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.

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