Chicken Pox

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What causes chicken pox?

Chicken pox is caused by a virus called Varicella Zoster Virus.

Is it contagious (catchy)?
Yes.  Person to person spread occurs by direct contact or through contact with mouth or respiratory secretions.  The most contagious period is being in contact with a person 1-2 days prior to the rash appearing.  Chicken pox is still contagious during the first week as well. It will take about 2 weeks after contact before a rash develops.  Children can go back to day care or school after the pox has scabbed over, which is approximately one week after the onset of the rash.
What are the symptoms of chicken pox?
Usually a high fever is present along with typical rash.  The rash initially is reddish for one to two days, then later develops into fluid filled “dew drops” that scab over in several days.  Occasionally, pneumonia may also be present with symptoms of a cough.  Brain infections have also been known to occur with chicken pox, but are extremely rare.
What is the treatment for chicken pox?
The best treatment is preventing infection by receiving two doses of vaccine prior to age 6 years. The first dose is usually given at age 12 months and is followed by a booster at 4-5 years of age. If your child does come down with chicken pox contact your pediatrician within the first 24 hours and a medication may be prescribed. It can shorten the duration and intensity of symptoms. Otherwise, they key is to prevent complications.  Never give aspirin or aspirin containing products to a child with chicken pox due to the possibility of Reyes’s Syndrome.  Try to prevent your child from scratching or picking at the pox rash.  This may cause a bacterial infection and scarring.  Baking soda baths or lubricating baths with oatmeal in lukewarm water may help the itching.  Shake lotions gently applied to the pox marks may be helpful.  Acetaminophen (Tylenol) can be used for fever reduction.
When to call your child’s pediatrician?
Call your physician if any of the following symptoms occur:
·         If fever above 102 degrees Fahrenheit persists longer than 48 hours.
·         If your child is vomiting repeatedly.
·         If any “pox marks” with surrounding redness greater than the size of a quarter (approximately on inch in diameter) develop, or if any pox marks look infected.
·         If your child is lethargic, difficult to arouse or loses balance easily when walking.
·         If you are uncertain whether the rash is a chicken pox rash or if you would like your child to receive the antiviral medication.
What should I do if my new baby is exposed to chicken pox?
Normal full term infants exposed after birth to chicken pox do not have any greater risk of complications than older children. If the child’s mother is immune to chicken pox then the infant is protected for the first several months of age.
Will my child contract shingles if he never catches chicken pox?
No.  If you never get chicken pox you will never get “shingles”

Colds

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What causes colds?
Colds are caused by viruses that infect the nose, throat and sinuses.  Most children have frequent colds, especially during the first two years of life.
What are the symptoms?
The main symptom is a runny nose.  There may also be sneezing, a sore throat and dry cough.  A slight fever may be present, but it should last only 1 or 2 days.
How long does a cold last?
A cold most often lasts about 7 to 10 days.
Are colds harmful?
Although colds may cause discomfort, in most cases they do not cause major problems. The most common problems caused by colds are ear infections.
When should I call my child’s pediatrician?
Your child’s pediatrician may want to check your children if any of these occur:
·         If the cold lasts longer than 2 weeks.
·         If the fever lasts longer than 2 days or comes back after going away.
·         If the fever is over 103 degrees.
·         If your child is very fussy and very drowsy.
·         If your child has a bad cough, is wheezing or has trouble breathing.
·         If your child keep vomiting.
·         If your child pulls at his ears, complains of an earache or has any ear discharge.
Are antibiotics helpful for a cold?
No, antibiotics are not effective against viral infections.  For those children who have recurrent ear infections, antibiotics may help prevent an ear infection from occurring.
What can I do to help relieve the symptoms?
·         For a runny nose or congestion, use nasal saline (1/4 tsp. in 1 cup of water or store bought ready to use saline sprays) 3-4 times per day and use a bulb syringe.
·         For fever, headache or aching muscles use acetaminophen.
·         For congestion and coughs use a cough suppressant, antihistamine, and /or decongestant as directed by your physician.  Be careful to avoid medications that make your child more active.
·         Vaporizers may be helpful in relieving cold symptoms.  Hot air vaporizers can be dangerous because they can cause burns, so it is better to use a cool mist vaporizer.  If a cool mist ultrasonic humidifier is used, fill it with distilled water.
·         Babies under age 3 months cannot breathe well through their mouths, so it is important to keep the nose clear in this age group.  Use a bulb syringe to suction the nose every 2-3 hours or more often if needed.  If the mucous in the nose is very thick, you can loosen it with a few drops of salt water before suctioning the nose.
·         Using the bulb syringe also will take some practice.  Make sure you seal off the other nostril when using the bulb syringe and then make a tight seal around the bulb in the other nostril with your free fingers.  Place one or two drops of salt water in the nostril before using the bulb syringe.  Put some petroleum jelly just on the outer edge of the nose to prevent irritation.
·         Have your child drink extra liquids.  This will help prevent dehydration.
How are colds spread?
The cold virus is most often spread by touch rather than through the air.  Teach your child to wash her hands often and use alcohol based hand sanitizers many times throughout the day and especially when she has a cold.  The cold “germs” are spread when you touch your nose or eyes after your hands have been contaminated with a cold virus.

