Feet and Legs

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What is clubfoot?

When the foot’s tendons and ligaments are tight and underdeveloped there is a twisting of the entire foot downward and inward.  Repair involves serial casting and sometimes surgery.

What is metatarsus adductus (curved foot)?
In this problem the foot is curved with the toes curved inward with a kidney bean shape.  This condition is treated with serial casting and motion exercises.  If the condition is mild and there is no rigid (fixed) deformity of the foot then no treatment is needed and the foot is watched closely to see that the curvature continues to improve.
What causes “toeing in?”
Most toeing in is caused by the tibia (shin bone) turning inward (internal tibial torsion) or the femur (thigh bone) rotating inward (femoral anteversion).  These conditions usually go away by age four.
What is “toeing out?”
This is usually caused by the tibia or femur rotating outward.  It almost always corrects itself and is frequently seen when a child is learning to walk.
Do most infants have flat feet?
Most infants look like they have flat feet due to a fat pad in the instep.  By the age of three years most children develop a visible arch.
Are there any key things to remember about foot conditions?
Shoes are for warmth and protection.  They serve no function in the structural growth of the feet.  Look for a shoe which is flexible.  You should be able to bend the ball area about 40 degrees while holding the heel.  Measure your child’s foot in the shoe while he is standing in it.  Make certain there is enough room (one half your thumb’s width) at the tip of the big toe and at the widest parts of the foot.  Your child should be able to wiggle and curl all his toes inside the shoe and the back of the shoe should not be too tight or too loose.
Are hand me down shoes OK?
Yes, as long as they fit well and are still structurally okay. Shoes are for warmth and protection. They do not help feet develop

Fever

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What is a fever?
A fever is a raised body temperature.
What causes fever?
When an infection or inflammation is present in the body, frequently the body will respond with a raised body temperature.  It can also be caused by increased activity, the environment being too warm, or the child is too bundled.
How do I take a temperature?
It is taken rectally, orally, or under the arm (axillary.)
What is a normal body temperature?
·         Rectal       99.6 F              37.6 C
·         Oral          98.6 F             37.0 C
·         Axillary    97.6 F              36.5 C
When does my child have a temperature?
When the reading is 1 degree higher than normal.
When should I notify my child’s doctor?
Notify your child’s doctor immediately if your child is under 2 months of age and had any temperature elevation (100.4 C degrees F/38 degrees or higher).
For children 3 months to 2 years of age, be cautious and discuss with your physician when notification should occur (usually for a fever of 102 degrees F/ 38.9 degrees C or more).
For older infants and children, call your physician for persistent fevers lasting longer than two days, a temperature 3 degrees above normal, or if your child is cranky, difficult to sooth, or difficult to arouse.
Remember to discuss all of these rules with your physician since individual recommendations do vary.
What can I do when my child has a fever?
Give your child acetaminophen (non-aspirin).  Body temperature sponge baths (do not use alcohol) can be used to promote cooling evaporation.  Give cool liquids and place your child in lightweight clothing while keeping the room cool, but keep your child warm enough to prevent shivering.
Does a fever harm my child?
Fevers almost never cause brain injury.  The problems that may accompany fevers (like meningitis) are what cause injury.  Approximately 3-5% of all children will have seizures with fever.  Call your physician if a seizure occurs.
What dose of acetaminophen (“Tylenol”) do I use?
The package insert will provide the dose for age. For younger children talk to your doctor at your health maintenance visits.

Insect Bites

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What should I do if my child gets bitten by a bee or insect?
Most bee or insect stings are not serious and result in only in minor pain and swelling around the bite.  Occasionally a systematic reaction (reaction to the sting elsewhere in the body) can occur and these can be serious.  Signs and symptoms of a serious systematic reaction include the following: hives, chest tightness or wheezing, muffled voice, hoarseness in the throat, pale or clammy skin, fainting or passing out.  If any of these symptoms are observed, call your physician and ambulance immediately and go directly to your closest Emergency Room.  If any of these signs or symptoms have occurred in the past, skin testing by a pediatric allergist with desensitization shots advised.  An insect sting kit should include a preloaded Epinephrine syringe that is capable of going through clothing (such as EpiPen JR.), a tourniquet, and antihistamine syrup or tablets.  Your physician will instruct you on how to use the insect sting kit.
What should I do immediately after a bee or insect sting?
First pull the stinger, insect or possibly tick from the bite site, by gentle firm straight out traction, using tweezers.  Fingernail will suffice if tweezers are not available.  Next, clean the area with soap and water.  Apply cold compresses followed by baking soda paste or calamine lotion.  If your child is scratching the bite, an antihistamine can be prescribed by your doctor.  If the bite becomes infected (redness, swelling or pus at the sting site), call your child’s physician immediately.  If bitten by a tick, call your child’s physician especially if living in an area known to have Lyme Disease.
How can I prevent bee stings?
Some helpful hints to prevent bee stings are as follows:
·         Avoid orchards, flowers, blooming trees and shrubs.
·         Do not wear brightly colored decorative clothing on your child that could attract bee or insects.  Wear long sleeved shirt and trousers on your child in area that you think may have insects and bees.  Be sure to pull socks up over your child’s trousers leg to prevent any insects or bees from getting up the pant leg.  Always wear shoes on your child and do not let him or her go barefoot.
·         Avoid scented sprays, colognes, perfumes.
·         Screen all windows and doors.
·         Avoid picnic area and garage and trash can areas that attract insects and bees

