Teething

Infants begin teething between four and six months of age. The first teeth to come in are often the bottom two middle teeth, followed by the two upper central teeth.

Symptoms associated with teething are increased drooling, swollen gums, increased fussiness and general discomfort. A slight temperature is frequently associated with teething, but a temperature over 100.4 is atypical and your pediatrician should be called.

Treatment for teething consists of applying a cool wash cloth to your child’s gums, applying teething gels like Nums‐it or Orajel, allowing your child to gnaw on a cooled soft toy like a “teething ring” and finally giving Tylenol or Motrin (if older than six months) if your child has significant discomfort. 

Sun Safety

All children should be protected from sunburn with protective clothing like hats and fine‐meshed shirts as well as a sunblock.

Our recommendation is to apply a PABA‐free, UVB/UVA sunscreen that is waterproof and has a sun protection factor (SPF) of 30 or greater. Sunscreens should be applied 30 minutes before outdoor activity and should be reapplied several times throughout the day, especially after coming out of water, to insure proper protection.

For children less than 6 months of age, the best approach is to avoid direct sun exposure and to use protective clothing. If direct sun is unavoidable, sunscreen application is ‘ok’ to utilize.

The Environmental Working Group has a website that gives a list of the most environmentally safe and friendly products. The link to this site is: www.cosmeticsdatabase.com. 

Introducing Solids

Most babies are ready to eat solid foods between four and six months of age. Before beginning solids, your infant should have good head control. Children with a family history of allergies should consider introducing food at six months of age.

FOUR TO SIX MONTHS: Generally, we recommend starting with two tablespoons of rice cereal twice a day for the first two weeks. (This simple grain cereal is generally well‐tolerated by infants and allows the child the opportunity to “learn” what it is like to take solid foods.)

After two weeks of rice cereal, white fruits (such as apple sauce, pears and bananas) and yellow vegetables (such as squash, carrots and sweet potatoes) may be introduced on a one‐ at‐a‐time basis every 4 to 5 days. A third meal can be added at this time as well.

This slow introduction process allows parents to assess for food allergies or intolerance, which can manifest as rashes, diarrhea or vomiting of the food. Any food that causes these symptoms in your child should be stopped immediately and your pediatrician should be notified.

Later on, after these blander foods are introduced, green vegetables (such as spinach and broccoli) and colored fruits (such as apricots and peaches) can be introduced. White meats, (such as chicken, fish and lamb) can be introduced around six months of age. Red meat, rich in zinc and iron, is typically introduced around eight to nine months of age.

EIGHT TO TEN MONTHS: This is a good time to introduce finger foods into the diet. Make sure that the pieces are cut up into small pieces (Cheerio‐sized) and that the food is soft enough to chew. You can also introduce egg yolks and dairy products like yogurt and soft cheeses at this time. If there is a family history of dairy allergy, however, we recommend that you speak with your pediatrician before starting these foods.

When a larger variety of solid foods is introduced, mothers will notice a decrease in the number of breastfeeding episodes to 4 to 5 times per day or a decrease in the amount of formula to about 20 to 14 ounces per day.

TEN TO TWELVE MONTHS: By this age, your baby’s diet should include nearly all table foods except those listed below:

**Do not give your child any honey, whole milk, citrus, peanut butter, nuts or shellfish prior to one year of age.

**Avoid nuts, popcorn, hotdogs, chewing gum, whole grapes, uncooked carrots and hard candy prior to three years of age due to the risk of choking.

Head Injuries

Head injuries are common among young children. Fortunately, serious consequences are rare, especially if there has NOT been a loss of consciousness after the injury.

The best way to avoid a head injury is to prevent it. Car seats or booster seats from birth through six years OR 60 pounds are not only the law, they are a good idea! Always buckle up your child.

Once your child becomes mobile, safety proofing your home is important. Be wary of sharp edges, tabletops and fireplaces.

Children like to climb on furniture, so be sure that wall units and bookcases are fixed to the wall.

