by a bacteria.

Colds: Normal Viral Symptoms

• Colds can cause a runny nose, sore throat, hoarse voice, a cough or croup. They can also cause stuffiness of the nose, sinus or ear. Red watery eyes can also occur. Colds are the most common reason for calls to the doctor. This is because of all the symptoms that occur with colds.
• Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money. It can help you to avoid some needless trips to the doctor. The cold symptoms listed below are normal. These children don't need to be seen:
  • Fever up to 3 days (unless it goes above 104° F or 40° C)
  • Sore throat up to 5 days (with other cold symptoms)
  • Nasal discharge and congestion up to 2 weeks
  • Coughs up to 3 weeks

Colds: Symptoms of Secondary Bacterial Infections (other health problems)

Using this guide, you can decide if your child has developed another health problem. This happens in about 5 to 10% of children who have a cold. Many will have an ear infection or sinus infection. Look for these symptoms:

• Earache or ear discharge
• Sinus pain not relieved by nasal washes
• Lots of pus in the eyes (Eyelids stuck together after naps)
• Trouble breathing or rapid breathing (could have pneumonia)
• Fever lasts over 3 days
• Fever that goes away for 24 hours and then returns
• Sore throat lasts over 5 days (may have Strep throat)
• Nasal discharge lasts over 2 weeks
• Cough lasts over 3 weeks

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

• Struggling for each breath or shortness of breath
• Tight breathing so that your child can barely speak or cry
• Ribs are pulling in with each breath (called retractions)
• Breathing has become noisy (such as wheezes)
• Breathing is much faster than normal
• Lips or face turn a blue color

When to Call for Colds

Care Advice for Colds

1. What You Should Know About Colds:
   • It's normal for healthy children to get at least 6 colds a year. This is because there are so many viruses that cause colds. With each new cold, your child's body builds up immunity to that virus.
   • Most parents know when their child has a cold. Sometimes, they have it too or other children in school have it. Most often, you don't need to call or see your child's doctor. You do need to call your child's doctor if your child develops a complication. Examples are an earache or if the symptoms last too long.
   • The normal cold lasts about 2 weeks. There are no drugs to make it go away sooner.
   • But, there are good ways to help many of the symptoms. With most colds, the starting symptom is a runny nose. This is followed in 3 or 4 days by a stuffy nose. The treatment for each symptom is different.
   • Here is some care advice that should help.
2. For a Runny Nose with Lots of Discharge: Blow or Suction the Nose
   • The nasal mucus and discharge is washing germs out of the nose and sinuses.
   • Blowing the nose is all that's needed. Teach your child how to blow the nose at age 2 or 3.
   • For younger children, gently suction the nose with a suction bulb.
   • Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness.
3. Nasal Saline to Open a Blocked Nose:
   • Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
   • Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop.
   • Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
   • Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear.
   • How Often. Do nasal saline rinses when your child can't breathe through the nose.
   • Limit. If under 1 year old, no more than 4 times per day or before every feeding.
   • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
   • Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.
   • Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
   • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
   • For young children, can also use a wet cotton swab to remove sticky mucus.
4. Fluids - Offer More:
   • Try to get your child to drink lots of fluids.
   • Goal: Keep your child well hydrated.
   • It also will thin out the mucus discharge from the nose.
   • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
5. Humidifier:
   • If the air in your home is dry, use a humidifier.
   • Reason: Dry air makes nasal mucus thicker.
6. Medicines for Colds:
   • Cold Medicines. Don't give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can't remove dried mucus from the nose. Nasal saline works best.
   • Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough.
   • No Antibiotics. Antibiotics are not helpful for colds. Antibiotics may be used if your child gets an ear or sinus infection.
7. Other Symptoms of Colds - Treatment:
   • Pain or Fever. Use acetaminophen (such as Tylenol) to treat muscle aches, sore throat or headaches. Another choice is an ibuprofen product (such as Advil). You can also use these medicines for fever above 102° F (39° C).
   • Sore Throat. If over 6 years of age, your child can also suck on hard candy. For children over 1 year old, sip warm chicken broth. Some children prefer cold foods, such as popsicles or ice cream.
   • Cough. For children over 1 year old, give honey ½ to 1 teaspoon (2 to 5 mL). Caution: Do not use honey until 1 year old. If over 6 years of age, you can also use cough drops. Avoid cough drops before 6 years. Reason: risk of choking.
   • Red Eyes. Rinse eyelids often with wet cotton balls.
8. Return to School:
   • Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities.
   • For practical purposes, the spread of colds can't be prevented.
9. What to Expect:
   • Fever can last 2-3 days
   • Nasal drainage can last 7-14 days
   • Cough can last 2-3 weeks
10. Call Your Doctor If:
    • Trouble breathing occurs
    • Earache occurs
    • Fever lasts more than 3 days or goes above 104° F (40° C)
    • Any fever if under 12 weeks old
    • Nasal discharge lasts more than 14 days
    • Cough lasts more than 3 weeks
    • You think your child needs to be seen
    • Your child becomes worse
11. Extra Advice - Air Travel with Colds:
    • It's safe to fly when your child has a cold.
    • He could get some mild ear congestion or even a brief earache while flying. Most often, that can be prevented. (See # 12).
    • Flying will not cause an ear infection.
12. Extra Advice - Prevent Ear Congestion During Air Travel:
    • Most symptoms happen when the airplane is coming down in altitude. This is the descent of the plane during the 15 minutes before landing.
    • Keep your child awake during takeoff and descent.
    • Swallow during descent using fluids or a pacifier.
    • Children over age 4 can chew gum during descent.
    • Yawning during descent also can open the middle ear.
    • Drink lots of fluids throughout the flight. This will prevent the nasal secretions from drying out.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Constipation

Causes of Constipation

• High Milk Diet. Milk and cheese are the only foods that in high amounts can cause constipation. It causes hard pale stools. This is why you want your child to eat a well-balanced diet.
• Low Fiber Diet. Fiber is found in vegetables, fruits and whole grains. Fiber keeps stools soft, bulky and easy to pass. A low fiber diet causes hard, small stools.
• Low Fluid Intake. This can also cause stools to be dry and harder to pass. It's rarely the only cause of constipation.
• Lack of Exercise. Exercise also keeps the bowel from slowing down. Not a cause in children unless they are confined to bed.
• Holding Back Stools Because of Pain. If passing a stool causes pain, many children will hold back the next one. This can happen with a Strep infection around the anus. It can also occur with a bad diaper rash or anal fissure (tear).
• Holding Back Stools Because of Power Struggles. This is the most common cause of recurrent constipation in children. Most often it's a battle around toilet training. If they are already trained, it may begin with the start of school. Reason: some children refuse to use public toilets. Some children postpone stools because they are too busy to sit down.
• Slow passage of food through the intestines. Most often, this type runs in families. Called slow transit time.

Stools: How Often is Normal?

• Normal Range: 3 per day to 1 every 2 days. Once children are on normal table foods, their stool pattern is like adults.
• Kids who go every 4 or 5 days almost always have pain with passage. They also have a lot of straining.
• Kids who go every 3 days often drift into longer times. Then, they also develop symptoms.
• Passing a stool should be free of pain.
• Any child with pain during stool passage or lots of straining needs treatment. At the very least, the child should be treated with changes in diet.

Imitators of Constipation: Normal Patterns and Stools

• Breastfed and Over 1 Month Old. Stools every 4-7 days that are soft, large and pain-free can be normal. Caution: before 1 month old, not stooling enough can mean not getting enough breast milk.
• Straining in Babies. Grunting or straining while pushing out a stool is normal in young babies. It's hard to pass stool lying on your back with no help from gravity. Babies also become red in the face during straining. This is normal.
• Brief straining under 10 minutes can occur at times at any age.
• Large Stools. Size relates to the amount of food eaten. Large eaters have larger stools.
• Hard or Dry Stools. Also can be normal if passed easily without too much straining. Often, this relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.

