Eczema

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What is it?
It is a rash caused by irritation to the skin.  Usually it is “itchy,” “raised,” “dry,” and “reddish.”  There may be a family history of asthma, hayfever and other relatives with eczema. It is also called atopic dermatitis.
Can you catch it?
No.
Where does it occur?
The rash will involve the cheeks, back of arm, arm creases, back of legs, leg creases, behind the ears or neck creases.
How can I prevent it?
·         Avoid overheating and have your child wear cotton clothes.
·         Use humidified air in your house with proper temperature control.
·         Moisturize your child’s skin by adding baby oil to the bath water.  Use a lubricant like “Eucerin” after the bath and before drying your child.  Softly pat your child dry without firm rubbing, which tends to dry out the skin.
·         Use mild soaps or no soaps, except in the diaper area.
·         Rinse your child’s clothes well.
When should I see my child’s pediatrician?
If the rash is weeping or reddened, a topical steroid cream/ointment or antibiotic may be needed.  Call your baby’s pediatrician if these symptoms persist.

Eyes and Vision

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How can I tell if my baby’s vision is developing normally?
At birth, babies are very nearsighted and can only focus on objects at close range, up to 10 inches away.  One of the first things babies will be able to focus on is your face.  Practice talking to your baby at close range.  Move slowly from side to side to see if your baby can follow your face.  By 2 months of age, your child should begin to regard your face gradually and track you from side to side.
What are some potential vision problems that can occur in young infants?
Your pediatrician will examine your infant’s eyes at birth to screen for these problems.  Infants with abnormalities of the eyelids or surrounding eye structures should be examined closely for vision problems.  If your child was premature, weighing less than 3 ½ to 4 lbs. or required oxygen treatment for prolonged period of time (several weeks), an ophthalmologist (eye specialist) should examine and screen your child for potential problems.  If your baby’s family history includes any inherited eye disease, these should be discussed with the baby’s physician (diseases such as cataracts or glaucoma.)
What are common symptoms children may exhibit that have vision problems?
Up to 5% of children may have problems with eye alignment.  Children have occasional eye deviation of overly tired, sleepy and/or ill.  This is normal.  However, persistent eye deviation or a regular occurrence of the eye misalignment is a concern.  If your child’s eye(s) appear crossed or turn outward after 3 to 4 months of age, notify your physician.  Most infants can fixate on objects or faces at arms length by 4 months of age and fully track from side to side.  By 6 months of age, your child should be able to accurately search out, find and retrieve small objects (such as an individual cheerio.)
Notify your baby’s pediatrician if your child exhibits any of the following eye symptoms or you have other concerns about your child’s vision.
·         Clouding of pupil
·         Constant rubbing of the eyes
·         Excessive tearing
·         Persistent redness
·         Excessive sensitivity to bright lights
·         Unequal pupil size
·         Squinting
·         Head tilting
·         Difficulty gazing side to side or up or down
·         Abnormal jerky eye movements

