Febrile Seizures

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Young children are prone to frequent viral illnesses and ear infections that are often associated with fever. When a young child has a fever he or she is at risk for having a febrile seizure. We consider a child to have had a febrile seizure of they have a seizure between age 6 months and 5 years that is associated with fever but not accompanied by any evidence of a central nervous system infection such as meningitis or encephalitis. About 5% of all children will have a febrile seizure. Most of these seizures are brief and last less than 1-2 minutes but can last up to 15 minutes and consist of sudden stiffening with some twitching of the extremities. This is called a generalized seizure. Rarely focal components may be present with one part of the body showing more involvement then another. Your child’s eyes may deviate upward and skin color may become pale but usually not blue. Your child will not respond to voice or touch and when the episode stops your child usually will go to sleep.

If your child has a seizure the most important response is to maintain your child’s airway and seek help. Turn your child on his side in a recovery position and maintain head and neck control so the upper windpipe does not close off. This also prevents your child from aspirating stomach contents if vomiting occurs. Vomiting is uncommon with febrile seizures. Call 911 or contact your doctor directly if the seizure has stopped and your child is resting comfortably. Your child will require a medical evaluation unless you are experienced with febrile seizures and your child has a history of similar febrile seizures in the past that you are comfortable handling. In most situations for the first febrile seizure and for all seizures in children under preschool years a medical evaluation and examination are needed.

If your child is under age 1 year and has not been immunized fully with HIB or Prevnar vaccines or has been receiving antibiotic that could be masking symptoms then a spinal tap may be needed. If your child shows any signs of a central nervous system infection then a spinal tap will be needed.

An EEG is not needed if a neurologically healthy child has a febrile seizure unless that seizure is complex. Laboratory testing is also rarely needed and should only be done if an evaluation of the cause of the fever is required. There is no need to pursue neuroimaging (CT or MR scans) are also not needed.

If your child has a febrile seizure there is a 30% risk of another febrile seizure before age 6 years. If a second seizure then there is a 50% risk. Seizure medications are not prescribed for the chronic management of children with febrile seizures. On rare occasions the use of a prophylactic benzodiazepine medication is considered for recurrent febrile seizures.

Recommendations for Weight Management in Children and Adolescents

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It is important you follow and are aware of your child’s yearly height and weight assessments. This allows a body mass index (BMI) to be calculated. If your child’s BMI is > 95% than he is severely over weight. Another term for this is obese but be cautious when this term is used. It is very important not to instill fear or a feeling of hopelessness when discussing weight issues. If he is between the 85% and the 95% he is overweight. If your child is in either of these categories an assessment by your pediatrician is needed and a decision must be made whether intervention is necessary.

The quality of every meal your child eats should be evaluated. Quantity and portion size are important but quality is just as important. Limit eating outside of your home, always eat breakfast, encourage family meals and avoid all sugar or artificially sweetened drinks. Eating whole fruit is much healthier than drinking juice. Make certain your child is eating a high fiber diet based on low caloric density that is high in fruits and vegetables. Avoid excessive consumption of foods that are high in energy density such as fat and protein.

Look at the environment your child lives in. Does it support a healthy dietary intake and an active lifestyle? Are there environmental or social barriers to physical activity? Is there excessive unbalanced media exposure to a diet high in unhealthy foods? Is adequate time spent every day away from sedentary activities such as television watching, video games and computer use?

Goals should include five or more servings per day of fruits and vegetables, less than two hours per day of screen time, one or more hours per day of moderately strenuous physical activity, no electronic devices in the bedroom and no sugar or artificially sweetened beverages.

A family history of obesity, heart disease, stroke and type 2 diabetes is important. If there is a history in your family of one or more of these then added attention to your child’s growth, activity level and dietary intake is essential. Special testing may also be required.

As a parent you must disengage from many of the minor food and activity decisions. Your child must be encouraged and allowed to self-regulate both food intake and daily exercise. This does not mean you do not discuss guidelines but rather establish a setting where success is easier to achieve and healthy choices become easier to make.

If routine interventions are unsuccessful then structured weight management protocols should be pursued under the direction and guidance of your pediatrician. This will include determination of the components of a healthy diet as well as structuring of daily meals and snacks. Activity time will also need to be supervised and screen time decreased to less than one hour per day. Structured behavior modification programs can also be used.

Fever Information

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Does she have a fever?  What is her temperature? Questions like these induce fear in most new parents. The word fever is a trigger for worry and concern. It spawns many questions including: What is wrong with my child? Is she seriously ill? Could she have something seriously wrong with her? What do I need to do for her? Does she need to see the doctor? Does she need an antibiotic? What other signs of infection should I be looking for? Could the fever cause her to have a seizure? These are just a few of the many thoughts you will experience. These concerns and many others are healthy and appropriate.  When concern is not managed and moderated worry replaces it and unhealthy consequences and patterns of behavior result. Your first step in this process is to learn about the causes and meaning of fever.

