絞ヶ婓盄侕15973
忑珜 - 痔諦忑珜 - 襞妏惘探@埽擄毞挭 - 恅梒堐黍 [痔諦忑珜] [忑珜]
苤嫁都獗瓷腔誘燴迵茼勤(荎恅唳)
釬氪ㄩhome99
楷桶奀潔ㄩ2009-10-27
載陔奀潔ㄩ2009-10-27
銡擬ㄩ4362棒
ぜ蹦ㄩ0う
華硊ㄩ98.
::: 戲醴 :::
迡跤袧鎔鎔1
惘惘誘燴迵傖酗3
迡跤袧鎔鎔3
峈佶蜊3
荎逄悝炾
峈侅百
倎玿軓氈
燴笙趕枙
峈佶蜊2
迡跤袧鎔鎔2
妗蚚訧蹋
惘惘誘燴迵傖酗2
峈佶蜊1
む坳
瓟狻翩艙趕枙
迡跤陔鎔鎔
惘惘誘燴迵傖酗1
祑弊坻盺

郔輪秪峈苤惘汜瓷ㄛ符砩妎善惘惘汜都獗腔※苤瓷§蝮陏倏刱楷尥妦繫腔珩祥褫綺弝陛﹝拸砩笢艘善涴跺壽衾珨虳苤嫁都獗瓷腔訧蹋ㄛ飲枑善蝥弮眝本分瞨狡黤藩厊僈嵿誕妗蚚ㄛ蝜砑眭耋睡奀剒猁湖萇趕跤PEDㄛ珩褫眕統蕉珨狟ㄛ棒唗覤瞿疫驤鶺植蕛Ms煦砅陛﹝

Colds
Cough
Fever
Croup
Asthma/wheezing(祄霪, 揚霪)
Sore throat
Swimmer's Ear (蚔蚞俶嫉瓷;蚔蚞俶嫉朒)
Ear Infection (earache, OTITIS MEDIA)
Eye Infection
Head Injuries
Febrile Seizures (俶儐婽, ▽瓟▼俶騍豵楷釬)
Vomiting
Diarrhea
Constipation
Abdominal Pain
Pinworms
Head Lice (芛坉)
Diaper Rash
Chickenpox (阨飩)

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Colds
(UPPER RESPIRATORY INFECTION (URI))

Runny or stuffy nose, sometimes with a fever, sore throat, cough, hoarse voice or swollen glands in the neck.

♂ Colds are caused by viruses, and antibiotics do not cure viruses.
♂ Transmission is by hand-to-hand contact, sneezing, coughing and they can persist on surfaces of objects for many hours. The virus is shed from the nasal discharge.
♂ People are contagious a day or two before the onset of symptoms and for an average of 7 to 10 days. As the cold progresses, contagiousness gradually decreases. Shedding of the virus from nasal discharge may last as long as 2 or 3 weeks. The incubation (time from exposure to the virus and the start of symptoms) is less than a week.
♂ Colds are not caused by cold air, drafts, or swimming.
♂ Some newborns sound stuffy on and off, but there is no nasal discharge. They are having dried mucous developing in the nasal passage which can be cleared with salt water drops and bulb syringing. Infants under about 4 months must breathe through their nose and sucking can become difficult with a cold. They may be at risk of becoming dehydrated if they are not feeding well.
♂ Most children get about six to ten colds per year. The frequency is higher if the child is in daycare, has siblings in school or is around a lot of other children.
♂ If a child is chronically congested (more than two or three weeks), allergies or sinusitis may be present. A foreign body placed in the nose may cause a one-sided foul smelling thick runny nose. Discuss these possibilities with your doctor if the runny nose is more than 10 to 14 days or if you suspect a foreign body in the nostril.
♂ Most colds last 7 to 10 days. Fevers usually last less than 3 or 4 days. The cough is usually the last symptom to go away (sometimes up to 2 weeks).
♂ Nasal discharge can be clear, white, yellow or green. It is often more colored in the mornings or after a nap. Sometimes at the end of the cold, the discharge is more green. The color alone does not necessarily mean an infection that requires antibiotics.
♂ Milk does not usually need to be eliminated with colds, unless allergies are being suspected.