Iron Deficiency Anemia

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What is it?
Iron deficiency anemia means low blood count due to inadequate iron in the body to make red blood cells.
Are there any other causes of anemia?
Yes, there are many.  Your doctor can discuss these with you.
What are the symptoms?
There may be no symptoms when your child only has a slightly low blood count.  As the blood count gets lower, your child may feel fussy, irritable, easily fatigued, or occasionally hyperactive.
How is it found?
A simple blood test called hemoglobin or hematocrit is done.
What is the treatment for iron deficiency anemia?
Your child should take iron for up to several months, or as long as your child’s physician directs, in order to replace the body’s stored of iron. A follow up test may be done to make sure the anemia is gone.
What foods are high in iron?
These foods are high in iron and will help provide your child with adequate iron: meats, green leafy vegetable, dried beans, egg yolks and cereal.  Prepare appropriately for your child’s age

Lead Poisoning

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What is lead poisoning?
It is a disease caused by swallowing or inhaling lead.
Who is at risk?
Your children face the greatest risk.  Children living in older homes that have peeling or chipping paint or whose home is being renovated a much higher risk.  Children living close to industrial areas are also at increased risk.
What are the symptoms?
·         Low level of lead exposure may not be obvious: however excitability, hyperactivity, poor attention and easy frustration may be some behavioral problems attributable to lead exposure in children.
·         Higher lead level in children may have more obvious symptoms such as fatigue, irritability, headache, clumsiness, weakness or vomiting.
Who should be screened?
Children are screened at 9 to 12  months.  High risk children should be screened as they grow..
How can lead exposure be prevented?
·         Be alert for chipping or peeling paint.
·         Don’t let children eat snow or icicles or put dirt in their mouths.
·         Use lead-free safe interior paints for your home.
·         Always wash hands before eating.
·         Do not store food in cans.
·         Test your water for lead and draw water for drinking from cold tap only.

Nursemaid’s Elbow

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What is a pulled elbow (nursemaid’s elbow)?
This is a problem where the bones at the elbow become misaligned.
What causes nursemaid’s elbow?
If there is a sudden pulling upon your child’s arm, such as when your child steps down from a curb while holding your hand.  If the child is pulled or swung by one or both arms, the bones of the elbow become misaligned.  When the pulling is released, the bones go back to their proper alignment but one of the elbow ligaments “get stuck.”  This is why x-rays do not show up abnormality.
When does this problem most commonly occur?
This problem most commonly occurs in children between one and four years of age.
How is this problem treated?
This problem is treated by rotating the arm in a specific fashion.  This maneuver is usually done by medical personnel.  Some physicians will instruct families on how to perform this maneuver themselves.
After the problem is fixed, will my child begin to move his arm again?
After solving the problem, your child usually will begin to move the arm spontaneously within one-half hour.  Most children have much less discomfort immediately after the maneuver to correct the condition.
Is any treatment necessary after my child has this problem?
No splinting is needed in most situations, and a sling generally is not useful.  You will be warmed about the cause of this problem to help prevent it reoccurrence.  Some children tend to have this problem repeatedly, but for most children this is not a common occurrence.

Sleep Problems

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Is it normal for my child to wake during the night?
Most children wake 4-6 times per night and adult 3 or 4 times.  Most of the time we fall back asleep and don’t remember waking.  Children frequently have trouble soothing themselves and returning to sleep.
Do most children take time to fall asleep?
Yes, children take even longer to fall asleep than adults.  At two months it takes about ½ hour and at 9 months, 15 minutes to fall asleep.  From 15 months to adulthood it takes an average of 10 minutes with a range of 1 to 30 minutes.
Is there any pattern to length of sleeping?
As infants grow older they sleep for longer periods of and are awake longer.  By 3 months most children will sleep for four hours and by 6 months, 6 hours in a row.
Are all children able to settle themselves?
Two out of three children by 3 months of age are able to settle themselves and return to sleep if they wake during the night.
Do children need to be fed during the night if they are going to sleep soundly?
No. By the age of 4 months, 90% of all children can go through the night without food.
Does cereal or solid food feeding of an infant less than 4 months of age help them to sleep more soundly?
No.  There is no evidence that babies less than 4 months of age fed a snack of cereal will help sleep better.
What simple solutions help sleep problems?
Using a simple bedtime rituals may help.  Be consistent.  Quiet play after supper can be followed by a bath and hen bedtime song or story.  The specifics of the routine are less important that the routine itself.
Should I rock or feed my child to sleep?
Children over 4 months of age should be encourage to fall asleep in bed by themselves.  Otherwise, they will wake 1-2 hours later and wonder “where you went.”
Do blankets and security object help?
Yes.  Security objects help to replace the parent and help the child feel safe.  Be careful that a pacifier or bottles do not consistently serve this purpose because it encourages a habit difficult to eliminate.
Are there any periods after infancy when sleep problems tend to return?
Yes.  At about 9-12, 18-24 months and 4-6 years, periods of added anxiety and nighttime waking occurs.  These periods relate to fears of separation and anxiety about independence.  Never scold or talk loudly to your child for not sleeping, rather be comforting and gentle.
What general guidelines should I use if my child wakes during the night?
First, if she is older than 2-3 months, try to see if she settles herself.  If it is an unusual cry, check on her immediately.  If she continues for 5 minutes then check on her briefly and try not to pick her up. Leave her with reassuring pat and voice, and wait another 10 minutes to check on her again.  Thereafter check on her every 15 minutes.  If you continue to have problems, see your physician for help.  Your doctor may ask you to complete a sleep diary for use in changing the sleep schedule.
Are there any medical reasons why a child will have problems sleeping?
Yes.  Many chronic medical problems which cause a child pain or discomfort can contribute to sleep disturbances.  These can include pain from chronic ear problems or skin problems which lead to itching and discomfort.  The list is numerous and you should always talk to your child’s physician if there is a sleep disturbance which is not readily explainable