Hearing Concerns

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How can I tell if my infant is hearing properly?
By 2 months of age, most infants are able to respond to sudden loud noise, such as a doorbell, the ring of a telephone, or the shake of a bell or rattle.  The usual infant responses are a startle (quick movements of the arms or legs), a cry, pausing during an activity such as sucking or feeding, or squinting and blinking of the eyelids.
By 3 to 5 months of age, infants are typically able to locate a loud noise by turning his or her eyes and head in the direction of the noise, if located to the right or left.  Facial expressions and beginning vocalizations such as cooing, gurgling, or babbling begin to occur in response to a parent’s normal voice level or tone.
By 6 months of age, your child should be able to accurately locate normal voice sounds at 8 to 10 feet away from either the right or left side.  Your child’s response should be to turn in the direction of your voice.  Try this test several times if your baby doesn’t respond.  Make sure your infant isn’t sleeping, eating or unusually fussy during the test. Babbling begins around this age as your baby starts making varied sounds like “ahh, ooh, uh.”
By 9 months of age, your child will soon imitate a few simple combinations sounds like “ba-ba, ma-ma or da-da.”  He or she begins to respond to softer sounds such as whispering words at close range.  Normal voice levels may awaken your baby from sleep.  He or she will start to attend to sounds that originate from other rooms.
By 12 months of age, hearing can be evaluated by your child’s speech pattern and understanding of spoken words.  Babbling takes on a pattern similar to normal speech.  Your child will be able to start to say a few words by 1 year of age and follow simple commands.  More spontaneous babbling emerges as you interact with your child.
What should I do if I suspect a hearing problem?
If you believe that your child is not responding appropriately to sounds or his or her speech is delayed, contact your baby’s physician.  A hearing specialist (audiologist) can test your child in a more detailed manner, and a referral will be made by your physician, if he/she suspects a problem.
Are there any factors which might contribute or predispose my child to hearing difficulties?
A family history of hearing problems may put your child at higher risk.  If other family members had hearing difficulties at a young age, especially if they require a hearing aid, your baby’s pediatrician may want to formally screen your child soon after birth.
Frequent ear infections, especially if the infections are difficult to clear, can cause a delay in speech due to a temporary hearing loss.  Your pediatrician will want to recheck your child’s ears after treatment to make sure the infection has cleared.  If antibiotics are unsuccessful in curing an infection and speech is significantly delayed, a referral to an ear, nose, and throat specialist may be necessary.

Reflux

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How common is spitting up?
Spitting of formula or breast milk is a common occurrence for most babies.  Rarely does this present a major health concern.  However, if frequent enough or if forceful large quantities of formula or breast milk are actually vomited, treatment may be necessary. If your child is diagnosed as having gastroesophageal reflux (GER) medication may be prescribed.
What are some of the reasons for “spitting?”
·         One common reason for spitting is over-feeding.  If the baby’s stomach is overfilled and distended, “milk” may not pass readily into the gut.  Instead, milk may be spit up because of the increase in pressure in the stomach.  It is important to feed your baby when he or she is hungry, but do not overfeed or force your baby to drink more formula or milk than he or she desires. (Please refer to general feeding guidelines under the topic “Feeding Your Baby.”)
·         Another reason for spitting is not burping your baby during the feeding. If your baby is a vigorous bottle feeder, air as well as liquid is being swallowed.  This air can build up in the stomach causing excess spitting.  Be sure to burp your baby after every 2-3 ounces of feeding.  Breast fed infants can be burped in between switching to the other breast.
·         Over stimulation after feeding can cause spitting as well. Try not to over stimulate your infant after feeding.  Limit active play prior to the feeding rather than after.
·         Positioning is important after feeding.  Babies have more of a tendency to spit if laid flat on their backs or if bent at the waist.  Both of these positions can encourage spitting.  The best position to place your infant after feeding is on his or her stomach with the head slightly elevated.  (Remember no pillows, instead elevate the mattress or use blocks under the crib to accomplish this.)
When should I call the baby’s pediatrician?
·         If your child is spitting more than ½ to 1 ounce each feeding.
·         If your child is choking on his feeding.
·         If you notice coughing or wheezing associated with feeding.
·         If you notice projectile “forceful” vomiting.
·         If a greenish tinge to the vomit is observed.
·         If you suspect your child is not gaining weight as he or she should.
·         If you observe any symptoms of dehydration such as dry mouth, decreased urination, lethargy (not as active as usual) or excessive sleepiness.
What treatments are helpful for spitting up?
Your physician may prescribe a different formula, especially if there is a family history of cow’s milk allergy or if your child exhibits other allergic symptoms, such as diarrhea, blood in the stools, wheezing, or skin rashes.  Call your physician if any of these symptoms persist before you make any formula changes.
If breast feeding, a mother’s diet can be changed slightly to avoid certain foods that can contribute to your baby’s spitting problem.  Sometimes, too much cow’s milk, chocolate, caffeine and other foods may be the culprit.  Before making any changes in your diet, discuss these with your physician.  A well balanced diet for nursing mother is essential while your baby depends solely on breast milk for his nutrition and for mothers to have proper energy food stores.
If formula feeding, one treatment that may be helpful is to gradually thicken the formula with rice cereal.  Start 1 to 2 tablespoons of rice cereal per 4 ounces bottle.  Gradually increase to 4 to 5 tablespoons of rice per 4 ounce bottle if needed.  Be sure that the nipple hole is large enough to allow an intermittent stream of formula and cereal to go through it, but not too fast that it may cause your baby to gag or choke.  If too much cereal is added to the formula, the mixture may be too thick for your baby to swallow.  Be sure to add cereal to the formula gradually to prevent this from happening.