When to Call for Constipation

Care Advice for Constipation

1. What You Should Know about Constipation:
   • Constipation is common in children.
   • Most often, it's from a change in diet. It can also be caused by waiting too long to stool.
   • Passing a stool should be pleasant and free of pain.
   • Any child with pain during stool passage or lots of straining needs treatment. At the very least, they need changes in diet.
   • Here is some care advice that should help.
2. Normal Stools:
   • Normal range: 3 per day to 1 every 2 days. Once children are on a regular diet, their stool pattern is like adults.
   • Kids who go every 3 days often drift into longer times. Then symptoms start.
   • Kids who go every 4 and 5 days almost always have pain with passage. They also have lots of straining.
3. Diet for Infants Under 1 Year Old:
   • Age over 1 month old only on breast milk or formula, add fruit juice.
   • Amount. Give 1 ounce (30 mL) per month of age per day. Limit amount to 4 ounces (120 mL).
   • Pear and apple juice are good choices. After 3 months, can use prune (plum) juice. Reason for fruit juice: approved for babies in treating a symptom.
   • Age over 4 months old, also add baby foods with high fiber. Do this twice a day. Examples are peas, beans, apricots, prunes, peaches, pears, or plums.
   • Age over 8 months old on finger foods, add cereals and small pieces of fresh fruit.
4. Diet for Children Over 1 Year Old:
   • Increase fruit juice (apple, pear, cherry, grape, prune). Note: Citrus fruit juices are not helpful.
   • Add fruits and vegetables high in fiber content. Examples are peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, or dates. Offer these foods 3 or more times per day.
   • Increase whole grain foods. Examples are bran flakes or muffins, graham crackers, and oatmeal. Brown rice and whole wheat bread are also helpful. Popcorn can be used if over 4 years old.
   • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
   • Fluids. Give enough fluids to stay well-hydrated. Reason: keep the stool soft.
5. Stop Toilet Training:
   • Put your child back in diapers or pull-ups for a short time.
   • Tell him that the poops won't hurt when they come out.
   • Praise him for passing poops into a diaper.
   • Holding back stools is harmful. Use rewards to help your child give up this bad habit.
   • Avoid any pressure or punishment. Also, never force your child to sit on the potty against his will. Reason: It will cause a power struggle.
   • Treats and hugs always work better.
6. Encourage Sitting on the Toilet (if toilet trained):
   • Set up a normal stool routine, if your child agrees to sitting.
   • Have your child sit on the toilet for 5 minutes after meals.
   • This is especially important after breakfast.
   • If you see your child holding back a stool, also take to the toilet for a sit (if cooperates).
   • During sits, stay with your child and be a coach. Just focus on helping the poop come out.
   • Do not distract your child. Do not allow your child to play with video devices, games or books during sits.
   • Once he passes a normal size stool, he doesn't need to sit anymore that day.
7. Warm Water to Relax the Anus:
   • Warmth helps many children relax the anus and release a stool.
   • For straining too long, have your child sit in warm water.
   • You can also put a warm wet cotton ball on the anus. Vibrate it side to side for about 10 seconds to help relax the anus.
8. Flexed Position to Help Stool Release:
   • Help your baby by holding the knees against the chest. This is like squatting for your baby. This is the natural position for pushing out a stool. It's hard to have a stool lying down.
   • Gently pumping the left side of the belly also helps.
9. Stool Softeners (Age Over 1 Year Old):
   • If a change in diet doesn't help, you can add a stool softener. Must be over 1 year of age.
   • Use a stool softener (such as Miralax). It is available without a prescription. Give 1-3 teaspoons (5-15 mL) powder each day with dinner. Mix the powder in 2 to 6 ounces (60-180 mL) of water.
   • Fiber products (such as Benefiber) are also helpful. Give 1 teaspoon (5 mL) twice a day. Mix it in 2 ounces (60 mL) of water or fruit juice.
   • Stool softeners and fiber work 8-12 hours after they are given.
   • Safe to continue as long as needed.
10. What to Expect:
    • Most often, changes in diet helps constipation.
    • After your child is better, be sure to keep him on high fiber foods.
    • Also, have your child sit on the toilet at the same time each day.
    • These tips will help to prevent the symptoms from coming back.
11. Call Your Doctor If:
    • Constipation lasts more than 1 week after making changes to diet
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Cough

Causes of Cough

• Common Cold. Most coughs are part of a cold that includes the lower airway. The medical name is viral bronchitis. The bronchi are the lower part of the airway that go to the lungs. Bronchitis in children is always caused by a virus. This includes cold viruses, influenza and croup. Bacteria do not cause bronchitis in healthy children.
• Sinus Infection. The exact mechanism of the cough is unknown. It may be that post-nasal drip irritates the lower throat. Or pressure within the sinus may trigger the cough reflex.
• Allergic Cough. Some children get a cough from breathing in an allergic substance. Examples are pollens or cats. Allergic coughs can be controlled with allergy medicines, such as Benadryl.
• Asthma. Asthma with wheezing is the most common cause of chronic coughs in children. In adults, it's smoking.
• Cough Variant Asthma. 25% of children with asthma only cough and never wheeze. The coughing spells have the same triggers as asthma attacks.
• Air Pollution Cough. Fumes of any kind can irritate the airway and cause a cough. Tobacco smoke is the most common example. Others are auto exhaust, smog and paint fumes.
• Exercise Induced Cough. Running will make most coughs worse. If the air is cold or polluted, coughing is even more likely.
• Serious Causes. Pneumonia, bronchiolitis, whooping cough and airway foreign object

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

• Struggling for each breath or shortness of breath
• Tight breathing so that your child can barely speak or cry
• Ribs are pulling in with each breath (called retractions)
• Breathing has become noisy (such as wheezes)
• Breathing is much faster than normal
• Lips or face turn a blue color

Phlegm or Sputum: What's Normal?

• Yellow or green phlegm is a normal part of the healing of viral bronchitis.
• This means the lining of the trachea (windpipe) was damaged by the virus. It's part of the phlegm your child coughs up.
• Bacteria do not cause bronchitis in healthy children. Antibiotics are not helpful for the yellow or green phlegm seen with colds.
• The main treatment of a cough with phlegm is to drink lots of fluids. Also, if the air is dry, using a humidifier will help. Sipping warm clear fluids will also help coughing fits.

When to Call for Cough

Care Advice for Cough

1. What You Should Know About Coughs:
   • Most coughs are a normal part of a cold.
   • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
   • A cough can be a good thing. We don't want to fully turn off your child's ability to cough.
   • Here is some care advice that should help.
2. Homemade Cough Medicine:
   • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
   • Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
   • Age 1 year and older: Use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
   • Age 6 years and older: Use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
3. Non-Prescription Cough Medicine (DM):
   • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 6 years old. (FDA)
   • Honey has been shown to work better for coughs. Caution: Do not use honey until 1 year old.
   • If age 6 years or older, you might decide to use a cough medicine. Choose one with dextromethorphan (DM), such as Robitussin Cough syrup. DM is present in most non-prescription cough syrups.
   • When to Use: Give only for severe coughs that interfere with sleep or school.
   • DM Dose: Give every 6 to 8 hours as needed.
4. Coughing Fits or Spells - Warm Mist and Fluids:
   • Breathe warm mist, such as with shower running in a closed bathroom.
   • Give warm clear fluids to drink. Examples are apple juice and lemonade.
   • Age under 3 months. Don't use warm fluids.
   • Age 3 - 12 months of age. Give 1 ounce (30 mL) each time. Limit to 4 times per day.
   • Age over 1 year of age. Give as much as needed.
   • Reason: Both relax the airway and loosen up any phlegm.
5. Vomiting from Hard Coughing:
   • For vomiting that occurs with hard coughing, give smaller amounts per feeding.
   • Also, feed more often.
   • Reason: Vomiting from coughing is more common with a full stomach.
6. Encourage Fluids:
   • Try to get your child to drink lots of fluids.
   • Goal: Keep your child well hydrated.
   • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
   • It also will thin out the mucus discharge from the nose.
7. Humidifier:
   • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
8. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
9. Avoid Tobacco Smoke:
   • Tobacco smoke makes coughs much worse.
10. Return to School:
    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of coughs and colds cannot be prevented.
11. Extra Advice- Allergy Medicine for Allergic Cough:
    • Allergy medicine can bring an allergic cough under control within 1 hour. The same is true for nasal allergy symptoms.
    • A short-acting allergy medicine (such as Benadryl) is helpful. No prescription is needed.
    • Give every 6 to 8 hours until the cough is gone.
12. What to Expect:
    • Viral bronchitis causes a cough for 2 to 3 weeks.
    • Sometimes, your child will cough up lots of phlegm (mucus). The mucus can normally be grey, yellow or green.
    • Antibiotics are not helpful.
13. Call Your Doctor If:
    • Trouble breathing occurs
    • Wheezing occurs
    • Cough lasts more than 3 weeks
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Coughs: Meds or Home Remedies?

Medicines (OTC)

Over-the-Counter (OTC) cough and cold medicines can cause side effects. These side effects can be serious in young children. The risks of using these medicines outweigh any benefits. In 2008, the Food and Drug Administration (FDA) looked at this issue in children. They recommended these medicines never be used in young children. After age 6, the medicines are safe to use, if you follow the package instructions. But, it's easy to treat coughs and colds without these medicines.

Home Remedies:

A good home remedy is safe, cheap, and as helpful as OTC medicines. They are also found in nearly every home. Here are some simple but helpful home treatments.

1. Runny Nose: Just suction it or blow it. Teach your child how to blow the nose at age 2 or 3. When your child's nose runs like a faucet, it's getting rid of viruses. Allergy medicines (such as Benadryl) do not help the average cold. They are useful only if your child has nasal allergies (hay fever).

2. Blocked Nose: Use nasal saline.

• Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
• Step 1: Put 3 drops in each nostril. If age under 1 year old, use 1 drop.
• Step 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
• Step 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
• How Often: Do nasal saline rinses when your child can't breathe through the nose. Limit: If under 1 year old, no more than 4 times per day or before every feeding.
• Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
• Saline nose drops can also be made at home. Use ½ teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of warm water. Use bottled water or boiled water to make saline nose drops.
• Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
• Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow (or suction) each nostril.
• For young children, can also use a wet cotton swab to remove sticky mucus.
• Medicines. There are no drugs that can remove dried mucus from the nose.

3. Coughing: Use homemade cough medicines.

• Age 3 months to 1 year. Give warm clear fluids (such as apple juice or lemonade). Dose: 1-3 teaspoons (5-15 ml) four times per day when coughing. Under 3 months, see your child's doctor. Caution: Do not use honey until 1 year old.
• Age 1 year and older. Use Honey ½ to 1 teaspoon (2 to 5 ml) as needed. It thins the secretions and loosens the cough. If you don't have honey, you can use corn syrup. Research shows that honey works better than cough syrups to reduce nighttime coughing.
• Age 6 years and older. Use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
• Coughing fits. The warm mist from a shower can help.

4. Fluids: Help your child drink lots of fluids. Staying well hydrated thins the body's secretions. That makes it easier to cough and blow the nose.

5. Humidity: If the air in your home is dry, use a humidifier. Moist air keeps the nose and airway from drying out. Run a warm shower for a while to help put moisture in the air.

Treatment is Not Always Needed:

• If symptoms aren't bothering your child, they don't need medicine or any treatment. Many children with a cough or cold are happy, play fine and sleep well.
• Only treat symptoms if they cause discomfort or wake your child up. Treat a cough if it's hacking and really bothers your child.
• Fevers are helpful. Only treat them if they slow your child down or cause some discomfort. That does not occur until 102° F (39° C) or higher. Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be given. Use to treat higher fever or pain. See Dose tables.

Summary

If coughs or colds need treatment, home remedies may work better than medicines.