Croup

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What is croup?
It is an infection of the upper airway (windpipe).  The child with croup has barking cough, hoarseness, low grade fever, and some trouble breathing in (the “croupy” noise after a cough).  It often starts with a runny nose and a cold, for a day or so, before the “croup” begins.
What cause croup?
Croup is caused by a germ-a virus in this case- that goes around in the fall and early winter.  Children under 3 years are most often the ones who get croup.  Older children and adults who catch the germ end up with a cough and a cold.
How long does it last?
Your child will be sick for a week or so (5-10 days usually).  The first day or so the illness is mild with a runny nose and a little cough.  When the “croup” begins it can last for 3-5 days (the “croup” may worsen on the second day), and then gradually improves.  Like so many problems, it seems worse at night.  Sometimes, it may come on at night suddenly and be gone the next day.
Can it be cured?
Because it is caused by a virus germ, there is no antibiotic, “shot,” or other treatment that can cure it, or make it go away faster.  But if you follow some simple steps, your child will feel better. A long acting steroid called dexamethasone (Decadron) may be prescribed to decreasing the swelling that causes the barking cough.
What can I do to treat it?
Try some of these tips:
·         Humidity in the air helps.  Use either a humidifier or go into the bathroom, and turn on the shower or bath until the air gets “steamed up.”  Sometimes, if it’s not too cold outside, it helps to bundle up yourself and your child and walk in the cool night air.
·         Keep your child comfortable.  Use acetaminophen (Tylenol) every 4 hours, if needed, to take care of fever or pain.  Keep your child in a “position of comfort,” usually upright, and let him sleep in that position.  Avoid back slapping “to bring it up.”  This just makes the cost worse.
·         Encourage fluids.  Make sure your child drinks enough clear liquids or formula.  Your child’s appetite for solids is going to be less for a few days, and that’s okay if he drinks enough nourishing fluids.
·         Get enough rest yourself.  Share the “nursing” of your child with your spouse, a friend or a relative.
When should I call my child’s physician?
Call your pediatrician if the following symptoms or sins are present:
·         Trouble breathing or swallowing
·         Temperature above 102 degrees
·         Difficulty waking him
·         You suspect an ear infection
·         Excessive tiredness
·         Irritability
·         Drinking less than you’d expect
·         Excessive drooling

Gastroenteritis aka Diarrhea

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What is diarrhea?
Diarrhea means frequent, runny bowel movement. some people call it the “stomache flu”.
What causes it?
It is most cases diarrhea is mild and clears up in a few days.  Sometimes it can be more serious.
Is it serious?
In most cases diarrhea is mild and clears up in a few days.  Sometimes it can be more serious.
What are the signs that it could be serious?
·         Signs of dehydration such as sunken eyes, dry mouth, and drowsiness.
·         Vomiting that won’t stop.
·         Bloody or painful diarrhea.
·         Severe stomach pain.
·         High fever.
Remember: Call your pediatrician if your child has any of these signs!