Choking Management

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What should I do if my child is less than one year of age and begins to choke?
The first step is to call for emergency medical services or have someone else make the call.  Place your child head down on your forearm position at a 60 degree angle and support the head and neck carefully.  Rest your forearm against your body (such as against your leg) for added support.  If your child is large, you may want to lay him face down over your lap, while firmly supporting the head and keeping the head lower than the trunk.
Next, give four rapid blows with the heel of your hand to the infant’s back, striking high between the shoulder blade.
If the blockage is not relieved, then turn the infant over laying the child face up on a firm surface.  Give four rapid chest thrust over the breast bone using two fingers to depress the baby’s chest to a depth of one –half to one inch and then let up.  Do this four times in a row.
If breathing still does not start, then open the mouth with thumb held over the tongue and fingers wrapped around lower jaw.  This is a tongue-jaw lift maneuver and will draw the tongue away from the back of the throat and may help clear the airway.
If you can see the foreign body, it may be removed with a sideways sweep of your finger.  Remember never to poke the finger straight into the throat, and be very careful with any finger sweeps because they may cause further blockage.
If your infant still does not begin to breathe, then place your mouth over his mouth and nose and give two quick shallow breaths.  If breathing does not then start, repeat the previous steps and begin CPR.
What rules should I follow if my child is over one year  of age?
The first step is as previously described.  You should make certain that you or someone else had called for emergency medical services.
Place the child on his back and kneel at his feet.  Put the edge of one of your hands in the midline between the navel and the rib cage.  Place the second hand on top of the first.  Press firmly but gently into the abdomen with a rapid inward and upward thrust.
Repeat this maneuver six to ten times.
These abdominal thrusts are called the Heimlich Maneuver.  If breathing does not start, open the airway using the tongue-jaw lift technique previously described.  If you can see the foreign body you can try to remove it with a sideways sweep of your finger.  Be careful to prevent any object from being forced down further into the airway.
If your child does not begin to breathe right away, attempt to restore breathing with the mouth-to- mouth technique.  If this fails, repeat a series of six to ten abdominal thrusts.
Are there any children where the Heimlich Maneuver should not be performed?
The Heimlich Maneuver should not be done on children under the age of one year due to the damage or injury from the abdominal pressure.
How can the child be  positioned when the Heimlich Maneuver is performed?
In older children the Heimlich Maneuver can be performed when the child is standing or sitting.  It can also be done while the child is lying in a face up position.
Is it enough for me to know what to do for my child in case of choking or should I know more?
Basic information on what to do in case of choking is not enough for parents.  All parents or caretakers of children should be able to perform basic cardiopulmonary resuscitation (CPR).  A CPR course should be taken by all child caretakers.
Where can I obtain further information concerning CPR and choking?
Information describing the above techniques and problems can be obtained from the American Trauma Society, 1400 Mercantile Lane, Suite 188, Landover, Maryland 20785, or from the American Academy of Pediatrics, Department of Publications, 141 North Westpoint Blvd., Elk Grove Village, Illinois 60009-0927.
What should I remember about choking?
Choking can happen to anyone, especially children.  It is important that you know how to deal with choking and more importantly that you learn CPR.

Cuts and Bruises

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What should I do if my child cuts himself?
First apply pressure to the cut area with a clean bandage or dressing to control bleeding for the first 5 – 10 minutes.  After the bleeding is controlled, rinse the cut well with soap and water.  Thoroughly rinse the cut area under luke warm tap water for several minutes.  Pat the area dry.  Cover the cut area with a nonstick sterile dressing or bandage.  A Band-Aid will suffice for small cuts.  If loose skin edges are noted, trim these away so that the wound edges can come together and heal properly.
When should I see my physician?
·         If the cut is till bleeding after pressure is applied for 5- 10 minutes.
·         If the cut is gaping and split open.
·         If the cut was made by a “dirty object.”
·         If you suspect dirt or any objects are still left in the cut or wound after through cleansing.
·         IF it look infected with pus, swelling or redness.
·         If the bleeding is excessive, apply pressure and seek emergency aid and/or a physician immediately.