Cracked or Dry Skin

Causes of Cracks in the Skin

• Most cracked skin is found on the feet, hands or lips.
• Feet. The soles of the feet are most commonly involved. Most often, cracks occur on the heels and big toes. This is called tennis shoe dermatitis. Deep cracks are very painful and can bleed. The main cause is wearing wet or sweaty socks or swimming a lot.
• Hands. Cracks can develop on the hands in children. The main cause is washing the hands too much or washing dishes. Can also occur from working outside in winter weather. The worse cracks of the fingers occur with thumb sucking.
• Lips. The lips can become chapped in children from the sun or wind. If the lips become cracked, it's usually from a "lip-licking" habit. The skin around the lips can also become pink and dry. This occurs especially in children who suck on their lips.

Causes of Dry Skin

• Dry skin is a common condition.
• Soap. Dry skin is mainly caused by too much bathing and soap (soap dermatitis). Soap removes the skin's natural protective oils. Once they are gone, the skin can't hold moisture.
• Climate. Dry climates make dry skin worse, as does winter weather (called winter itch).
• Genetics also plays a role in dry skin.
• Dry skin is less common in teenagers than younger children. This is because the oil glands are more active.
• Keratosis Pilaris - dry, rough, bumpy skin on the back of the upper arms. It's made worse by soaps. Treat with moisturizing creams.
• Pityriasis Alba - dry pale spots on the face. These are more prevalent in the winter time and are also made worse by soaps. Treat with moisturizing creams.
• Eczema. Children with eczema have very dry itchy skin.

Liquid Skin Bandage For Deep, Chronic Cracks

• Liquid plastic skin bandage is a new product that seals wounds. It is a plastic coating that lasts up to 1 week.
• It is the best way to relieve pain and promote healing. As the crack heals from the bottom upward, it pushes the plastic seal up.
• After the wound is washed and dried, put the liquid on. It comes with a small brush or with a swab. It dries in less than a minute. Then apply a second coat. It's waterproof and may last a week.
• You can buy this at any drug store. Many brands of liquid bandage are available. No prescription is needed.

When to Call for Cracked or Dry Skin

Care Advice

Treatment for Cracked Skin on the Feet

1. What You Should Know About Cracks on Feet:
   • Most often, cracked skin of the feet is caused by repeated contact with moisture.
   • The main cause is often wearing wet (or sweaty) socks. Swimmers also have this problem.
   • The soles of the feet are most often involved. Usually, you see cracks on the heels and big toes.
   • This is called tennis shoe or sneaker dermatitis.
   • Cracked, dry feet usually can be treated at home.
   • Here is some care advice that should help.
2. Shallow Cracks - Use Ointment:
   • Cracks heal faster if protected from air exposure and drying.
   • Keep the cracks constantly covered with petroleum jelly (such as Vaseline). Put it on the cracks 3 times a day.
   • If the crack seems mildly infected, use an antibiotic ointment instead (such as Polysporin). No prescription is needed. Put it on the cracks 3 times a day.
   • Covering the ointment with a bandage (such as Band-Aid) speeds recovery. You can also cover it with a sock.
   • Option: If you have it, a liquid skin bandage works even better. Don't use liquid bandage and ointment together.
3. Deep Cracks - Use Liquid Skin Bandage:
   • Deep cracks of the feet or toes usually do not heal with ointments.
   • Use a liquid skin bandage that will completely seal the crack. Many brands of liquid bandage are available. No prescription is needed.
   • Start with 2 layers. Put on another layer as often as needed.
   • As the crack heals, the plastic layer will be pushed up.
4. Prevention of Cracks on Feet:
   • Change socks whenever they are wet or sweaty.
   • Take an extra pair of socks to school.
   • When practical, do not wear shoes. Go barefoot or wear socks only.
   • Do not use bubble bath or other soaps in the bath water. Soaps take the natural oils out of the skin.
   • Use a moisturizing cream on the feet after baths or showers.
   • Wear shoes that allow the skin to "breathe."
5. What to Expect:
   • Most cracks heal over in 1 week with treatment.
   • Deep cracks heal if you keep them covered all the time with crack sealer. Deep cracks will heal in about 2 weeks with crack sealer.
6. Call Your Doctor If:
   • Starts to look infected (redness, red streak, pus)
   • Cracks last more than 2 weeks on treatment
   • You think your child needs to be seen
   • Your child becomes worse

Treatment for Cracked Skin on the Hands

1. What You Should Know About Cracks on Hands:
   • Cracked skin of the hands is usually caused by repeated contact with moisture.
   • Examples are washing dishes or washing the hands often.
   • Soap removes the natural protective oils from the skin.
   • Cracked, dry hands usually can be treated at home.
   • Here is some care advice that should help.
2. Shallow Cracks - Use Ointment:
   • Cracks heal faster if protected from air exposure and drying.
   • Keep the cracks constantly covered with petroleum jelly (such as Vaseline). Put it on the cracks 3 times a day.
   • If the crack seems mildly infected, use an antibiotic ointment instead (such as Polysporin). No prescription is needed. Put it on the cracks 3 times a day.
   • Covering the ointment with a bandage (such as Band-Aid) speeds recovery. You can also cover it with a glove.
   • Option: If you have it, a liquid skin bandage works even better. Don't use liquid bandage and ointment together.
3. Deep Cracks - Use Liquid Skin Bandage:
   • Deep cracks of the fingers usually do not heal with ointments.
   • Use a liquid skin bandage that will completely seal the crack. Many brands of liquid bandage are available. No prescription is needed.
   • Start with 2 layers. Put on another layer as often as needed.
   • As the crack heals, the plastic layer will be pushed up.
4. Prevention of Cracks on Hands:
   • Wash the hands with warm water.
   • Use soap only if the hands are very dirty. Also, use soap for anything that won't come off with water.
   • Wear gloves when washing dishes.
   • During cold weather, wear gloves outside.
   • Use a moisturizing cream on the hands after anytime they have been in water.
5. What to Expect:
   • Most cracks heal over in 1 week with treatment.
   • Deep cracks heal if you keep them covered all the time with crack sealer. Deep cracks will heal in about 2 weeks with crack sealer.
6. Call Your Doctor If:
   • Starts to look infected (redness, red streak, pus)
   • Cracks last more than 2 weeks on treatment
   • You think your child needs to be seen
   • Your child becomes worse

Treatment for Chapped Lips

1. What You Should Know About Chapped Lips:
   • The lips can become chapped in children from too much sun or wind.
   • If the lips become cracked, it's usually from a "lip-licking" habit.
   • The skin around the lips can also become pink and dry. This occurs especially when children suck on their lips.
   • Here is some care advice that should help.
2. Lip Balm:
   • A lip balm should be used often, even hourly.
   • Be sure to put it on after eating or drinking.
3. Avoid "Lip-Licking":
   • Help your child give up the habit of lip-licking or sucking.
   • This habit usually is not seen before age 6.
   • This habit will only change if you can gain your child's active participation.
   • Appeal to your child's pride. Show your child in a mirror how lip-sucking has affected their appearance.
   • Give them a lip lubricant to put on their lips. Tell them to use it when they feel the urge to suck on them. Another option is to replace lip-sucking with chewing gum.
   • Offer an incentive for going an entire day without lip-sucking. Examples of rewards are money or points towards a prize.
   • Avoid any pressure or punishment. It will backfire, cause a power struggle and make the habit last longer.
4. Call Your Doctor If:
   • Starts to look infected (redness, red streak, pus)
   • Cracks last more than 2 weeks on treatment
   • You think your child needs to be seen
   • Your child becomes worse

Treatment for Dry or Itchy Skin

1. What You Should Know About Dry Skin:
   • Dry skin is a common condition.
   • Mainly caused by too much bathing and soap (soap dermatitis).
   • Soap removes the skin's natural protective oils. Once they are gone, the skin can't hold moisture.
   • Dry climates make it worse, as does winter weather (called winter itch).
   • Genetics also plays a role in dry skin.
   • Dry skin is less common in teenagers than younger children. This is because the oil glands are more active in teens.
   • Here is some care advice that should help.
2. Bathing - Avoid Soap:
   • Young children with dry skin should avoid all soaps. Soaps take the natural protective oils out of the skin. Bubble bath does the most damage.
   • For young children, the skin can be cleansed with warm water alone. Keep bathing to 10 minutes or less.
   • Most young children only need to bathe twice a week.
   • Teenagers can get by with using soap only for the armpits, genitals, and feet. Also, use a mild soap (such as Dove).
   • Do not use any soap on itchy areas or rashes.
3. Moisturizing Cream:
   • Buy a large bottle of moisturizing cream (such as Eucerin). Avoid those with fragrances.
   • Put the cream on any dry or itchy area 3 times per day.
   • After warm water baths or showers, trap the moisture in the skin. Do this by putting on the cream everywhere after bathing. Use the cream within 3 minutes of completing the bath.
   • During the winter, apply the cream every day to prevent dry skin.
4. Steroid Cream:
   • For very itchy spots, use 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
   • Use up to 3 times per day as needed until the itching is better.
   • Eventually, the moisturizing cream will be all that you need for treating dry skin.
5. Humidifier:
   • If your winters are dry, protect your child's skin from the constant drying effect.
   • Do this by running a room humidifier full time.
6. Preventing Dry Skin:
   • Don't use soaps or bubble bath.
   • Wash the hands with warm water. Use soap only if the hands are very dirty. Also, use soap for anything that won't come off with water.
   • Don't use swimming pools or hot tubs. Reason: Pool chemicals are very drying.
   • Run a humidifier in the winter if the air is dry.
   • During cold weather, wear gloves outside. This helps prevent drying of the skin.
   • Drink lots of fluids.
7. Call Your Doctor If:
   • Dry skin lasts more than 2 weeks on treatment
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Cradle Cap

Symptoms of Cradle Cap

• Yellow scales and crusts attached to the scalp
• Occurs in patches
• Scales can be greasy or dry
• Not itchy or painful
• Begins in the first 2 to 6 weeks of life

Cause of Cradle Cap

• Cradle cap is probably caused by hormones from the mother. These hormones cross the placenta before birth. The hormones cause the oil glands in the skin to become overactive. They then release more oil than normal.
• Dead skin cells normally fall off. The extra oil causes these cells to "stick" to the skin. These cells form yellow crusts and scales on the scalp.

