Iron Deficiency Anemia

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

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

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

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

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

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

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.

Impetigo

What is impetigo?
It is an infection of the skin.
What does it look like?
It most often looks like golden crusted blisters or weeping sores on the skin.
Where does it occur?
It occurs mostly around the nose and mouth but can occur on any part of the body.
Is it contagious (“catchy”)?
It is contagious and can be spread to other parts of the body as well as to other persons.
How is it treated?
Your child’s physician will most often prescribe an antibiotic ointment or an antibiotic to be taken by mouth. More serious staph infections, especially those due to methicillin resitant staph aureus (MRSA) are treated differently. Ask your doctor about MRSA infections.
What can be done at home?
·         Use a separate wash cloth, towel and linens.
·         Bathe or shower your child daily and gently wash sores with soap and water.
When can my child go back to school?
A child with impetigo can most often go back to school after he has been treated for 1 day.

Strep Throat

What is pharyngitis?
It is a sore throat caused most often by a virus, but it can be caused by the strep germ which is called “strep throat”.
What are the symptoms of strep throat?
A strep throat often causes a bad sore throat and fever.  It may also cause headache, stomach ache, pus on the tonsils, swelling of the neck glands and a rash.
How can I tell if my child has a virus or strep throat?
The symptoms of a virus sore throat are often milder than strep and include a cough or runny nose.  The physician may be able to tell the cause by exam alone.  Often a strep test is needed.
What is the treatment for a strep throat?
The usual treatment is amoxicillin or penicillin which should be taken for 10 full days.  This will help prevent rheumatic fever and keep the sore throat from coming back.  A single shot of penicillin is also available and treatment for 10 days is not needed.
Do antibiotics help fight a virus?
It is often helpful to take acetaminophen (Tylenol).
Should my child’s tonsils be taken out if he has repeated strep throats?
If your child has many strep throats in a year or if the tonsils are very big and cause trouble with eating or breathing, your child’s physician, may want to refer him to a surgeon for an evaluation as to whether your child’s tonsils should be removed.  Some signs of tonsils or adenoids which are large include snoring at night, mouth breathing, as well as nasal speech.

Enuresis

Children with enuresis (bedwetting) often have daytime symptoms of urgency, urinary frequency and daytime urine accidents.  Medication is often helpful as are voiding schedules and techniques. Behavioral modification techniques are also helpful.
Some children sleep soundly and do not wake when they feel the urge to urinate. For many children genetics and gender play a role. Boys are twice as likely to wet the bed as girls and if a mother had bedwetting when she was a child there is a 3-4 times higher likelihood of bedwetting in her offspring.
Children with primary enuresis have never been consistently dry at night. These children make more urine during the night than their bladder can hold and do not wake during the night to urinate. Physical causes are rare and include defects in the genitourinary tract or spinal cord problems. Each child with primary enuresis must be carefully evaluated for these rare conditions.
Secondary enuresis, also called temporary enuresis, is often seen in children with recent life stress issues. In secondary enuresis children who had been previously dry for many months begin to bed wet.  These causes include physical, emotional or sleep related issues.
The most common primary and secondary cause of enuresis is constipation. Over a period of days to weeks or months a child develops a pattern of stool retention. This causes the child’s rectum to become a reservoir for stool and pushes on the bladder causing the bladder to become overactive and have “less room” to store urine. This results in frequent urination and night time accidents. A comprehensive history and physical examination are essential to this diagnosis as is an effective and comprehensive treatment protocol that addresses all physical, dietary and social-emotional issues.
Uncommon secondary issues include diabetes and infection.
Your pediatrician will work with you to identify and assess the causes and any family dynamics issues related to the enuresis. A collaborative treatment program focused on you and your child’s needs, including financial and medication concerns, must be developed and supported so you can make the right decision about a treatment program for your child.