What is the treatment?
For very mild diarrhea, no treatment is needed other than diet changes.  These changes include:
·         Stop giving milk and solid foods, especially if there is vomiting.  Give clear liquids such as:
For children under 12 months: Consider a rehydrating solution such as Pedialyte. For older children: Same as above, or use a variety of clear liquids or sports drinks.
Discuss with your child’s physician and avoid plain water or excessive fruit juices.
In most cases, clear liquids should not be used for more than 1 day.  Soy formula may be recommended instead of clear liquids.
If there is vomiting, use frequent small feeding (1-2 oz. every hour for young infants and 2-4 oz. for older children), and gradually increase as tolerated.  Children with diarrhea will tend to have a bowel movement every time they drink or eat something.  If the child is not vomiting, it may help to give larger portions at each feeding to help “slow down” the number of bowel movements.
·         After the vomiting has stopped for several hours you may give your child as many liquids as they want for 1-2 hours and then advance them to a diet high in complex carbohydrates. Be careful about giving too much fat or protein.
·         From then on, slowly start back on his regular diet over 1 to 2 days.
What about medicines for diarrhea?
In most cases diarrhea can be controlled just by changing the diet.  Medications are generally not necessary.

Ear Infections

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What is otitis media?
It is a disease caused by germs in the middle ear, which is behind the eardrum.
How does it happen?
There is a tube between the middle ear and the back of the throat called the Eustachian (you-STAY-shun) tube.  During a cold, germs can spread from the back of the throat, up the tube and into the middle ear.  The germs can multiply in the middle ear and cause an infection behind the eardrum.
Is it caused by cold air?
No, it is not caused by cold air or by not wearing a hat.  It is always caused by germs.
What are the signs and symptoms?
They include ear pain, ear rubbing or pulling, crying, pus coming out of the ear, fever, balance problems, or hearing loss.  If it is not treated promptly and correctly, the infection could cause hearing loss and a more serious infection.
What is the treatment?
·         Your child’s physician will prescribe and antibiotic.  Be sure to complete the course of treatment.  If you give less or skip too many doses, the earache may come back quickly.  You should start the medicine on the same day it is prescribed (if you can’t get to a drug store or can’t buy it. Tell your physician).
·         You can help relieve the pain by giving acetaminophen (Tylenol) or ibuprofen (Advil) and by using heat, such as a warm wash cloth or heating pad held up to the ear.  Sometimes ear drops will be recommended.  These drops may help with the pain but only the antibiotic will get rid of the infection.
When should I see my child’s pediatrician again?
·         If your child is not better after 2 days of treatment or if his symptoms get worse, he should be seen again or your pediatrician should be contacted for advice.
·         In younger children the ears checked again in about one month.  Your pediatrician needs to make sure the ears are normal and that there is no fluid behind the ear drum.
Are there any special tests which might be needed?
Tests which are commonly done include hearing tests and tympanometry.  Tympanometry measures the pressure behind the ear drum and can help your child’s physician decide if the ear examination is normal or abnormal.  Neither test is painful and tympanomerty can be easily done in most offices.
Can all children have their hearing tested?
Yes.  Children have a hearing screeing done at birth and young children may require a special type of testing called Auditory Brainstem Response testing. All children can receive otoacoustic emission screening and children over 1 year of age can have visual reinforced audiometry (VRA) testing. Older children can have routine sound booth testing or routine screening in your pediatrician’s office