When to Call for Cradle Cap

Care Advice for Cradle Cap

1. What You Should Know About Cradle Cap:
   • Cradle cap is a common skin condition of newborns.
   • It's caused by overactive oil glands in the scalp.
   • It's harmless and will go away on its own. But it takes time.
   • Here is some care advice that should help.
2. Shampoo Daily:
   • Wash the hair with an anti-dandruff shampoo (such as Head and Shoulders). Do this twice a week. No prescription is needed. Note: The daily use of anti-dandruff shampoo isn't approved until after 2 years old. But, using it twice a week is fine.
   • On the other days, wash the hair with baby shampoo.
3. Scalp Massage:
   • While the hair is lathered, massage the scalp with a soft brush. You can also use a rough washcloth or your fingers for 5 minutes. Don't worry about hurting the soft spot.
4. Baby Oil:
   • If the scalp has thick crusts (scales), put some baby oil on the scalp. Do this for 15 minutes before shampooing to soften the crusts.
   • Wash all the oil off, however, or it may worsen the cradle cap. (Reason: The oil blocks the oil glands on the baby's scalp.)
   • Do not use olive oil. (Reason: may increase the growth of yeast)
   • Cradle cap lotions for loosening up the scales are also available without a prescription. Apply the lotion 15 minutes before shampooing.
5. Steroid Cream:
   • If the rash on the scalp is red and irritated, use 1% hydrocortisone cream. An example is Cortaid. No prescription is needed.
   • Put this on once a day.
   • After 1 hour, wash it off with soap and water.
   • Do this for 7 days or less.
6. Expected Course:
   • Cradle cap will eventually go away on its own between 6 and 12 months of age. Usually, it doesn't cause any symptoms (such as pain or itching).
   • Therefore, treatment is optional. It is mainly done for cosmetic reasons.
   • Shampoos, lotions and brushing will reduce the thickness of the scales. They will usually make them go away sooner.
7. Return to Child Care:
   • Cradle cap cannot be spread to others.
   • Your child does not need to miss any child care.
8. Call Your Doctor If:
   • Gets worse with treatment
   • Lasts over 12 months of age
   • You think your child needs to be seen

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Croup

Stridor: A nother Health Problem of Croup

• Stridor is a harsh, raspy tight sound best heard with breathing in
• Loud or constant stridor means severe croup. So does stridor at rest (when not crying or coughing).
• All stridor needs to be treated with warm mist
• Most children with stridor need treatment with a steroid (such as Decadron)
• For any stridor, see First Aid for treatment

Causes of a Croupy Cough

• Viral Croup. Viruses are the most common cause of croup symptoms. Many respiratory viruses can infect the vocal cord area and cause narrowing. Even influenza (the flu) can do this. A fever is often present with the barky cough.
• Allergic Croup. A croupy cough can occur with exposure to pollens or allergens in a barn. A runny nose, itchy eyes and sneezing are also often present.
• Inhaled Powder. Breathing in any fine substance can trigger 10 minutes of severe coughing. Examples are powdered sugar, flour dust or peanut dust. They can float into the lungs. This is not an allergic reaction.
• Airway Foreign Object (Serious). Suspect when there is a sudden onset of coughing and choking. Common examples are peanut and seeds. Peak age is 1 to 4 years.
• Food Allergy (Serious). Croup symptoms can also be caused by a food allergy. This can be life-threatening (anaphylaxis). Examples are nuts or fish.

When to Call for Croup

Care Advice for Croup

1. What You Should Know About Croup:
   • Most children with croup just have a barky cough.
   • Some have tight breathing (called stridor). Stridor is a loud, harsh sound when breathing in. It comes from the area of the voicebox.
   • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
   • We want to help a productive cough, not turn it off.
   • Here is some care advice that should help.
2. First Aid For Stridor (Harsh sound with breathing in):
   • Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes.
   • You could also use a wet washcloth held near the face.
   • Caution: Do not use very hot water or steam which could cause burns.
   • If warm mist fails, breathe cool air by standing near an open refrigerator. You can also go outside with your child if the weather is cold. Do this for a few minutes.
3. Calm Your Child if He or She has Stridor:
   • Crying or fear can make stridor worse.
   • Try to keep your child calm and happy.
   • Hold and comfort your child.
   • Use a soothing, soft voice.
4. Humidifier:
   • If the air in your home is dry, use a humidifier.
   • Reason: Dry air makes croup worse.
5. Homemade Cough Medicine:
   • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
   • Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
   • Age 1 year and older: Use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
   • Age 6 years and older: Use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
6. Non-Prescription Cough Medicine (DM):
   • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 6 years old. (FDA)
   • Honey has been shown to work better for coughs. Caution: Do not use honey until 1 year old.
   • If age 6 years or older, you might decide to use a cough medicine. Choose one with dextromethorphan (DM) such as Robitussin Cough syrup. DM is present in most non-prescription cough syrups.
   • When to Use: Give only for severe coughs that interfere with sleep or school.
   • DM Dose: Give every 6 to 8 hours as needed.
7. Coughing Fits or Spells - Warm Mist and Fluids:
   • Breathe warm mist, such as with shower running in a closed bathroom.
   • Give warm clear fluids to drink. Examples are apple juice and lemonade.
   • Age under 3 months. Don't use warm fluids.
   • Age 3 - 12 months of age. Give 1 ounce (30 mL) each time. Limit to 4 times per day.
   • Age over 1 year of age. Give as much warm fluids as needed.
   • Reason: Both relax the airway and loosen up any phlegm.
8. Fluids - Offer More:
   • Try to get your child to drink lots of fluids.
   • Goal: Keep your child well hydrated.
   • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
9. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
10. Sleep Close By to Your Child:
    • Sleep in the same room with your child for a few nights.
    • Reason: Stridor can start all of a sudden at night.
11. Avoid Tobacco Smoke:
    • Tobacco smoke makes croup much worse.
12. Return to School:
    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of croup and colds cannot be prevented.
13. What to Expect:
    • Most often, croup lasts 5 to 6 days and becomes worse at night.
    • The croupy cough can last up to 2 weeks.
14. Call Your Doctor If:
    • Trouble breathing occurs
    • Stridor (harsh raspy sound) occurs
    • Croupy cough lasts more than 14 days
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Crying Baby - Before 3 Months Old

Causes of Unexplained Crying

• Hungry Baby. The most common reason babies cry is because they are hungry. They stop crying at the onset of feeding. By the end of the feeding, they are happy.
• Sleepy Baby. The second reason babies cry is they need sleep. They need their parent to put them in a comfortable position. It may be swaddled and on their back. Then they fuss a little and fall asleep.
• Fed Too Much. Some babies cry because of a bloated stomach from overfeeding. Unlike gas, too much milk can cause discomfort that lasts a short time.
• Caffeine. Caffeine is a stimulant that can cause increased crying and trouble falling asleep. Breastfeeding mothers need to limit their caffeine intake.
• Clothing. Being too hot or too cold can make a baby cry. So can clothing that is too tight.
• Dirty Diaper. Stool is very irritating to the skin. If not cleaned off, it can cause pain and burning.
• Colic. Colic is the main cause of recurrent crying during the early months. All babies have some normal fussy crying every day. When this occurs over 3 hours per day, it's called colic. When they are not crying, they are happy.
• Pain (Serious). Painful causes include an earache, mouth ulcers, or a raw diaper rash. An ulcer on tip of penis may also cause pain and crying. These babies cry a lot and are not happy when they are not crying. They need to see a doctor to make a diagnosis. Fever in this age group is serious until proven otherwise. Shaken baby syndrome is a concern.

Myths About Causes of Crying

• Not Due to Gas. Gas passing through normal intestines does not cause pain or crying. All crying babies pass lots of gas. Their stomachs also make lots of gassy noises. The gas comes from swallowed air. The gas is normal. It does not become trapped nor cause any pains. That's why burping a baby doesn't help the crying. Blaming gas is a myth.

Definition of Colic

• A lot of crying once or twice per day
• Usually consolable when held and comforted
• Acts normal (happy, contented) between bouts of crying
• The baby is getting enough to eat and is not hungry
• The baby is not sick
• Onset most often before 2 weeks of age
• Usually goes away by 3 months of age (sometimes up to 4 months)

When to Call for Crying Baby - Before 3 Months Old

Care Advice for Normal Crying or Colic

1. What You Should Know About Crying:
   • Normal Crying: All babies cry when they are hungry. Also, the normal baby has 1 to 2 hours of unexplained crying each day. It is scattered throughout the day. As long as they are happy and content when they are not crying, this is normal.
   • Colic: Some babies are very hard to comfort. Some babies also cry a lot (over 3 hours per day). If growing normally and have a normal medical exam, the crying is called colic. Remind yourself that colic is due to your baby's temperament. It has nothing to do with your parenting or any medical disease.
   • Here is some care advice that should help both types of crying.
2. Feedings:
   • For formula-fed babies, feed if more than 2 hours since the last feeding. For breast-fed babies, feed if more than 1½ hours since the last feeding.
   • Be careful not to feed your baby every time she cries. Some babies cry because of a bloated stomach from overfeeding. Let your baby decide when she's had enough milk. (For example, she turns her head away.) Don't encourage your baby to finish what's in the bottle.
   • Caffeine. If breastfeeding, decrease your caffeine intake. Limit your coffee, tea and energy drinks to 2 servings per day. That's 2 cups or 16 ounces (480 mL).
     