Swollen Glands

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What causes swollen glands in children?
Swollen glands, called lymph nodes, are very common occurrence in children.  Lymph nodes help children fight infection, particularly viral infections in the head or neck areas.  Most swollen glands are found under the jaw or chin and are less than one inch in size, or about the size of a kidney beam, and are not tender to the touch.  Most glands will increase in size as a result of ear, nose, throat, and possibly scalp or skin infections.  Over several weeks (4-6) the glands will decrease in size to less than ½ inch, but swelling may persist for several months.
Are there any treatments for swollen glands?
Yes, if glands are tender to the touch, have overlying redness or feel like they are filled with fluid, then a bacterial infection may be present.  An antibiotic may be necessary to help fight the infection.  On rare occasions, swollen glands may need to be looked at by a surgeon to decide whether a biopsy needs to be performed.
Are there reasons to contact a physician for swollen glands?
Yes, the following symptoms suggest an underlying cause for swollen glands that requires your physician to examine your child.
·         Glands located under the arm, in the armpits.
·         Enlarged glands just above the collar bone.
·         Glands that are larger than one inch and are not decreasing in size over 4-6 weeks.
·         Glands that are tender to touch or feel warm.
·         Children with associated fever lasting longer than three days duration or with easy bruisability, nighttime sweating and/or weight loss.
·         A persistent cough or breathing difficulty associated with swollen glands.
·         Any swollen glands in infants under three months of age.
·         Children who have been exposed to tuberculosis.
·         Children who have received cat scratches.

Pink Eye

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What is conjunctivitis aka Pink Eye?
Conjunctivitis occurs when germs infect the outer lining of the eye. It is often called “pink eye.”
What are the symptoms?
Symptoms include redness, itching, and discharge.  The eyes may look pink or red.
Is pinkeye harmful?
It is most often harmless but it can cause much discomfort and it is contagious (“catchy”).
What can I do?
You can try using cool compresses or artificial tears.  Call your child’s physician if redness or discharge increases, the eyes are painful, or if symptoms get worse.
What is the treatment?
Use good hygiene.  Softly wipe all “crusting” from the eyes as often as needed.  Your physicians may prescribe eye drops or an ointment.
How do you use the drops or ointment?
·         Before putting the drops or ointment in the eye, gently pinch the lower eyelid to make a small pocket and apply medicine.

Try not to touch the eye with the dropper, the tube or your finger. Follow instructions from your child’s physician for the dose of the medicine.

Ringworm

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What is ringworm?
Ringworm is a fungal infection of skin (tinea corporis), hair (tinea capitis), or nails (tinea unguium).  It is most common during warm weather months.
What does it look like?
On the skin it appears as a round or oval red to tan area with raised borders.  It usually is one to two inches in size and can appear almost anywhere on the body.  On the scalp it is oval or round and can cause scaling, pus formation, scabbing and hair loss.
How is it acquired and is it contagious (catchy)?
It is acquired through contact with fungus.  Tinea can be caught through other individuals or through the environment (such as contaminated dirt or grass) and occasionally pets.  Yes, it is contagious and one has to be careful and use good hygienic (hand washing) measures to prevent the spread of the infection.
What is the treatment?
Your physician will prescribe a cream for the skin infection that should be applied three times a day for several weeks. OTC medication like lotrimin and lamisil are also effective.  If a scalp infection or nail infection is a problem, an oral antifungal medicine called Griseofulvin is usually prescribed.  This medicine should be taken exactly as prescribed and your child will usually need to take this medicine for several weeks to months. Call your physician:
·         If side effects of the oral medicine are noted such as vomiting, diarrhea or nausea.
·         If the infection is not improving.
·         If pus, increased redness, or the infection is spreading.