Finally, children should wear a protective head gear while doing any activity that could result in head injury. Bicycle riding, skiing and skateboarding are three good examples.

IF YOUR CHILD DOES SUSTAIN A SIGNIFICANT HEAD INJURY, we recommend that you call us immediately. Having your child evaluated by a physician is also critical.

IN THE FIRST 24 HOURS AFTER INJURY, your child should be monitored for the following symptoms:

‐ Increased fatigue
‐ Vomiting and nausea ‐ Headache complaints

‐ Double or blurred vision ‐ Unsteady gait
‐ Personality changes
‐ Confusion

‐ Excess irritability

**If your child displays any of the above symptoms, please call us for an evaluation. 

First Aid Kit - What to Include

We recommend having the following products at home so that when they are needed, you are well prepared.

1. Infant/Children’s Tylenol (Acetaminophen)

2. Infant/Motrin (Ibuprofen) ***Not to be given to children under 6 months 

3. Desitin or other diaper rash cream with Zinc Oxide

4. Sunblock: PABA free with both UVA and UVB coverage

5. Children’s Benadryl suspension

6. Hydrocortisone 1% ointment

7. Lotrimin (clotrimazole) ointment

8. Aquaphor or other hypoallergenic skin moisturizer

9. Nasal saline drops and bulb suction (We like the Nasal Aspirator) 

10.Thermometer and KY jelly for rectal digital thermometers

11. Neosporin ointment

12. Cold packs

13. Band‐Aids

14. EpiPen if your child has ever had a severe allergic reaction to foods or environmental stimuli (i.e. Bees). 

Ear Pain

Ear pain is one of the most common complaints in children. As there are many possible causes of ear pain, it is important to have your child evaluated by a physician. It is difficult to assess a child’s ear pain over the phone and cannot be diagnosed appropriately. There are three main causes of ear pain, and we will discuss each one briefly.

1. Inner Ear Infection: Inner ear infections may be caused by either a viral or bacterial infection and therefore not all infections require antibiotics. A recent cold or nasal congestion or fluid in the inner ear places your child at greater risk of an ear infection.

   a. Symptoms include: ear pain, fever, irritability and nasal congestion.

b . Treatment for inner ear infections is typically antibiotics, but in some circumstances, it is okay to watch for 48 hours to see if this will resolve without intervention. Tylenol and Motrin and numbing ear drops will help with pain symptoms.

1. Outer Ear Infection (Swimmer’s Ear) is an infection in the ear canal. Children who swim or have frequent contact with water are at greater risk. Water in the canal can cause irritation and can allow for bacterial infection.

   1. Symptoms: outer ear pain, especially when pulling on ear; discharge from the ear canal. Some children will also develop a fever.

   2. Treatment: antibiotic ear drops

   3. Prevention: if your child develops recurrent outer ear infections, thorough drying of the ears after swimming and bathing may decrease incidence. Over the counter ear drops such as Swimmer’s Ear work well.

2. Teething: Even though it is the gums that are painful and swelling, a child may feel the pain in the ear and this is what is called “referred pain.” The molars are the ones that particularly cause referred pain.

   1. Symptoms: drooling, low‐grade fever, pulling or gnawing on toys

   2. Treatment: see teething section for more details: massaging gums with finger or a cool wash cloth, Tylenol or Motrin for severe symptoms. 

Diarrhea

Diarrhea is defined as a sudden increase in watery stools. It is most often caused by a viral infection of the intestines called gastroenteritis. Diarrhea may present alone or with other symptoms including vomiting, fever and abdominal cramping. It can last for up to a week but typically the symptoms are the most severe in the first 24‐48 hours. Because it is a virus, treatment is supportive care and ensuring adequate hydration. If the diarrhea is persistent, then it is best to speak to your pediatrician, as there are other causes of diarrhea as well.

For children with diarrhea, the most important aspect of treatment is hydration.