What causes a bruise?
Bruising is caused by bleeding into a muscle or soft skin area usually following some type of trauma.
What should I do for bruising?
Apply ice to the area for 15- 20 minutes and then remove for 15- 20 minutes.  This will help prevent swelling and ease the pain during the first 24 hours after the injury.  This can be repeated several times for the first day after the injury.  Acetaminophen (Tylenol) can be given to help alleviate pain and soreness.  If bruising has occurred to an extremity (arm or leg) elevation of the extremity will also help decrease swelling.  Heat to the area after the first day will help alleviate stiffness and soreness as will massaging the area.
When should I call the baby’s pediatrician?
·         If excessive bruising occurs with little or no trauma.
·         If persistent pain or swelling is noted after 24 hours.
·         If your child has difficulty moving or using an arm or leg after the trauma.
·         If you suspect an underlying fracture (broken bone.)

Dental Care

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When do children’s teeth start to form?
About 6 weeks into the pregnancy.
When will the first tooth come in?
The lower front teeth are usually first and begin between 6 and 10 months.  All 20 teeth are in by 3 years of age.
What occurs with teething?
Irritability, low grade fever, drooling and mild diarrhea can occur.
What can done for teething pain?
Allow your child to chew on things like cold teething rings.  Over-the-counter gum medications may irritate the gums and should be avoided.  Acetaminophen can be given if necessary (see section on Fever for dosages (Tylenol).
When should I start to brush my child’s teeth?
Start with the first tooth and use a moist, soft cloth, cotton swab, or a soft wet child size toothbrush.  Continue brushing the teeth, yourself, at least once each day until your child has fine motor skill to brush the teeth correctly.  This usually is between 5 and 7 years of age.
Should I use toothpaste?
Many children dislike it.  Be careful not to use excessive toothpaste if it contains fluoride since most children swallow the toothpaste rather than spitting it out.  After three years of age children should be able to rinse and not swallow the toothpaste.  Use non-fluoridated toothpaste prior to age three or use a small pea sized amount when you brush their teeth.
How often should the teeth be brushed?
At least once a day, but after each meal is recommended. Flossing is also recommended.
Can my child brush his own teeth?
Yes, but under the age of 5-7 years should brush the teeth at least once a day.
Does my child need fluoride?
Yes.  If you do not have fluoride in your water supply then fluoride supplements should be used until adolescence.  The dose of fluoride recommended for your child will change at 3 and 6 years of age.  Discuss this with your child’s pediatrician and dentist.
Can teeth decay come from bottle feeding?
Yes.  Do not use a bottle as a pacifier with sweet liquids.  Do not allow a child to fall asleep with a bottle.  Unswallowed milk and sweet liquids in the mouth can cause tooth decay.
Can pacifier, bottle use, or thumb sucking cause poor teeth alignment?
Yes.  Generally the longer thumb sucking, pacifier use and/or bottle use are practiced, the greater the chance for teeth problems.
Is fluoride use safe?
There is no scientific evidence that fluoride use is unsafe.  Many statements have been made concerning an increased risk for problems including cancer.  There is no evidence, however, that any increased risk exists.
How do I know if I have fluoridated water?
Ask your physician, dentist or local health department.
Can my child take too much fluoride?
Yes.  Follow the recommended dosages which can be obtained from your child’s pediatrician or dentist. You should also consider topical fluoride treatments for your child’s teeth.
When should I take my child to a dentist?
Recommendations do vary but most parents take their child to a dentist between the ages of 2 and 4 years.  Some children are very cooperative, but others need time to get use to the idea of someone examining their teeth.  Talk about the upcoming visit, prior to taking your child to the dentist. Remember that denta care begins at age 6 months when fluoride needs to be given to your child if you are breastfeeding or if fluoride is not in your water supply.

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