▽Call the doctor immediately if:▼
♂ Breathing is difficult and does not improve with suctioning of the nose, especially in a young infant under 4 months
♂ Is becoming dehydrated because of inability to feed or vomiting
(See other sections on fever, ear infection, cough if appropriate)

▽Call during office hours if:▼
♂ Nasal discharge is more than 10 to 14 days, especially, if the child appears to be getting worse
♂ Skin under the nose becomes scabbed/crusted
♂ Yellow eye discharge (See eye problems)
♂ Earache or very sore throat
♂ Fever more than three days
♂ Having difficulty eating because of stuffiness in infant under 4 months
♂ Suspicion of a foreign body in the nose

▽Home treatment▼
1. Runny nose with lots of discharge.
For young infants, use a bulb syringe to clear the secretions. It is especially helpful before a baby nurses or takes a bottle. Use a humidifier at night. Cool mist humidifiers are safer than steam vaporizers because of the risk of a curious toddler burning himself with the steam. Elevate the head of the crib or bed. This is best done in cribs or bassinets by placing a pillow underneath the mattress. Never place infants on pillows.

2. Stuffy nose with little discharge.
Warm nose drops with a solution of salt water (use 1 teaspoon of salt in a cup of warm water) or purchased saline drops can be placed in each nostril. This will often help to break up the mucous and the child can then be suctioned with the bulb syringe. For best results, block the opposite nostril when bulb suctioning. In an older child they can be told to blow the nose after the drops have been in for a minute. This may need to be repeated a few times. In addition, having the child sit with the parent in a steamed up bathroom with the shower running is also helpful. Use the humidifier at night.

3. Allergies.
Occasionally, a child may have allergies that is causing a stuffy or runny nose. Things that may make you think about allergies:
♂ recent introduction of new formula or milk products
♂ family history of allergies, asthma or eczema
♂ runny nose more than 2 weeks, often associated with sneezing, or itchy eyes
♂ runny nose is on and off
♂ child does not seem ill
♂ dark circles under the eyes, called "allergic shiners" or a crease on the nose from rubbing an itchy nose

If you have concerns about allergies, contact your doctor during office hours.

4. Complications of a cold.
Ear infections, sinusitis and pneumonia may be complications of a cold. All green noses do not mean infections which need antibiotics. Sinusitis is a bacterial infection of the sinus cavities (small spaces in the bones of the face). Symptoms of sinusitis may include: clear, green or yellow congestion for two or more weeks and nighttime or morning cough from a postnasal drip. Sometimes, they have a fever, foul breath, fussiness and headaches. One way to diagnose this is by obtaining a sinus x-ray. Infants under one year of age do not have well-developed sinuses and are not as prone to getting sinusitis. Treatment involves antibiotics and topical nasal steroid sprays.

5. Over-the-counter medications.
Over-the-counter medications may or may not be helpful. They do not shorten the course of the cold and they may not prevent ear infections. Some of these medications will cause a child to be either jittery and "hyper" or sleepy. They are recommended when the child is very miserable and having difficulty drinking or sleeping. Please discuss with your doctor during office hours about their philosophy and recommendations for these medications, because this may vary according to your doctor. Acetaminophen or ibuprofen may be used for fever and may be given at the same time as a over-the-counter cold medicine.

6. Diet.
Milk does not necessarily need to be eliminated with a cough or cold, unless milk allergy is suspected. Fluids do need to be encouraged and solid foods are not as important. Make sure the child is staying well-hydrated.

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Cough

A reflex that forces air from the lungs with a sudden noise. It is a symptom for a wide group of diseases.