Fruit juices may exacerbate the loose stools and it is best to avoid them. For a majority of children, dairy is okay and we encourage continuing to breastfeed, but in a minority of children it may cause increased bloating or cramping. If this is the case, then it is best to avoid dairy until the diarrhea resolves. If you child feels like eating, you can offer foods like bread, rice, applesauce and toast.

Probiotics have also been shown to help decrease diarrheal symptoms and we do recommend giving it daily during this illness.

Please call the office if:

• Signs of dehydration: no urine for more than 8 hours, no tears when

  crying, dry mouth, listlessness, weight loss and sunken eyes.

• Any blood in the stool

• Fever for more than 72 hours

• Localized abdominal pain

• Persisted diarrhea for more than 48 hours 

Croup

Croup is a viral illness that causes fever and inflammation of the upper airway. This inflammation causes the “barky” or seal‐like cough. The swelling can also make the airway so narrow that they have noisy breathing even without coughing and this is called stridor. The cough is usually worse at nighttime and can be very scary for the family.

Children are more likely to get croup between 6 months and 3 years of age. After 3 years of age, the airway is larger, so the swelling typically does not cause any significant trouble. Like other viral respiratory illnesses, it can last for a week but typically there are just 2‐3 nights of significant coughing and the fever usually does not last for more than 72 hours.

Croup can be scary, but it is important to stay calm because the more calm your child is, the more comfortable he will be able to breath. Warm moist air can help with the stridor. Run a hot shower in the bathroom with the door closed and sit with your child for at least 10 minutes. A humidifier in the room while sleeping will also help as well. If your child does not improve and has stridor at rest (as opposed to when he is crying, agitated, or coughing), then he needs to be evaluated and may need steroids to decrease the swelling. Like other viruses, antibiotics will not make this illness better.

Please call the office immediately if your child is having any difficulty breathing. 

Bee Stings

Summertime brings out the bees and sometimes, no matter how careful we try to be with our children, they get STUNG! When this happens, scrape out the stinger gently at the level of the skin. (Grabbing the stinger with your fingers can actually result in more venom being injected into your child.)

Immediately after a sting, your child will experience pain and some swelling.
These symptoms usually resolve within a couple of hours. Some children have swelling and redness that persists for a few days. If this does occur, please contact one of our physicians.

For mild reactions, apply a cold compress to the area. This will help decrease symptoms. Home remedies such as meat tenderizer (that helps to denature the venom proteins) and toothpaste do work. Finally, oral Benadryl is helpful in reducing the allergic response associated with beestings.

Call 911 if your child displays any of the following symptoms:
*Sudden onset of a hoarse voice, shortness of breath or difficulty breathing *Lightheadedness, dizziness or loss of consciousness
*Nausea, diarrhea or vomiting 

Cough and Cold

Children are notorious for having many colds throughout their early years and most will have at least 8‐10 colds in the first two years of life. Since these symptoms can last for up to three weeks, it may feel like they have a constant runny nose!

Colds are caused from viruses and typically peak during the fall and winter months. They are spread directly through contact with the virus such as sneezing or coughing. Cold symptoms are coughing, sneezing, fever, nasal congestion and runny nose. Most children do not need any treatment for viruses and antibiotics are used to treat bacterial infections, NOT viral infections. The best treatment is supportive care. There are many cough and cold medications that are available but these preparations are no longer recommended for children under 4 years of age.

Young infants are susceptible to colds and because they are nasal breathers, may become fussy during feeding or have some difficulty sleeping. In this case, you may need to let your child take several breaks during feeding to catch their breath. To help their breathing, you can place a few drops of nasal saline in each nostril and then suction with a nasal aspirator. The saline helps to break up the mucous and this will help their breathing. We recommend doing this prior to feeding and sleeping. Furthermore, a cool mist vaporizer in the room may help loosen nasal secretions and ensure a more comfortable sleep.

When to call the office:
• Fever that persists for more than 72 hours
•Any difficulty breathing
• Infant less than 2 months old with a fever
• If your child is lethargic or refuses to eat
• Fever that does not respond to Tylenol or Motrin