3. Hold and Comfort for Crying:
   • Hold and try to calm your baby whenever he cries without a reason. Hold your baby flat to help them relax and go to sleep.
   • Rock your child in a rocking chair, in a cradle or while standing. Many babies calm best with rapid tiny movements like vibrations.
   • Place in a windup swing or vibrating chair.
   • Take for a stroller ride, outdoors or indoors.
   • Do anything else you think may be comforting. Examples are using a pacifier, massage, or warm bath.
4. Swaddle your Baby in a Blanket for Crying:
   • Swaddling is the most helpful technique for calming crying babies. It also keeps your baby from waking up with a startle reflex.
   • Use a big square blanket and the "burrito-wrap" technique:
   • Step 1: Have the arms inside and straight at the sides.
   • Step 2: Pull the left side of the blanket over the upper body and tuck.
   • Step 3: Fold the bottom up with the knees a little flexed. Safe swaddling keeps the legs in a straddle position.
   • Step 4: Pull the right side over the upper body and tuck.
   • Caution: Don't cover your baby's head or overheat your baby.
   • Caution: Stop swaddling when your baby shows signs of rolling over. Age limit: 4 months.
   • Read the book (or view the DVD),"The Happiest Baby on the Block". Both products are authored by Dr. Harvey Karp. It is the best resource on how to calm fussy babies.
5. White Noise for Crying:
   • Swaddling works even better when paired with a low-pitched white noise. Examples are a CD, vacuum cleaner, fan or other constant sound.
   • Caution: Avoid making white noise too loud. Reason: risk of hearing damage.
   • Keep the white noise on any time your baby is crying.
   • When your baby is awake and not crying, keep your baby unwrapped. Turn off the white noise. Reason: So she can get used to the normal sounds of your home. (For details, view Dr. Karp's DVD.)
6. Falling Asleep on their Own:
   • Often babies cry because they need to sleep. If over 2 hours have passed since the last nap, this probably is the reason.
   • You have tried different ways to comfort your baby. You fed him recently. Nothing you do seems to help your baby relax. So, now, it's time to get out of the way.
   • Swaddle your baby. Place him on his back in his crib. Turn on some white noise or soothing music. Then, leave the room.
   • Let your baby fuss until he falls asleep.
   • For some overtired babies, this is the only answer.
7. Encourage Nighttime Sleep (Rather Than Daytime Sleep):
   • Try to keep your child from sleeping too much during the daytime.
   • If your baby has napped 2 hours or longer, gently wake him up. Play with or feed your baby, depending on his needs. This will lessen the amount of time your baby is awake at night.
8. Warning: Never Shake a Baby
   • It can cause bleeding on the brain. Severe brain damage can happen in a few seconds.
   • Never leave your baby with someone who is immature or has a bad temper.
   • If you are frustrated, put your baby down in a safe place.
   • Call or ask a friend or relative for help.
   • Take a break until you calm down.
9. What to Expect:
   • The right technique should start to reduce the crying. You may have to try several things before finding the best method.
   • The crying should start to decrease to about 1 hour per day.
   • Colic gets better after 2 months of age. Most often, it is gone by 3 months.
10. Call Your Doctor If:
    • Your baby starts to look or act abnormal
    • Cries nonstop for more than 2 hours
    • Your child can't be consoled using this advice
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Crying Child - 3 Months and Older

Causes of Unexplained Crying

• New Illness. Coming down with an illness is the main physical cause. Young children cry about being sick, even if they don't have any pain.
• Physical Pain. Painful causes include earache, sore throat, mouth ulcers, or a raw diaper rash. A sore on the penis or constipation may also cause pain or crying.
• Behavioral Causes. Most crying means the child is upset about something. Crying can occur when a young child is separated from his parents. Other examples are crying with tantrums or when overtired. This guide detects many babies with sleep problems. Crying always occurs during re-training programs for bad sleep habits. Some preverbal children cry any time they want something.
• Hunger. After the early months, most parents can recognize hunger and feed their child. If they don't, the child may cry.
• Cold Medicines. Drugs like Sudafed can also cause crying. Note: FDA does not advise cough and cold medicines for children under 4 years.

Myths About Causes of Crying

• Not Due to Teething. Teething may cause some babies to be fussy. But, in general, it does not cause crying.
• Not Due to Gas. Gas passing through normal intestines does not cause pain or crying.
  

When to Call for Crying Child - 3 Months and Older

Care Advice

Mild Fussiness of Unknown Cause

1. What You Should Know:
   • Your child is crying and fussing more than normal. But, if acting normal when not crying, the cause is probably not serious.
   • He could be coming down with an illness. Most often, that will become clear in a day or so.
   • He could be reacting to some changes in your home or child care setting. See if you can come up with some ideas.
   • At times, children can also go through a "clingy phase" without a reason.
   • If the crying stops with comforting, it's not serious.
   • Here is some care advice that should help.
2. Comfort Your Child:
   • Try to comfort your child by holding, rocking, or massage.
   • Talk in a quiet, calm voice.
3. Undress Your Child- Check the Skin:
   • Sometimes, part of the clothing is too tight. Loosen it.
   • Also, check the skin for redness or swelling (such as an insect bite).
4. Stop Any Over-the-Counter Medicines:
   • If your child is taking a cough or cold med, stop it.
   • The crying should stop within 4 hours.
   • Allergy meds like Benadryl can cause screaming in a small number of children. Also, may cause some children to be more fussy than normal.
   • Drugs that lessen congestion like Sudafed can cause crying.
   • The FDA does not approve any of these drugs for children under 4 years old.
5. Sleep - Take a Nap:
   • If your child is tired, put him to bed.
   • If he needs to be held, hold him quietly in your arms. Sometimes, lying next to him will comfort him.
   • Some overtired infants need to fuss themselves to sleep.
6. Warning: Never Shake a Baby
   • It can cause bleeding on the brain. Severe brain damage can happen in a few seconds.
   • Never leave your baby with someone who is immature or has a bad temper.
   • If you are frustrated, put your baby down in a safe place.
   • Call or ask a friend or relative for help.
   • Take a break until you calm down.
7. What To Expect:
   • Most fussiness with illnesses goes away when the illness does.
   • Fussiness may be due to family stress or change (such as new child care). Fussiness due to this cause lasts less than 1 week.
8. Call Your Doctor If:
   • Nonstop crying lasts more than 2 hours
   • Crying with an illness gets worse
   • Mild crying lasts more than 2 days
   • You think your child needs to be seen
   • Your child becomes worse

Normal Protest Crying

1. What You Should Know:
   • Normal children cry when they don't get their way.
   • Normal children cry when you make changes in their routines.
   • Crying is how young children communicate in the first years of life.
   • Crying can mean, "I don't want to."
   • This is called normal protest crying and is not harmful.
   • Do not assume that crying means pain.
2. Call Your Doctor If:
   • Crying becomes worse
   • Your child does not improve with this advice
   • You have other questions or concerns

Temper Tantrum Crying

1. What You Should Know:
   • Crying is the most common symptom of a temper tantrum.
   • Temper tantrums occur when your child is angry or trying to get his way.
   • This is likely the cause of the crying if it occurs at these times.
   • All kids have some temper tantrums, starting at about 9 months of age.
2. Tips for Dealing with Temper Tantrums:
   • Ignore most tantrums (such as wanting something the child doesn't need).
   • Don't give your child an audience. Leave the room.
   • For tantrums from frustration (such as when something doesn't work), help your child.
   • For tantrums that involve hitting or throwing objects, put in timeout. Leave your child there until he calms down.
   • Don't give in to tantrums. No means No.
   • Be a good role model. Do not yell or scream at others (adult tantrums).
3. Call Your Doctor If:
   • Crying becomes worse
   • Your child does not improve with this advice
   • You have other questions or concerns

Sleep Problem Crying

1. What You Should Know:
   • Sleep problems can cause crying. Suspect this if most of your child's crying occurs in his crib or bed. The crying mainly occurs when you put him down for naps and at night. Also, suspect a sleep problem if your child acts normal during the daytime.
   • Sleep problems are common in childhood.
2. Tips for Treating the Sleep Problem:
   • Re-train your child to be a good sleeper at bedtime and naptime.
   • Place your child in the crib "sleepy but awake."
   • Once placed in the crib, don't take your child out again.
   • If needed, visit your child every 10 minutes or so until asleep.
   • For waking at night, it's fine to hold your child until calm.
   • Do all of this in a loving way with a calm voice.
   • Never feed until asleep. Always stop before asleep.
   • Never sleep in the same bed with your child.
3. Call Your Doctor If:
   • Crying becomes worse
   • Your child does not improve with this advice
   • You have other questions or concerns

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Cut, Scrape, or Bruise

Types of Skin Injury

• Cuts, lacerations, gashes and tears. These are wounds that go through the skin to the fat tissue. Caused by a sharp object.
• Scrapes, abrasions, scratches and floor burns. These are surface wounds that don't go all the way through the skin. Scrapes are common on the knees, elbows and palms.
• Bruises. These are bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.

When Sutures (Stitches) are Needed for Cuts

• Any cut that is split open or gaping needs sutures.
• Cuts longer than ½ inch (12 mm) usually need sutures.
• On the face, cuts longer than ¼ inch (6 mm) usually need to be seen. They usually need closure with sutures or skin glue.
• Any open wound that may need sutures should be seen as soon as possible. Ideally, they should be checked and closed within 6 hours. Reason: to prevent wound infections. There is no cutoff, however, for treating open wounds.

Cuts Versus Scratches: Helping You Decide

• The skin is about 1/8 inch (3 mm) thick.
• A cut (laceration) goes through it.
• A scratch or scrape (wide scratch) doesn't go through the skin.
• Cuts that gape open at rest or with movement need stitches to prevent scarring.
• Scrapes and scratches never need stitches, no matter how long they are.
• So this distinction is important.