♂ The main concern is in watching for signs of difficult breathing:
*Mild difficulty breathing is noted when a child is breathing a little faster than usual, but is able to eat and talk normally. Babies are able to take a bottle or nurse comfortably and are able to smile and coo. The stomach muscles may be moving in and out very slightly when the child breathes. This visible movement of extra muscles to breathe is called retractions. Places to look for retractions include the muscles in the neck, the muscles in between or below the ribs and the stomach muscles.

*Moderate difficulty breathing is noted when a child is breathing with more effort than normal, has retractions of the muscles of the stomach and possibly between the ribs. He may appear pale, but not blue. He will interact and talk in short phrases, but maybe not in complete sentences and may play for brief periods. A baby taking the bottle or nursing may need to pause more frequently, but is able to feed.

*Severe difficulty breathing is noted when a child is struggling to take each breath. Retractions are seen of the stomach muscles, the muscles between the ribs and those above the collarbone. Audible grunting may be noted. He may need to sit up and lean forward just to breathe. The child will appear agitated or frantic. The child will not make good eye contact, interact and there is obvious difficulty getting a word out. A baby may appear listless and is unable to suck a bottle or nurse effectively. The tongue, lips and possibly nailbeds will appear blue. This is a real emergency and it must be decided if it is quicker to take the child immediately to the emergency room or call 911.

♂ Coughs may be dry and hacking or wet and productive. This does not really help to tell you the cause of the cough.
♂ Coughs help protect the lungs and do not necessarily need to be suppressed with medications.
♂ Coughs are usually the last symptom to resolve during the course of a cold and may last up to 2 weeks.
♂ Coughs may cause a child to vomit immediately after a coughing episode.

Causes of cough can include:
♂ Cold viruses often causes a postnasal drip and that causes a cough. This is the most common cause for a cough.
♂ Croup is characterized by a barking, "seal-like" cough caused by a virus.
♂ Pneumonia, which is an infection in the lungs. It may be caused by viruses or bacteria. There is also an unusual organism called mycoplasma, which causes the classic "walking pneumonia". Children with pneumonia can barely appear sick with low-grade fever and a mild cough or be very ill with high fevers and labored breathing.
♂ Asthma may cause coughing and wheezing. This may be triggered by viruses, exercise or an allergic trigger like dust, smoke, mold or pets.
♂ Foreign body aspiration should be suspected if there is a history of a coughing or choking episode with eating, especially with small hard foods like nuts or popcorn.
♂ Sinusitis may cause a cough especially at night or in the mornings. (See colds for information on sinusitis).
♂ "Spitting up" or gastroesophageal reflux in babies under a year may trigger coughing because of small amounts of aspiration of food into the lungs. Wheezing or recurrent pneumonia may be associated with reflux.
♂ Pertussis or whooping cough is an infection that is characterized by a severe cough where the child has difficulty catching his breath with the coughing episodes and may turn blue with coughing.
♂ Bronchitis is a debated issue in pediatrics. Some researchers feel that children don*t really develop true bronchitis. The very deep cough, "bronchitis type cough" is sometimes from a postnasal drip or may be due to pneumonia.

▽Call the doctor immediately if:▼
♂ Signs of severe or moderate difficulty breathing
♂ Breathing is fast and/or labored in between coughing episodes
♂ Appears agitated, gasping for breath
♂ Lips or tongue or nailbeds turn blue or purple with the coughing episodes
♂ Blood tinged secretions being coughed up
♂ Chest pain that is continuous
♂ Listless, lethargic or difficult to arouse or acting sick
♂ Suspicion of aspiration of a foreign body, household chemicals or powders

▽Call during office hours if:▼
♂ Fever more than 48 hours
♂ Cough more than 2 weeks
♂ Coughing episodes associated with chest pain
♂ Less than 2 months old
♂ Coughing episodes that cause lack of sleep
♂ Coughing associated with significant vomiting

▽Home treatment▼
1. Medications. Coughs may be a helpful mechanism for the body to protect the lungs, they do not necessarily need to be suppressed. If the cough interferes with a child*s sleep or school or work, a cough suppressant may be helpful. They should not be used under one year of age without discussing with your physician. Dextromethorphan (DM) is an over-the-counter medicine available in many of the cold remedies. Codeine cough suppressants are available only by prescription and should not be used without the approval from a physician. Cough drops are not recommended in young children because of a choking risk.