Fluid Behind the Eardrum

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What is otitis media with effusion?
It means fluid in the middle ear. The middle ear is behind the ear drum.
What causes it?
Fluid in the middle ear may have many causes.  It most often is caused by “germs” in the middle ear.  It can also occur from a cold or allergies.
Why do children get more ear problems than adults?
Children “catch” more “colds” than adults and this, along with problems due to poor draining of their middle ear through the Eustachian tube, makes them more likely to develop middle ear problems.  These problems often cause hearing problems due to a buildup of fluid in the middle ear. This is often called eustachian tube dysfunction (ETD).
How often does an effusion follow an ear infection?
It is very common after an ear infection.  One month after an ear infection had been treated 4 out of 10 children have fluid in the middle ear.  After 3 months, 1 out of 10 children still have fluid.
What are the symptoms?
Many times there are no symptoms of the middle ear fluid. Symptoms include noises in the ears, speech problems, sleep problems, balance problems and trouble hearing.
Can it be serious?
Yes, it frequently causes some degree of hearing loss.  If not treated, it can cause hearing, speech, learning and behavior problems with usually are temporary.  Keep all follow-up appointments with your child’s physician to have the ears checked until the fluid is gone.
What is the treatment?
Antibiotics and oral steroids do not help. Occasionally nasal steroids sprays will be used if your pediatrician feels there is an allergic comonent to the eustachian tube dysfunction (ETD).   In most cases, the best treatment is watching, since middle ear fluid will usually slowly go away with time.
What if the fluid doesn’t go away?
If the middle ear fluid does not go away, the usual treatment is to lance the eardrums (called a “myringotomy”) and to drain the fluid.  Tubes may then be put in the eardrums to keep the fluid from coming back.  This type of surgery is done by an ear, nose and throat physician.
What else can help?
Try some of the following:
·         If your child is still taking a bottle, do not allow him to take the bottle lying down.  He should be sting up when taking a bottle and should never be allowed to take a bottle to bed.
·         Smoke in the house due to cigarette, fireplaces not properly vented, etc., may cause more problems with middle ear fluid.  No one should smoke in the house or around a child.

Separation Anxiety

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Why does my child cry and become so upset when I leave the room?
·         Most children from age five or six months up to 3 years of age will protest separation from the primary care giver (usually the mother) by crying and/or demonstrating anger and frustration.
·         Even brief separations, like walking into the next room, will bring a protest from a young infant.
·         Two years olds often will try to retrieve mother by following her and get her attention by a variety of means, including temper tantrums.
·         These protest behaviors during separation demonstrate the beginning of the affectional tie with the mother and your infant’s ability to associate gratification of his need with the object mother.
Why is my baby’s protesting separation much worse at times?
The protesting is worse at times when your baby is:
·         Tired, hungry or sick.
·         In unfamiliar surroundings.
·         Disturbed by any alarming events occurring at the time.
·         In the presence of unfamiliar people or animals.
·         Trying to adjust to several changes occurring at the same time in her environment.
·         Not prepared for you’re leaving or you leave unexpectedly and/or leave by unfamiliar routes.
What are some things I can do to prepare and comfort my child when separation is necessary?
It depends upon the child’s age; however, try to avoid any of the above mentioned situations.  Remember, your baby is not “spoiled” or becoming overly dependent (dependency is more related to your doing things for your child as she gets older and has demonstrated she can do them herself.)
Some other things you can do are:
·         Do not scold, discipline or belittle your infant for protesting and getting upset when you leave.  He is developing an attachment to you as the most important object (person) in his environment.
·         Separations at night when putting your child to bed can be particularly difficult.   Follow a routine, be firm about keeping him in bed and leave the night light turned on.  Give him several favorite, safe, cuddly, soft toys, and always talk softly.
·         When your infant is about five or six months old, it is wise to select a mature, experienced babysitter who matches your child’s personality.  Then, make sure there are several opportunities for the babysitter to be with you and your child before leaving them alone.  Have your child awake when the babysitter arrives, and for a few nights have the babysitter help you go through the routine of putting your child in bed.  This will help your child not to expect mother to be present if he awaken during the night.
·         Talking and singing while you go about the house is reassuring to your baby even if he cannot actually see you all of the time.
·         Learning occurs through experience and practice.  When you leave, your child may be upset, but by following the same routine (like leaving, by the same door and always returning the same way), helps your child to adjust to that pattern.  As it is repeated your child gains confidence that you will return.
·         Peek-a-boo and hide-go-seek are important games to play at this age (8 to 15 months).    Have your children watch you hide toys behind a pillow and retrieve them- then let them find the toy they watched you hide.  These games help your child realize that things and people can be out of sight and then return.