Fevers are healthy. A fever is an elevated body temperature above the normal baseline of 98.6 F. It represents your child’s physical response to stimuli inside or outside her body. Some fevers are caused by high ambient temperature or excess clothing. Infants do not shed heat as well as older children. Your infant does not sweat as well as older children and hence she does not cool herself as well via evaporation. Your body cools when water evaporates. Evaporation causes a net loss of energy and results in surface cooling. As humans we rely on sweating as a defense mechanism to prevent overheating. We sweat when our basal body temperature rises, when we exercise. or when we are placed in a warm environment. Blood vessels in the skin dilate and you become flushed. These are healthy responses and protect each of us. Infants, however, are less able to respond in this fashion and hence are more prone to environmental overheating. To help you decide whether your child’s fever is from overheating or something else the first step is to take her temperature and check out your surroundings. Is she overdressed for the environment or being exposed to excess radiant heat? Does she seem fussy and unsettled? Has she shown any other signs of illness? Feel her tummy and her toes. If both of them are overly warm she may be overheated.  Take off her clothes down to the diaper and smile and talk to her. If she becomes more comfortable and playful you found your answer. You can even spritz her with tepid water to assist evaporation. More heat is lost by evaporation than by radiation or conduction.  cool clothes can be placed on areas of her body where large blood vessels pass. These include her neck, groin and armpits. Such cooling is rarely needed. Misting with tepid water and fanning her is almost always enough unless severe overheating has occurred. These same strategies can be used if a high fever due to illness occurs.
If the fever is due to illness do not be scared. A fever is healthy. It is your daughter’s response to an infection. A fever enhances her body’s ability to fight off the infection. An elevated body temperature helps her body kill invading germs. Infants under 6 weeks of age, however, must be handled differently than older children when it comes to fever. If your infant under 2 months of age has a temperature over 100.5 F you must call your pediatrician. Young infants do not fight off infection as well as older infants. Your pediatrician will see your child and decide if any testing is needed. In children under 6-8 weeks of age extensive tests may need to be done including blood tests, urine tests and spinal fluid tests. Often these infants are admitted to the hospital and are placed on intravenous antibiotics for several days while waiting for culture results. Almost always the final diagnosis is a viral illness but the risk for a bacterial infection must always be considered.
For infants and children over 2 months the most important thing for you to do is relax, breathe and look at your child. Do a quick survey. How she is acting? Has she been eating well? Does she have any breathing difficulty? Has she been coughing? Has there been any change in her urine production or urine quality. Does she seem irritable or is she smiling and happy? Does she have a clear runny nose? Are other household members ill with colds? These questions will help you decide if you need to call the pediatrician. If the temperature is greater than 101F or climbing then you should call your pediatrician. If it is low grade and you see no warning signs then sit back, try to relax, and talk to your baby. Take her clothes off down to the diaper and recheck the temperature in 30 minutes. You do not need to give tylenol or ibuprofen. Most low grade fevers are due to minor viral infections that require no treatment. If your intuition tells you to call or your child shows irritability, poor feeding or breathing issues then always call your pediatrician. Temperature is not as important as the other signs and symptoms. If in doubt, always call. Reassurance is the best medicine.  As your child and your experience grow you will soon be giving advice to other parents.

RSV and Bronchiolitis

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Infants are at risk to develop bronchiolitis. Bronchiolitis is the name given to
infections in the small passageways within your infants lungs. These are called
bronchioles. The most common cause is an infection caused by the RSV
(respiratory syncitial virus).  Most of these infections start off as a minor
cold with a clear runny nose and a mild cough. Over several days the cough
increases and often becomes repetitive and staccato. Often your child will gag
and choke due to the coughing. Feeding may decrease and breathing will increase
in effort and rate.  You may notice retractions between your infants ribs or
above their collarbone or sternum. They may have a seesawing breathing pattern
called tummy breathing where their chest moves in while their abdomen pushes
out. All of these are signs of increased breathing effort. In these situations
you must talk to your pediatrician. Often these infants will have a normal body
temperature and when not coughing they may smile and be playful. As her work of
breathing increases, however, she will become irritable and her sleep pattern
will be disrupted.

Your pediatrician will decide if your infant needs to
receive any support to help with the infection. Support options include
admission to the hospital for intravenous fluids and oxygen. Antibiotics do not
help since the cause is a viral infection. An Xray is often done and sometimes
antibiotics are given while waiting for culture results. Nebulized medication
may be given via a mask over her nose and mouth. This helps the pediatrician
decide if any bronchospasm is present. Bronchospasm is the name given to the
tightening of the small airways in your child’s lungs. Her lungs are like two
upside down oak trees. Each branch is covered by bark which can become
constricted due to inflammation from a viral infection. The mist that comes out
of the nebulizer has a medication in it called albuterol. It relaxes the bark
and increases the size of the branches for air and oxygen to enter the lungs.
Another medication is racemic epinephrine. This medication is similar to
chemicals released in your body when you become scared or frightened. This
chemical is called adrenaline. It allows you to breathe deeper and take in more
oxygen and is part of what is called your body’s “fight or flight”
response.