When to Call for Cut, Scrape, or Bruise

Care Advice for Minor Cuts, Scrapes or Bruises

1. Cuts, Scratches and Scrapes - Treatment:
   • Use direct pressure to stop any bleeding. Do this for 10 minutes or until the bleeding stops.
   • Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
   • Caution: Never soak a wound that might need sutures. Reason: It may become more swollen and harder to close.
   • Gently scrub out any dirt with a washcloth.
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage (such as Band-Aid). Change daily.
2. Liquid Skin Bandage for Minor Cuts and Scrapes:
   • Liquid skin bandage seals wounds with a plastic coating. It lasts up to 1 week.
   • Liquid skin bandage has several benefits compared to other bandages (such as Band-Aid). Liquid bandage only needs to be put on once. It seals the wound and may promote faster healing and lower infection rates. Also, it's water-proof.
   • Wash and dry the wound first. Then, put on the liquid. It comes with a brush or swab. It dries in less than a minute.
   • You can get this product at a drugstore near you. There are many brands of liquid bandage. No prescription is needed.
3. Bruises - Treatment:
   • Use a cold pack or ice bag wrapped in a wet cloth. Put it on the bruise once for 20 minutes. This will help to stop the bleeding.
   • After 48 hours, use a warm wet wash cloth. Do this for 10 minutes 3 times per day. This helps to reabsorb the blood.
4. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
5. Tetanus Shot:
   • A tetanus shot update may be needed for cuts and other open wounds.
   • Check your vaccine records to see when your child got the last one.
   • For Dirty Cuts and Scrapes. If last tetanus shot was given over 5 years ago, need a booster.
   • For Clean Cuts. If last tetanus shot was given over 10 years ago, need a booster.
   • See your child's doctor for a booster during regular office hours. It's safe to give it within 3 days or less.
6. What to Expect:
   • Small cuts and scrapes heal up in less than a week.
7. Call Your Doctor If:
   • Bleeding does not stop after using direct pressure to the cut
   • Starts to look infected (pus, redness)
   • Doesn't heal by 10 days
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Diaper Rash

Causes of Diaper Rash

• Irritant Diaper Rash. Mild rashes can be caused by the drying effect of soaps.
• Stool Diaper Rash. Stool left on the skin can be very irritating because it contains bacteria. Urine alone has no germs in it and usually doesn't irritate the skin. This rash is common on the scrotum or anywhere that stool can hide. Small ulcers around the anus are often from prolonged stool contact.
• Ammonia Diaper Rash. Stool and urine left in diaper too long can combine to make ammonia. It can cause a mild chemical burn. The fumes when you change the diaper will smell like ammonia. This is more common with cloth diapers.
• Diarrhea Diaper Rash. Rashes just found around the anus are common during bouts of diarrhea. Diarrhea stools also contain enzymes that digest food and irritate the skin.
• Yeast Diaper Rash. Rashes from irritants can get a secondary infection with yeast. Yeast infections are bright red. They can be raw and weepy. The borders are sharp. Small red bumps or even pimples may occur just beyond the border. If treated correctly, a diaper rash should be cured in 3 days. If not, it has probably been invaded by yeast. Treat with an anti-yeast cream.
• Bacterial Diaper Rash. Bacteria can also cause a secondary infection of irritated skin. This is less common than yeast rashes. Bacteria cause sores, yellow scabs, pimples or draining pus. They look like impetigo, a local skin bacterial infection. Can also become a painful red lump (boil)
• Cellulitis (Serious). The bacterial infection spreads into the skin. Gives redness that spreads out from the sore. The red area is painful to the touch.
• Staph Scalded Skin Syndrome (Serious). SSSS is caused by a Staph bacteria. The main finding is widespread large blisters. The skin is bright red. The baby acts very sick.

Symptoms of Diaper Rash

• Mild rashes just have areas of pink, dry skin.
• Severe rashes have areas of red skin. In some areas, the skin may become raw or even bleed.
• Pink rashes are not painful, but raw ones can be very painful. This can lead crying and poor sleep.

Prevention of Recurrent Diaper Rash

• Change diapers more often. Focus on preventing skin contact with stool.
• Rinse your baby's skin with lots of warm water when cleaning off stool. Don't depend on diaper wipes alone to cleanse the skin.
• Be sure to clean stool off all the skin folds. Cleaning the scrotum can be a challenge.

When to Call for Diaper Rash

Care Advice for Diaper Rash

1. What You Should Know About Diaper Rashes:
   • Diaper rashes are very common in babies.
   • Often caused by not cleaning stool off the skin soon enough.
   • Stool is a strong irritant to the skin.
   • Here's some care advice that should help.
2. Change More Often:
   • Change diapers more often to prevent skin contact with stool.
   • You may want to get up once during the night to change the diaper.
3. Rinse with Warm Water:
   • Rinse the baby's skin with lots of warm water during each diaper change.
   • Wash with a mild soap (such as Dove) only after stools. Reason: Using soap often can interfere with healing.
   • Do not use diaper wipes. Reason: They leave a film of bacteria on the skin.
4. Leave Bottom Open to Air:
   • Expose the bottom to air as much as possible.
   • Attach the diaper loosely at the waist to help with air exposure.
   • When napping, take the diaper off and lay your child on a towel. Reason: Dryness reduces the risk of yeast infections.
5. Anti-Yeast Cream:
   • Most diaper rashes respond to 3 days of warm water cleansing and air exposure. If you've tried this or the rash is bright red, suspect a yeast infection.
   • Buy an anti-yeast cream (such as Lotrimin.) No prescription is needed.
   • Use this cream 3 times per day.
6. Raw Skin - Treatment:
   • If the bottom is very raw, soak in warm water for 10 minutes. Add 2 tablespoons (30 mL) of baking soda to the tub of warm water.
   • Do this 3 times per day.
   • Then, put an anti-yeast ointment (such as Lotrimin) on the rash.
7. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil). Avoid ibuprofen under 6 months of age.
   • Use as needed.
   • Age less than 3 months. Don't use pain medicines unless your doctor says it's okay. Have your child seen if the rash is causing a lot of pain.
8. Sore or Scab on End of the Penis Treatment:
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Do this 3 times per day.
   • Reason: The sore is a bacterial infection that can cause painful urination.
9. Diarrhea Rash - Use Protective Ointment:
   • If your child has diarrhea and a rash around the anus, use a protective ointment. Examples are Vaseline or Desitin.
   • This forms a barrier between the skin and the stool.
   • Otherwise, these generally are not needed.
   • Caution: Wash off the skin before putting it on.
10. What to Expect:
    • With proper treatment, most diaper rashes are better in 3 days.
    • If the rash does not respond, a yeast infection has probably occurred.
11. Call Your Doctor If:
    • Rash isn't much better after 3 days of using yeast cream
    • It starts to look infected (with sores and scabs)
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Diarrhea

Causes of Acute Diarrhea

• Virus (such as Rotavirus). An infection of the intestines from a virus is the most common cause.
• Bacteria (such as Salmonella). Less common cause. Diarrhea often contains streaks of blood.
• Food Poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
• Giardia (a parasite). More likely in child care center outbreaks.
• Traveler's Diarrhea. Caused by germs in food or drink. Suspect this if it follows recent foreign travel.
• Serious Causes. Most bacterial diarrhea goes away on its own. A few can cause a severe large bowel infection (such as Shigella colitis). C. difficile is a serious cause that can occur after being on strong antibiotics.
• Serious Complication: Dehydration. This is the health problem where the body has lost too much fluid. (See below for more on this).

Causes of Recurrent Diarrhea

• Cow's Milk Allergy. Can cause loose, slimy stools in babies. Can be blood-streaked. Starts within the first 2 months of life. Need to avoid cow's milk formulas.
• Toddler's Diarrhea. Toddlers who pass 3 to 6 sloppy stools per day. Stools may run out of the diaper. Symptoms begin at age 1. Symptoms resolve at age 3 or 4, after toilet trained. Harmless and no impact on growth. Fruit juice makes it worse. The cause is rapid transit time from stomach to anus. May develop irritable bowel syndrome (IBS) in adult years.
• Lactose Intolerance. Lactose is the sugar in milk. Many people cannot absorb lactose. The gut bacteria convert the lactose to gas. The main symptoms are a lot of gas, loose stools and stomach bloating. Onset usually at age 4 or 5. This most often runs in the family (genetic).

Diarrhea Scale

• Mild: 2-5 watery stools per day
• Moderate: 6-9 watery stools per day
• Severe: 10 or more watery stools per day
• The main risk of diarrhea is dehydration.
• Loose or runny stools do not cause dehydration.
• Frequent, watery stools can cause dehydration.

Dehydration: How to Know

• Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. A weight loss of more than 3% is needed. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.
• Dehydration is the most important problem caused by diarrhea. Dehydration is a reason to see your doctor right away.
• These are signs of dehydration:
• Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.
• Dry tongue and inside of the mouth. Dry lips are not helpful.
• Dry eyes with decreased or absent tears
• In babies, a depressed or sunken soft spot
• Slow blood refill test: longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
• Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
• A child with severe dehydration becomes too weak to stand. They can also be very dizzy when trying to stand.

Diarrhea in Breastfed Babies: How to Tell

• Diarrhea in a breastfed baby is sometimes hard to tell.
• Normal breastfed stools are loose (often runny and seedy). Stools are yellow, but sometimes can be green. The green color is from bile. Runny stools can even be bordered by a water ring. These are all normal stools.
• Breastfed babies often pass more than 6 stools per day. Until 2 months of age, they may pass a stool after each feeding. But, if stools suddenly increase in number and looseness, suspect diarrhea. If it lasts for 3 or more stools, the baby has diarrhea.
• If the stools contain mucus, blood or smell bad, this points to diarrhea.
• Other clues to diarrhea are poor eating, acting sick, or a fever.

Diarrhea in Formula-Fed Infants: How to Tell

• Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.
• The stools are yellow in color and thick like peanut butter.
• Suspect diarrhea if the stools suddenly increase in number or looseness. If it lasts for 3 or more stools, the baby has diarrhea.
• If the stools contain mucus, blood, or smells bad, this points to diarrhea.
• Other clues to diarrhea are poor eating, acting sick or a fever.
• After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They no longer appear to have mild diarrhea.

