Nutrition

Development

Behavior Control

Reading and Electronic Media

Dental Care

Safety Tips

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Immunizations

The virus that causes influenza (which is also called the flu) changes every year.  Children over 6 months of age should receive an annual flu vaccine starting in late September.  Many offices offer both tradition flu shots as well as Flumist (which is a painless squirt in the nose without any needles

Acetaminophen (Tylenol) Dosage Table

• CAUTION: In May, 2011, a move to one standard concentration (160 mg/5 ml) of liquid acetaminophen medicine for infants and children was announced. Up until that time, there were mainly 2 concentrations: 80 mg/0.8 ml (Infant Concentrated Drops) and 160 mg/5 ml (Children’s Liquid Suspension or Syrup). Old concentrations (80mg/0.8 ml) of infant acetaminophen may still be available in some homes. Therefore, if it is an older product, please have the caller confirm the correct concentration of infant acetaminophen.
• AGE LIMIT: Don’t use under 12 weeks of age (Reason: fever during the first 12 weeks of life needs to be documented in a medical setting and if present, your infant needs a complete evaluation.) EXCEPTION: Fever from immunization if child is 8 weeks of age or older. Avoid multi-ingredient products in children under 6 years of age. (Reason: FDA recommendations 1/2008).
• DOSAGE: Determine by finding child’s weight in the top row of the dosage table
• MEASURING the DOSAGE: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medicine. If not, medicine syringes are available at pharmacies. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 ml and that ½ teaspoon equals 2.5 ml.
• FREQUENCY: Repeat every 4-6 hours as needed. Don’t give more than 5 times a day.
• ADULT DOSAGE: 650 mg MAXIMUM: 3,000 mg in a 24-hour period.
• BRAND NAMES: Tylenol, Feverall (suppositories), generic acetaminophen
• MELTAWAYS: Dissolvable tabs that come in 80 mg and 160 mg (jr. strength)
• SUPPOSITORIES: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories (the rectal dose is the same as the dosage given by mouth).
• EXTENDED-RELEASE: Avoid 650 mg oral products in children (Reason: they are every 8 hour extended-release)

Research supports the need for children to get adequate sleep if they are to be
healthy. An insufficient quantity or quality of sleep causes negative effects on
your child’s physical and mental health, ability to learn and behavioral and
academic success. Numerous studies have shown the negative effects of sleep
restriction. and the positive effects of sleep extension have also been well
documented.

Toddlers need about 12-14 hours of sleep; preschoolers 11-13 hours; and school
aged  children 10-11 hours.

Sufficient sleep allows your child to think more clearly and complete more complex task easier than when they are drowsy or fatigued. When your child is sleepy he is more irritable and less prone to succeed in performance related activities at home and at school.

Adolescents as a group are at high risk for sleep deprivation and the serious
consequences of sleepiness. Some of the most troubling risks include the
decreased attention patterns that effect cognitive and school performance as
well as the potential risks from a delayed response while driving. Drowsiness
and fatigue are principal causes of traffic accidents each year and other
unintentional injuries. Young drivers are especially prone to fall-asleep
crashes.

Adolescents require as much sleep as they did prior to adolescence.
In general adolescents require 8.5 to 9.25 hours each night. They
also prefer to go to bed later and wake up later than they did when they were
younger, Unfortunately, this conflicts with school schedules and places them at
a higher risk for difficulty falling asleep even when they try to arrange their
schedule to allow them to go to bed earlier. They also have to wake for school
when their body is telling them they need to sleep in longer. This phase delay
on top of other behavioral and schedule issues that cause them to stay up later
increases their sleep debt. Average sleep durations in early adolescence is 8
hours and later adolescence is 7 hours. Neither of these are adequate. Only
about 15% of adolescents report they sleep 8.5 hours or more each night. They
also have an extreme variability between weekday and weekend sleep schedules.
This further disrupts the quality and quantity of their sleep.

All children are different and sleep needs vary but most children do not get
adequate sleep. The best way to tell if your child is getting adequate sleep is
to look for signs of insufficient sleep. Is he difficult to wake in the morning?
Does he wake on his own? Does he sleep in on weekends and vacations? Is he extra
tired on Monday mornings? Does he show daytime sleepiness or become irritable
and short tempered when he is tired? Does he look rested? These are just some of
the clues to determine if your child is getting adequate sleep.

You should also look for healthy sleep practices. Regular bedtimes and bedtime
routines should be followed at all ages. Caffeine should be avoided and bedtime
electronics should be left out of the hours prior to going to bed. Try to fade
the intensity of light your child is exposed to and avoid vigorous exercise
during the 2-3 hours before bedtime. For the preschool and older child
it often helps to take a hot bath or wear extra clothes one hour before bed.
This warms up the body surface and helps them to relax. During the ensuing hour
before bed allow his surface temperature to drop by wearing light weight
pajamas. He should start to feel “cold” and want to get in bed between the
covers to warm up.  Once in bed he will begin to feel “warm and toasty”.
This encourages and prepares your child to fall asleep.

Your goal is a pattern of healthy sleep habits and a consistent sleep schedule that
is tailored to your child’s age and developmental level. Sleep environments must
be dark, cool, quiet and relaxed. For the younger child set a daily sleep
schedule and a consistent routine and follow through with it. For the older
child keep televisions and computers out of the bedroom and try to keep a
consistent schedule on weekends and weekdays.

Although estimates vary a CT scan of the chest is equal to several hundred chest X-rays. Due to their age and the sensitivity of their developing organs children are more vulnerable than adults to radiation. A dose of radiation that does not harm an adult can place a child at an increased lifetime risk for cancer. Another issue concerns CT accessibility. CT scans have been available for many years but now they are much faster than in the past. Consequently, when a CT scan was ordered in the past sedation was often needed. Today, distraction is often successful and this is a smaller roadblock to obtaining a CT. Two areas where CT scans are frequently obtained and are unnecessary are for minor head injury and for abdominal pain.

Many children who experience a head injury and are seen in an emergency room do not need to have a head CT done. they can be managed by taking a careful history, performing a thorough exam and providing close follow-up. Although a parent may be reassured by the normal result the reassurance does not justify the radiation their child is exposed to.

Another situation concerns the use of an abdominal CT scan in the diagnosis of appendicitis in children. Although CT scans are very good at making the diagnosis of appendicitis clinical diagnosis and the use of other non-radiation tests such as ultrasound can be very successful in the diagnosis and CT scans can be used on a limited basis depending on clinical course and examination findings.

CT scans are also frequently obtained to evaluate children who have their first seizure. In this situation as in the above examples the most important determinant of whether a CT actually needs to be obtained is the history and physical examination. If the history and physical examination do not point to structural problem with the brain a CT scan is not needed.

What should you do as a parent? Ask questions and listen to the answers. If you feel a CT is being done for reasons that do not justify the risk discuss your concerns with your child’s doctor. Almost always such a discussion will allow your child to receive the best care possible. If there is justification to do the test then do it.  If not, seek more advice and another opinion. As always, trust yourself and trust your doctor.