Thumb Sucking

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How can I stop my child from sucking his thumb?
Thumb sucking is not uncommon.  Approximately 20% of children by five years of age still suck their thumb.  If thumb sucking is a rare event, it need not be treated.  However if thumb sucking is a regular problem, especially after four years of age, treatment is advised.  Methods of therapy that often work are giving rewards instead of punishments.  Bitter taste treatment applied to the thumb, dental appliance installations and simply just ignoring the thumb sucking altogether may also work.
Is thumb sucking harmful to children?
Thumb sucking can cause both physical and psychological problems for your child, if it is still regular habits after four years of age.  Some of these problems include nail infection, hyperextension of the thumb, dental problems, especially malocclusion (improper tooth alignment).
Many children may not want to be around children who suck their thumbs or may make fun of them if they do.  This may hurt your child’s feelings and/or be confusing to him or her.
Another psychological problem children may experience from thumb sucking is a too aggressive approach by parents to stop the actual habit of thumb sucking.  Remember, be patient with your child and use positive reward system instead of punishment.  Punishment for thumb sucking may do more harm to your child than the actual thumb sucking habit itself.

Toilet Training

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What is the first step?
First decide when you feel your child should be toilet trained
There are two general approaches.  The first is to wait for your child to indicate verbally that he wants to stop wearing diapers and wear “big boy pants.”  The second is to watch for indicators of developmental and physical readiness including: walking alone: being able to express needs verbally: physically being able to cooperate and carry out simple instructions: and being aware of when he needs to urinate or have a bowel movement.  Routine behavior management methods are then used to begin training (reward successes, ignore accidents, encourage your child to tell you when he wants to “potty”.
What is one of the biggest mistakes parent make?
Many parents become impatient with toileting process and the child.  When the routine goes slowly parents may wonder: “what am I doing wrong?” or “what is wrong with him and why is he having so many accidents?”
When do most children become trained?
Somewhere between 18 and 36 months most children develop daytime bowel and bladder control.  Boys may be slower than girls.
How do I approach toilet training?
You need to set realistic step-by-step goals which both you and your child are interested in achieving.  Reward all successes.  All caretakers must be involved and a positive attitude and consistency are essential.  Good hygiene is necessary for both wiping, hand washing and toilet paper disposal.
What warnings may be present if there is a medical reason why my child is slow to be toilet trained?
If you answer yes to any of the following questions you should talk to your child’s physician.
·         S he constantly wet?
·         Is his urine discolored?
·         Does he have a “weak stream” when he urinates?
·         Does he show pain when he urinates?
·         Is he always constipated?
What approach should I take to urine or stool accident?
Accidents do happen.  Do not scold or punish.  Keep a positive attitude and reward successes.  Set a limit for the number of accidents before you decide to step back and wait a few weeks before trying to train again.

Babysitters

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What should I look for in choosing a babysitter?
Look for someone who can meet the needs of your children.  The younger the child the more mature and responsible the babysitter needs to be.  Be cautious when brothers and/or sisters can easily manipulate or another; this can lead to trouble.
Try to use a consistent babysitter with your children so they can become familiar with one another.  Choose a babysitter who is comfortable around children and preferably has some type of child care experience in the past.  Try to match the personality of your babysitter with that of your children.
What are some important things to remember to tell the babysitter?
·         Safety is the first and foremost requirement for babysitting.  Make sure the babysitter and child know the rules. Set the ground rules and write them down on a sheet of paper before you leave the home.
·         Always leave a phone number where you can be reached, as well as a phone number of a friend or relative.  Consider checking in once or twice to make sure things are running smoothly once you leave the home.
·         Leave a flashlight with batteries on hand in case of light failure or power failure.
·         Show the babysitter how to use the fire extinguisher and where it is located.  Also show her where the smoke alarms are located.
·         Provide an activity or game that is safe, interesting and enjoyable for both your babysitter and children while you are away.
·         Discuss nutritious drinks and snacks that are available for babysitter and your children while you are away.
What about discipline?
Make sure your babysitter understands how you want her to discipline your children if that may be necessary.  Set the rules as to which television programs are acceptable and instruct on limiting television viewing.
Where can I find trained babysitter?
If your community has an instruction class for babysitters, choose a babysitter from this group of candidates if possible.  If your babysitter has not been instructed through one of these classes suggest that she attend one if available.