2. Humidifiers. These are helpful, especially if a dry cough is present. If a child is having a coughing spasm that is difficult to stop, a session in a steamy bathroom with the shower running may be helpful. Humidifiers must be kept clean and if possible, distilled water is recommended. Cool mist humidifiers are safer than steam vaporizers because of the risk of a curious toddler burning himself with the steam.

3.Diet. Milk does not need to be eliminated with a cough or cold, unless milk allergy is suspected. Fluids do need to be encouraged, solid foods are not as important. Make sure the child is staying well-hydrated (see dehydration).

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Fever

A higher body temperature than normal. Fever is a healthy way in which the body fights infection.

♂ The main concern is how sick your child is acting and that is more important than the height of the fever. High fevers are not usually dangerous. The height of the fever does not tell us the seriousness of the infection.
♂ How to take a temperature.
♂ Temperature strips on the forehead are inaccurate
♂ Ear thermometers are not very reliable in children less than 6 months.
♂ High fevers do not cause brain damage unless greater than 107 F or associated with diseases that affect the brain, like meningitis (an infection of the fluid that covers the brain and spinal cord).
♂ Do not give tylenol in infants less than two months with a fever. If you are concerned your baby under 3 months feels warm, take a rectal temperature. Call your doctor immediately if above normal.
♂ Breathing rates and heart rates are increased with a fever.
Seizures associated with fevers only occur in about 3 to 5 percent of the population and these are called febrile seizures. They are generally harmless. See febrile seizures below.
♂ Teething does not cause a significant fever.
♂ A common viral infection called roseola (繭孵淟), affects infants from 6 months to about 3 years. There is a fever for 2 to 3 days and then as the fever goes away, a rash develops. The rash is flat and pink or slightly raised dots, that looks like an intense heat rash. It is mostly on the neck and body and lasts 1 to 2 days. Once the fever is gone for 24 hours, the child is not contagious. There is no specific treatment for the rash.
♂ Heat illness occurs because of excess heat exposure. There is a range of severity of this disease. Mild symptoms can include muscle cramps, stomachache, and headache. Heat stroke is a life-threatening emergency and is recognized by temperatures over 106 F (41 C), confusion and is usually brought on by vigorous exercise in the heat.

REPEAT TEMPERATURE IN 1 HOUR IF BETWEEN 100∼F AND 100.5∼F:
♂ Over bundled, especially common in babies under 3 months; unwrap and repeat temperature
♂ Recent exercise
♂ Eaten hot foods before an oral temperature
GIVE ACETAMINOPHEN OR IBUPROFEN:
♂ Received DPT (Diphtheria-Pertussis-Tetanus) injection in last 24 hours
♂ Received MMR (Measles-Mumps-Rubella) or varivax (chickenpox vaccine) in the last 7 to 14 days

▽Call the doctor immediately if:▼
♂ The child is less than two months old
♂ Constant crying, irritable, inconsolable and acting sick (if possible, decide one hour after acetaminophen or ibuprofen).
♂ Drooling more than usual and difficulty swallowing
♂ Stiff neck or headache out of proportion to fever
♂ Purple spots on the skin - may be large or pinpoint
♂ Difficulty breathing, unless it is due to a stuffy nose
♂ Difficult to arouse, confused or delirious
♂ Having his first febrile seizure

▽Call during office hours if:▼
♂ The child is 2 to 6 months old (unless after DPT shot)
♂ Fever is more than 72 hours
♂ Associated symptoms such as an earache, sore throat, urinary burning or frequency, persistent cough
♂ Fever is more than 104, especially if child is less than two years old