When to Call for Diarrhea

Care Advice for Diarrhea

Treatment for Mild Diarrhea

1. What You Should Know About Diarrhea:
   • Most diarrhea is caused by a virus.
   • Bacterial infections as a cause of diarrhea are not common.
   • Diarrhea is the body's way of getting rid of the germs.
   • The main risk of diarrhea is dehydration. Dehydration means the body has lost too much fluid.
   • Most children with diarrhea don't need to see their doctor.
   • Here are some tips on how to keep ahead of the fluid losses.
2. Mild Diarrhea:
   • Most kids with diarrhea can eat a normal diet.
   • Drink more fluids to prevent dehydration. Formula, breastmilk and/or regular milk are good choices for diarrhea.
   • Do not use fruit juices or full-strength sports drinks. Reason: they can make diarrhea worse.
   • Solid foods: eat more starchy foods (such as cereal, crackers, rice, pasta). Reason: they are easy to digest.
3. Formula-Fed Babies with Frequent, Watery Diarrhea:
   • Keep giving formula but feed more often. Offer as much formula as your child will take.
   • Mix formula the normal way. Reason: The formula contains plenty of water and doesn't need more.
   • Solid foods: If on baby foods, continue them. Cereals are best.
4. Breastfed Babies with Frequent, Watery Diarrhea:
   • Give your baby breastmilk more often.
   • Also, give extra fluid if breast milk isn't keeping up with the fluid losses. You can use formula or ORS (Pedialyte).
   • Solid foods: If on baby foods, continue them. Cereals are best.
5. Older Children (age more than 1 year old) with Frequent, Watery Diarrhea:
   • Offer as much fluid as your child will drink. If also eating solid foods, water is fine. So is half-strength Gatorade or half-strength apple juice.
   • If won't eat solid foods, give milk or formula as the fluid.
   • Caution: do not use most fruit juices, full-strength sports drinks or soft drinks. Reason: they can make diarrhea worse.
   • Solid foods: Starchy foods are easy to digest and best. Offer cereals, bread, crackers, rice, pasta or mashed potatoes. Pretzels or salty crackers will help add some salt to meals. Some salt is good.
6. Oral Rehydration Solutions (ORS), such as Pedialyte:
   • ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand. It can be bought in food stores or drug stores.
   • When to use: Start ORS for frequent, watery diarrhea if you think your child is getting dehydrated. That means passing less urine than normal. Increase fluids using ORS. Continue giving breastmilk, formula or regular milk.
   • Amount: For babies, give 2-4 ounces (60-120 mL) of ORS after every large watery stool.
   • For children over 1 year old, give 4-8 ounces (120-240 mL) of ORS after every large watery stool. Children rarely need ORS after age 3.
   • Caution: Do not give ORS as the only fluid for more than 6 hours. Reason: Your child will need calories and cry in hunger.
7. Probiotics:
   • Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the gut (stomach).
   • Age over 12 months old: Yogurt is the easiest source of probiotics. Give 2 to 6 ounces (60 to 180 mL) of yogurt. Do this twice daily. (Note: Today, almost all yogurts are "active culture".)
   • Probiotic supplements can also be bought in health food stores.
8. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
9. Diaper Rash - Prevention:
   • Wash buttocks after each stool to prevent a bad diaper rash.
   • To protect the skin, use an ointment (such as Vaseline or Desitin). Put it on the skin around the anus.
10. Return to School:
    • Your child can go back to school after the stools are formed.
    • The fever should also be gone.
    • The older child can go back if the diarrhea is mild.
    • The toilet trained child also needs to have good control over loose stools.
11. What to Expect:
    • Viral diarrhea lasts 5-14 days.
    • Severe diarrhea only occurs on the first 1 or 2 days. But, loose stools can last for 1 to 2 weeks.
12. Call Your Doctor If:
    • Blood in the diarrhea
    • Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
    • Diarrhea lasts over 2 weeks
    • You think your child needs to be seen
    • Your child becomes worse

Preventing Diarrhea Disease

1. Safety Tips in All Countries:
   • Hand washing is the key to preventing the spread of infections.
   • Always wash the hands before eating, feeding or handling young children or cooking.
   • Always wash the hands after any contact with vomit or stools.
   • Wash the hands after using the toilet or changing diapers. Help young children wash their hands after using the toilet.
   • Cook all poultry fully. Never serve chicken that is still pink inside. Reason: Undercooked poultry is a common cause of diarrhea in developed countries.
2. Extra Safety Tips in Developing Countries:
   • Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
   • Eat foods that have been fully cooked and that are still hot.
   • Dry foods such as bread are usually safe.
   • Avoid salads and raw vegetables. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
   • Avoid all undercooked meat and fish.
   • Avoid buying foods and drinks from street vendors. Reason: This is a common cause of traveler's diarrhea.
   • Formula for babies: Breastfeed if possible. If not, use premixed formula. If you prepare your own, mix the formula with bottled or boiled water.
   • Feeding babies: Wash bottles, nipples, spoons and dishes with soap and water. Then sterilize them in boiling water for 5 minutes if possible.
   • Brush your teeth with bottled or boiled water.
3. Call Your Doctor If:
   • You have other questions or concerns

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Diarrhea Diseases From Travel

How Tropical Diarrhea Diseases are Detected by this Symptom Checker

• These diseases can't be diagnosed over the phone. But, they can be suspected based on their symptoms. They are then referred to a medical setting where a diagnosis can be made.
• Cholera will be picked up by the Diarrhea or Vomiting guides. Diarrhea that lasts too long or is severe will refer the child to be seen. Dehydration is a health problem where the body has lost too much fluid. It can be a result of diarrhea and/or vomiting. This will also be picked up in these guides.
• Typhoid will be picked up by the Diarrhea guide. Diarrhea that lasts too long or is severe will refer the child to be seen. Bloody stools or fever lasting too long also refer the child to be seen.
• Traveler's diarrhea will be picked up by the Diarrhea or Vomiting guides. Diarrhea that lasts too long or is severe will refer the child to be seen. Dehydration will also refer the child to be seen.
• Travel to a high risk country should raise the concern. However, common diseases such as viral diarrhea also must be ruled out. They occur more commonly in these countries than the serious diseases. But, severe symptoms or symptoms that last too long make us think about these other diseases.

World-wide Causes of Death in Children Under Age 5

• 6.3 million children under the age of 5 died in 2013 worldwide.
• These 5 infections account for over 50% of all early child deaths:
  1. Pneumonia and other respiratory diseases 19%
  2. Diarrhea disease 18%
  3. Malaria 8%
  4. Measles 4%
  5. HIV/AIDS 3%
• Poor nutrition is a factor in over half who die older than one month of age.
• Over 80% of deaths occur in Africa and Southern Asia. India accounts for 21% of under-five deaths.
• More than half are due to diseases that we could prevent or treat.
• Resource: WHO report, September 2014

Tropical Countries

• Countries in the tropics are near the Equator. They have hot and humid climates.
• The tropics are also defined as regions without a cold season.
• Many diseases in these countries are spread by an insect bite.
• In the tropics, insects never hibernate. They are present in large numbers year round.
• Other diseases here are spread by germs that multiply in warm water. The water in the tropics usually stays warm.
• Tropical diseases occur in people who live in or travel to high-risk countries.
• Climate change is a factor that has allowed these diseases to spread.

When to Call for Diarrhea Diseases From Travel

Care Advice

Cholera Questions

1. What You Should Know About Cholera:
   • It is a severe diarrhea disease caused by a bacteria.
   • World Impact: There are over 4 million new cases per year. It causes over 100,000 deaths per year.
2. Symptoms:
   • Mild to severe diarrhea. About 5% develop severe watery diarrhea.
   • Without treatment, it can progress to severe dehydration and shock within 12 hours.
   • Other symptoms are vomiting, leg cramps and fever.
3. Cause:
   • Cholera is caused by the Vibrio cholera bacteria found in stool.
   • You get sick by swallowing food or drink made dirty with germs from stools.
4. Time Period to Get Sick:
   • The time from contact to symptoms is 1-5 days.
5. Contagious Period:
   • The disease can be spread to others for 1-2 weeks if not treated with antibiotics.
6. Tests and Treatment:
   • Stool tests are needed to diagnose it.
   • It is treated with special electrolyte fluids by mouth or IV fluids. These fluids are life-saving.
   • Antibiotics may also be helpful.
7. What to Expect:
   • Good outcome if diarrhea losses are replaced promptly with fluid.
8. How to Prevent:
   • Vaccine: New cholera vaccines taken by mouth are very protective.
   • Good hand washing.
   • Avoid unsafe food and drink.
   • Drink only bottled or boiled water.
   • Eat only well-cooked food.
9. Countries with Cholera:
   • It is seen in Africa and other tropical countries.
   • Rarely is seen in US in Florida and other Gulf states. Cause in US: Shellfish that isn't cooked fully.
   • For more info and current high-risk countries, see the CDC website: Cholera.
10. Call Your Doctor If:
    • You have other questions or concerns

Typhoid Fever Questions

1. What You Should Know About Typhoid Fever:
   • It is a severe diarrhea disease caused by a bacteria.
   • World Impact: There are 20 million new cases each year. It causes over 200,000 deaths each year.
2. Symptoms:
   • Starts with fever, stomach pain and diarrhea.
   • The fever lasts for weeks.
   • The diarrhea worsens and can become bloody.
   • Feeling tired, weakness and loss of appetite are common.
   • A rash of small rose-colored spots may occur on the chest and stomach.
3. Cause:
   • Typhoid is caused by the Salmonella typhi bacteria found in stool.
   • You get sick by swallowing food or drink made dirty with germs from stools.
4. Time Period to Get Sick:
   • The time from contact to symptoms is 6 to 30 days.
5. Contagious Period:
   • Can be prolonged if not treated with antibiotics.
   • Even those who are treated can become carriers.
6. Tests and Treatment:
   • Stool tests and blood tests are needed to diagnose it.
   • It is treated with special electrolyte fluids by mouth or IV fluids.
   • Antibiotics are given to kill the bacteria.
7. What to Expect:
   • With treatment, symptoms improve in 2 to 4 weeks.
   • Without treatment, the symptoms may last for months.
   • The disease may come back after treatment.
8. How to Prevent:
   • Vaccine: There is a typhoid vaccine.
   • Use good hand washing.
   • Avoid unsafe food and drink.
   • Drink only bottled or boiled water.
   • Eat only well-cooked food.
9. Countries with Typhoid:
   • It is common in Africa, Asia and Latin America.
   • It does occur in the US in low numbers. Mainly in travelers coming back to the US.
   • For more info and current high risk countries, see the CDC website.
   • Resource: Typhoid Travel Alert.
10. Call Your Doctor If:
    • You have other questions or concerns