This illness can last for several weeks. It usually peaks in severity over 3-5 days and the cough gradually fades over several weeks. If your child has bronchiolitis good hand washing and not sharing any bed clothes or toys that are exposed to the infant is very important. Most of the time if adults develop an RSV infection it will be a minor cold, but, young infants are at risk for more serious symptoms.  RSV infections are frequent in day care facilities. It is important infants do not share toys and that all caretakers
use good hand washing practices. Premature infants and infants with underlying
heart or lung problems may be given during RSV season (winter and early spring)
a monthly medication called Synagis. It increases the bodies ability to fight off an RSV infection.

Infants with RSV almost always respond well and heal themselves. Some of these infants are at higher risk for developing asthma as they become toddlers and preschoolers. Most of the time, however, your infant will do well and will begin to develop an immunity to infection that will protect her for years to come. This illness and many others will give you the first of many opportunities to learn how she is in charge of her own destiny. A destiny you will always be part of but not responsible for. From the day she was born this process of letting go began. RSV will become part of this journey.

Vomiting and Diarrhea

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When your young child develops vomiting or diarrhea for the first time it can be
scary. Frequently, the vomiting will develop first and in the next day diarrhea will start. If there is blood or yellow bile in the vomit, the vomiting is projectile or if you child cannot stop vomiting you should call the pediatrician. Most of the time, however, the vomiting will stop after several vomiting episodes. The first step is to survey your child for any other problems. Make sure there is no evidence of head injury or drug ingestion. As
long as he is alert and consolable the best thing you can do is to pursue watchful waiting. Do not give anything to drink for 30 to 60 minutes. If there is no more vomiting then give 1 tsp of an oral rehydrating solution like Gatorade or Pedialyte every 10 mintutes. Do this for 1 hour and then increase to 2 tsp every 10 minutes for the second hour and 3 tsp every 10 minutes for the third hour. Thereafter, he can have as much Gatorade, Pedialyte, breast milk or formula as he likes. If he again vomits then restart the process. As long as no warning signs are present and he continues to urinate at least 2 times every 12 hours he will not become dehydrated. Trust your intuition and call the pediatrician if you have any concerns.

After he has tolerated liquids for a few hours you can gradually return him to his prior diet. Go slowly and be cautious with foods that are high in protein and fat. These can be harder to digest. Foods that are high in complex carbohydrates are tolerated best. If he
is breastfeeding then resume breastfeeding. Breast milk has natural antibodies that can help reduce the risk of vomiting and diarrhea.

If he develops diarrhea the most important thing is to protect the diaper area from skin
irritation due to the liquid stool. Loose stools are irritating and contain enzymes that will break down the skin. Use plenty of vaseline and coat the entire diaper area. If necessary check the diaper every 20 minutes and apply vaseline to the entire diaper area every time. The more vaseline you apply the better. You will also find it is easier to clean the diaper area when vaseline serves as a barrier between the skin and the diaper. There is nothing worse than an infant crying from pain due to a severe diaper rash that burns every time another episode of diarrhea occurs. It will take up to several days for most diaper rashes to clear. It is like a rugburn. Once it happens the skin will take several days to heal. Protecting the skin also helps prevent yeast infection in
the diaper area. An ounce of protection is worth a pound of cure.

In the past a clear liquid diet was suggested for infants and children with diarrhea.
This is no longer suggested. Pediatricians now suggest a healthy diet with plenty of fiber be given. The complex carbohydrate diet described above is suggested with protein and fat in moderation. Fruits and vegetables are allowed.

Be cautious about fruit juice and other sweet flavored drinks that can aggravate the diarrhea.  Watch his urine output. If he is urinating 2-3 times every 12 hours he is safe from dehydration. If you see blood or mucous in the stool call your pediatrician for advice. If the diarrhea last longer than 1-2 days or if you have a young infant less than 12 months and he is having numerous watery stools a day you should call your pediatrician. Infants and young children who continue to vomit and have diarrhea are at high risk for dehydration. Do not let this happen.

A common diarrheal illness is rotovirus. It is spread by poor hand washing and poor stool hygiene.  Infants now receive an immunization to help prevent this infection but all children and adults are at risk for this “stomach virus”. If your infant has diarrhea he should not return to day care until the diarrhea has resolved. The diarrhea can last for several days but most young children do well. Young infants can be given intravenous fluids if needed and sometimes require a brief hospitalization.

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.