▽Home treatment▼
1. Acetaminophen.
Products such as Tylenol, Liquiprin, Tempra, Panadol, Anacin-3 and generic store brands are all acetaminophen products. They may be used to make a child more comfortable, but it does not treat the underlying illness. They may be given every 4 to 6 hours. Within 1 to 2 hours after given, the fever is usually down by 2∼ to 3∼ F. The temperature does not always return to normal. Again, how sick your child is acting is more important than if the fever comes down to normal or not. If your child is resting comfortably, there is no need to wake him to give acetaminophen, unless he is prone to febrile seizures.

2. Ibuprofen.
Products such as Children*s Motrin and Motrin oral drops, Advil and generic store brands are all ibuprofen products and are available over-the-counter. One advantage of ibuprofen is the longer-lasting effect of 6 to 8 hours of fever reduction. Some children who are not responding well to acetaminophen may respond better to ibuprofen.

3. Aspirin.
Aspirin is generally not recommended in pediatrics. This is because of the past association linking Reye*s syndrome to aspirin usage in children with chickenpox or influenza.

4. Less clothing.
Children should not be over bundled while having a fever as this tends to raise the temperature more. Dress with a minimum of clothes and use a light blanket if they are having chills. Sometimes, an overbundled infant may have a slight elevation of temperature. If you suspect this, undress and retake the temperature in about 1 hour.

5. Sponging.
Sponge baths are usually not necessary for low -grade fevers. Sponging may cause shivering (which is the body*s way to raise temperature) and may be uncomfortable. Sponge baths may be useful with heatstroke, confusion associated with high fevers or in children who are prone to febrile seizures. Never use alcohol or ice in the bath. Stop if the child is shivering or raise the water temperature. Lukewarm washcloths or sponges rubbed briskly over the skin with the child in 2 inches of water is the best technique.

6. Acting sick.
How your child is acting is more important than how high the fever is running. The terms lethargy and listless or acting sick can mean different things to different people. In order to tell how sick the child is acting when they have a fever, give an appropriate dose of acetaminophen or ibuprofen (see chart below) and see how the child is acting about 1 to 2 hours after the dose. Many parents who call us find out they have not given enough acetaminophen or ibuprofen. The fever may not necessarily return to normal, but is often lower. Keep in mind that some children can be seriouly ill without any fever.

A baby or child is probably not seriously ill if:
♂ a baby will coo, make eye contact, smile or reach for an object;
♂ a toddler will pay attention to activities, smile, walk around to get things;
♂ an older child will engage in quiet activities like coloring or reading.

A child is seriously ill if despite reducing the fever:
♂ a baby is not making eye contact, refuses to feed, cries or cannot be comforted:
♂ a toddler refuses to play, cries inconsolably, moans, appears very weak, turns away and stares repeatedly or is very hard to awaken if sleeping;
♂ an older child refuses to talk and won't interact or is unable to get out of bed.
♂ keeps dropping ff to sleep without periods of activity; remember sick children do tend to sleep more

7. Febrile seizures. These are usually harmless and occur most often from 6 months to 4 years, although they may occur up to 5 or 6 years of age. There is often a family member who had febrile seizures as a child. They occur in about 3 to 5 % of the population. Typically, the seizure occurs when the fever is rapidly increasing. They are typically brief, lasting only 3-5 minutes. They may occur with any type of infection that causes a fever. Any first febrile seizure should be evaluated by a physician. The possibility of meningitis or other serious illness needs to be ruled out. Because a child has a history of febrile seizures does not mean they will go on to have epilepsy as an adult. Febrile seizures do not cause brain damage, unless they last for a longtime (more than about 10 minutes and the child is not getting enough oxygen. The treatment involves controlling the fever aggressively with acetaminophen or ibuprofen. Some children with complicated or frequent febrile seizures need prescription anti-seizure medicines.