Traveler's Diarrhea (TD) Questions

1. What You Should Know About Traveler's Diarrhea (TD):
   • It is a disease seen in travelers to developing countries in the tropics.
   • World Impact: In high-risk countries, TD affects up to 40% of travelers. There are about 20 million new cases each year. Mainly, it disrupts vacations. About 30% of people can't pursue planned activities. Deaths are very rare.
2. Symptoms:
   • Sudden onset of loose stools, twice or more the normal number.
   • Nausea is often present, but only 20% have vomiting.
   • May also include stomach cramps and an urgent need to pass a stool.
   • Fever occurs in 10%.
   • Blood in the stools occurs in 5% of cases. This means the infection has become more severe.
3. Cause:
   • Caused by germs from stools present in the water, food or drinks.
   • Over 80% is caused by E. coli bacteria. These bacteria are not harmful ones. But, they are new to the traveler's body and gut.
   • Sometimes, more serious bacteria such as Shigella are the cause.
   • Parasites cause 5-10%. Diarrhea from parasites has a more gradual onset.
4. Time Period to Get Sick:
   • The time from contact to symptoms is 1-3 days for bacteria.
   • Diarrhea from parasites takes 2-4 weeks to start.
5. Contagious Period:
   • TD can be passed to others until the stools are formed.
6. Tests and Treatment:
   • Most often, the diagnosis is based upon symptoms and recent travel history. Lab tests are not needed.
   • If the stools become bloody, stool tests may be done. If it lasts more than 2 weeks, parasite tests may be done.
   • It is treated with special electrolyte fluids by mouth. Less than 1% of people need IV fluids.
   • Probiotics (such as yogurt) may also be helpful.
   • Antibiotics are sometimes given to kill the bacteria. They are mainly used if fever, bloody stools, severe diarrhea or stomach cramps occur.
7. What to Expect:
   • TD is a self-limited illness.
   • Most people that aren't treated have diarrhea that lasts 3 to 5 days.
   • About 5% develop blood in the stools.
   • It is more severe and lasts longer in young children.
8. How to Prevent:
   • Wash Hands: Use good hand washing.
   • Diet: Avoid unsafe food and drink. Drink only bottled or boiled water. Eat only well-cooked food.
   • Medicines: In some cases, Pepto-Bismol 4 times a day is advised. Antibiotics to prevent TD are not advised for healthy people. Check with your doctor before you travel out of the country.
   • Vaccine: There is no vaccine for TD.
9. Countries at Risk:
   • High-risk countries are in Latin America, Africa and Southern Asia. About 40% of travelers there get diarrhea.
   • Moderate-risk countries are in Southern Europe, Middle East, China and Russia. About 15% of travelers will get it.
   • Low-risk countries are the US, Western Europe, Canada and Japan.
   • For more info and for current high risk countries, see the CDC website: Travelers' Diarrhea.
10. Call Your Doctor If:
    • You have other questions or concerns

Diarrhea Disease: How to Prevent

1. Safety Tips in All Countries:
   • Hand washing is the key to prevent the spread of infections.
   • Always wash the hands before eating, feeding or handling young children or cooking.
   • Always wash the hands after any contact with vomit or stools.
   • Wash the hands after using the toilet or changing diapers. Help young children wash their hands after using the toilet.
   • Cook all poultry fully. Never serve chicken that is still pink inside. Reason: Poultry that isn't cooked all the way is a common cause of diarrhea.
2. Extra Safety Tips in Developing Countries:
   • Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
   • Eat foods that have been fully cooked and that are still hot.
   • Dry foods such as bread are usually safe.
   • Avoid salads and raw veggies. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
   • Avoid all meat and fish that isn't cooked all the way.
   • Avoid buying foods and drinks from street vendors. Reason: This is a common cause of traveler's diarrhea.
   • Formula for babies: Breastfeed if possible. If not, use premixed formula. If you prepare your own, mix the formula with bottled or boiled water.
   • Feeding babies: Wash bottles, nipples, spoons and dishes with soap and water. Then sterilize them in boiling water for 5 minutes if possible.
   • Brush your teeth with bottled or boiled water.
3. Call Your Doctor If:
   • You have other questions or concerns

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Dizziness

Causes of Dizziness

• Main Cause. Usually due to reduced blood flow to the brain for a short time. It can be triggered by many normal events:
• Standing too long in one place. Reason: This causes pooling of blood in the legs.
• Standing up suddenly. Reason: This causes sudden drop in blood pressure.
• Dehydration. This can be from losing fluids and/or from not drinking enough fluid.
• Low Oxygen (such as when running and out of breath). Reason: Lower than normal oxygen levels can't meet body's needs for a short time.
• Too Much Sun or Hot Tub Use. Reason: Increased sweating causes fluid loss.
• Sweating from Sports or Hard Work. Reason: Sweating causes fluid loss.
• Fasting. Skipping a meal causes low blood sugar.
• Fever
• Motion Sickness. Main symptoms are dizziness and nausea.
• Viral Syndrome. Patients with viral illnesses (e.g., colds, flu) often say they are a bit dizzy. This is never the only symptom. It may relate to weakness from being sick.
• Vertigo (Serious). In addition to dizziness, the child complains that the room is spinning. They can't walk if they have vertigo. True vertigo is very rare in children. It's usually caused by middle ear disease.

Symptoms of Dizziness

• Feeling dizzy or light headed
• Feeling unsteady with slight loss of balance
• Feeling "woozy" or not thinking clearly
• May also have brief blurring of vision

Dizziness Scale

• Mild: walks normal
• Moderate: interferes with normal activities such as playing, school or sports
• Severe: can't stand, needs support to walk, feels like passing out now

When to Call for Dizziness

Care Advice

Dizziness from Sudden or Prolonged Standing

1. What You Should Know:
   • Standing up quickly is the most common cause of dizziness. This type of dizziness only lasts a short time. Getting out of bed is when it usually happens.
   • Prolonged standing in one place is another common cause.
   • Not drinking enough fluids or eating enough salt always makes it worse.
   • Here is some care advice that should help.
2. Standing - Pump Legs:
   • In the mornings, sit up for a few minutes before you stand up.
   • This will help your blood flow stay steady and adjust before you stand up.
   • With prolonged standing, contract and relax your leg muscles. Reason: This helps pump the blood back to the heart.
   • Sit down or lie down if you feel dizzy.
3. Salt - Increase Intake:
   • Most people with this type of dizziness (due to standing) don't get enough salt.
   • Try to eat some salty foods (potato chips or pretzels) every day.
4. Fluids - Drink More:
   • Drink several glasses of fruit juice, other clear fluids or water.
   • This will improve your child's fluid status and blood sugar.
   • If the weather is hot, make sure the fluids are cold.
5. Lie Down:
   • Lie down with feet up for 1 hour.
   • Reason: This will increase blood flow to the brain.
6. Prevention:
   • Extra water and salty foods during sports or hot weather
   • Regular mealtimes and snacks
   • Enough sleep and rest
7. What to Expect:
   • With treatment, the dizziness usually goes away in 1 to 2 hours.
8. Call Your Doctor If:
   • After 2 hours of rest and fluids, still feels dizzy
   • Your child passes out (faints)
   • You think your child needs to be seen
   • Your child becomes worse

Dizziness from Poor Fluid Intake

1. What You Should Know:
   • Not drinking enough fluids and being a little dehydrated probably caused the dizziness.
   • It should go away with drinking fluids and resting in a cool place.
   • This is always made worse during hot weather. Too much sun exposure can also increase the body's need for fluid.
   • Here is some care advice that should help.
2. Fluids - Drink More:
   • Drink several glasses of fruit juice, other clear fluids or water.
   • This will improve your child's fluid status and blood sugar.
   • If the weather is hot, make sure the fluids are cold.
3. Cool Off:
   • If the weather is hot, use a cold pack or washcloth to the forehead.
   • Taking a cool shower or bath will help even more.
4. Lie Down:
   • Lie down with feet up for 1 hour.
   • Reason: This will increase blood flow to the brain.
5. Prevention:
   • Extra water and salty foods during sports or hot weather
   • Regular mealtimes and snacks
   • Enough sleep and rest
6. What to Expect:
   • With treatment, the dizziness usually goes away in 1 to 2 hours.
7. Call Your Doctor If:
   • After 2 hours of rest and fluids, still feels dizzy
   • Your child passes out (faints)
   • You think your child needs to be seen
   • Your child becomes worse

Dizziness from Unknown Cause

1. What You Should Know:
   • Dizziness that goes away is a harmless symptom.
   • It's usually due to not drinking enough water during sports or hot weather.
   • It can also be caused by skipping a meal or too much sun.
   • Sometimes, it's part of a viral illness.
   • Here is some care advice that should help.
2. Lie Down:
   • Lie down with feet up for 1 hour.
   • Reason: This will increase blood flow to the brain.
3. Fluids - Drink More:
   • Drink several glasses of fruit juice, other clear fluids or water.
   • This will improve your child's fluid status and blood sugar.
   • If the weather is hot, make sure the fluids are cold.
4. Cool Off:
   • If the weather is hot, use a cold pack or washcloth to the forehead.
   • Taking a cool shower or bath will help even more.
5. Prevention:
   • Extra water and salty foods during sports or hot weather
   • Regular mealtimes and snacks
   • Enough sleep and rest
6. What to Expect:
   • With treatment, the dizziness usually goes away in 1 to 2 hours.
   • Mild dizziness with a viral illness may last 1 or 2 days.
7. Call Your Doctor If:
   • After 2 hours of rest and fluids, still feeling dizzy
   • Mild dizziness lasts over 3 days
   • Your child passes out (faints)
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.