▽ACETAMINOPHEN AND IBUPROFEN DOSAGES CHART▼

1. Tips on giving medicines correctly
♂ Best if dosed by weight, not age
♂ Always measure with a dropper, dosage cup or other accurate measuring device. Kitchen teaspoons used for eating are not accurate.
♂ Acetaminophen or ibuprofen may be given with other medicines, like antibiotics or over-the-counter cold medicines. Just make sure the over-the-counter cold medicine does not already contain acetaminophen; otherwise you could be giving your child a double dose
♂ Liauid medicines may be mixed in with soft foods or liquids. Chewables may be crushed and added to the food. Mix the medicine with a small amount of food or drink, so you can make sure the child takes it all.
♂ One teaspoon = 5 ml. or cc. (milliliters or cubic centimeters)

2. ACETAMINOPHEN - given every 4 -6 hours, but not more than 5 times a day.

Weight﹛﹛ Age﹛INFANT﹛CHILDREN'S﹛CHILDREN'S﹛JUNIOR STRENGTH
﹛﹛﹛﹛﹛﹛﹛SUSPENSION﹛SUSPENSION﹛CHEWABLE﹛﹛CHEWABLE
﹛﹛﹛﹛﹛﹛﹛& DROPS﹛﹛& ELIXIR﹛﹛TABLETS﹛﹛TABLETS/CAPLETS
﹛﹛﹛﹛﹛﹛﹛80 mg/0.8 ml﹛160 mg/5 ml﹛﹛80 mg each﹛﹛﹛160 mg each
﹛﹛﹛﹛﹛﹛﹛﹛dropperful﹛﹛teaspoon﹛﹛﹛﹛tablet﹛﹛﹛﹛tablet/caplet
6-11 lbs.﹛﹛0-3 mos﹛﹛½﹛﹛﹛﹛﹛﹛
12-17 lbs.﹛4-11 mos﹛﹛1﹛﹛﹛﹛½﹛﹛﹛﹛
18-23 lbs.﹛12-23 mos﹛1½﹛﹛﹛﹛¾﹛﹛﹛﹛
24-35 lbs.﹛2-3 yrs﹛﹛﹛2﹛﹛﹛﹛1﹛﹛﹛﹛﹛﹛﹛2﹛﹛
36-47 lbs.﹛4-5 yrs﹛﹛﹛﹛﹛﹛﹛﹛1½﹛﹛﹛﹛﹛﹛3﹛﹛
48-59 lbs.﹛6-8 yrs﹛﹛﹛﹛﹛﹛﹛﹛2﹛﹛﹛﹛﹛﹛﹛4﹛﹛﹛﹛﹛﹛﹛2
60-71 lbs.﹛9-10 yrs﹛﹛﹛﹛﹛﹛﹛2½﹛﹛﹛﹛﹛﹛5﹛﹛﹛﹛﹛﹛﹛2½
72-95 lbs.﹛11 yrs﹛﹛﹛﹛﹛﹛﹛﹛3﹛﹛﹛﹛﹛﹛﹛6﹛﹛﹛﹛﹛﹛﹛3
95 lbs. & over﹛12 yrs﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛4

3. IBUPROFEN - given every 6-8 hours.
These doses are the recommended dosages for fever over 102.5 F.

Weight﹛Age﹛Oral drops﹛﹛Suspension﹛﹛Chewable﹛﹛Chewable﹛﹛Caplets
﹛﹛﹛﹛﹛50 mg/1.25 ml = 1﹛100 mg/5 ml﹛tablets﹛﹛﹛tablets﹛﹛100 mg each
﹛﹛﹛﹛﹛dropperful﹛﹛﹛﹛﹛﹛﹛﹛﹛﹛50 mg each﹛100 mg each
﹛﹛﹛﹛﹛dropperful﹛﹛﹛﹛teaspoon﹛﹛﹛tablet﹛﹛﹛tablet﹛﹛﹛﹛caplet
12-17 lbs.﹛6-11 mos﹛1﹛﹛﹛﹛½﹛﹛﹛﹛﹛﹛
18-23 lbs.﹛12-23 mos﹛2﹛﹛﹛﹛1﹛﹛﹛﹛﹛2﹛﹛﹛﹛﹛1
24-35 lbs.﹛2-3 yrs﹛﹛3﹛﹛﹛﹛1½﹛﹛﹛﹛﹛3﹛﹛﹛﹛1½
36-47 lbs.﹛4-5 yrs﹛﹛﹛﹛﹛﹛2﹛﹛﹛﹛﹛﹛4﹛﹛﹛﹛﹛2﹛﹛﹛﹛﹛﹛2
48-59 lbs.﹛6-8 yrs﹛﹛﹛﹛﹛﹛2½﹛﹛﹛﹛﹛5﹛﹛﹛﹛﹛2½﹛﹛﹛﹛﹛2½
60-71 lbs.﹛9-10 yrs﹛﹛﹛﹛﹛﹛3﹛﹛﹛﹛﹛6﹛﹛﹛﹛﹛3﹛﹛﹛﹛﹛﹛3
72-95 lbs.﹛11 yrs﹛﹛﹛﹛﹛﹛﹛4﹛﹛﹛﹛﹛8﹛﹛﹛﹛﹛4﹛﹛﹛﹛﹛﹛4

4. Normal temperature

♂ Oral temperature greater than 100∼ F (37.8∼ C): take orally over 5 or 6 years of age in a cooperative child. The tip of the thermometer is held under the tongue for 5 minutes.
♂ Rectal temperature greater than 100.4∼ F (38∼ C): most accurate and should be used in babies under 6 months. Lubricate the tip of the thermometer with vaseline or lubricating jelly and insert it about a half to one inch in the rectum. Hold the child firmly on their side and leave it in for about 5 minutes.
♂ Axillary temperature (under the arm) greater than 99.5∼ F ( 37.5∼ C): not as accurate, but may be used to screen for a fever. Hold the tip of the thermometer in the armpit and keep the arm against the body for 5 to 7 minutes. If borderline at 99-100∼ F, a rectal temperature is recommended, especially in infants less than 6 months.

5. Types of thermometers
♂ Digital thermometers are easy to read because they beep with a number when the final temperature is correct.
♂ Glass mercury thermometers are harder to read and care must be taken to avoid breakage while the temperature is being taken.
♂ Ear thermometers are easy to use and read, but are not always accurate. They are not very reliable in children under about 6 months.

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Croup

A distinctive cough in children that sounds like a barking seal or a foghorn. It is usually caused by a virus that affects the voice box (larynx). There may be a hoarse voice and sometimes by a breathing pattern called stridor. Stridor is a harsh raspy breathing sound heard mostly when breathing in.

♂ The main concern is if the child is having difficulty breathing. The difficulty breathing may be minimal or severe. A child who is having mild or moderate distress in the day may be alot worse in the night. The physician should be seen or at least contacted if they are having moderate to severe breathing difficulty in the day. Children at most risk for getting into trouble with their breathing are usually under 3 years of age. A child may switch from having mild to severe croup several times within the course of the disease.
♂ Croup may be caused by a virus which also causes cold symptoms such as congestion, sore throat and sometimes fever. It affects children between 6 months and about 4 or 5 years old. Symptoms are typically worse at night, or the child may awaken with the first signs of croup in the middle of the night. It peaks in severity over 3 to 5 days and then begins to resolve.
♂ Croup may be caused by a bacteria and is then called bacterial tracheitis. This is less common and more serious. These children have severe difficulty breathing, appear quite ill and are often hospitalized for oxygen and antibiotics.
♂ Children may get croup more than once in their life and some children seem to get it more often than others.

▽Call the doctor immediately if:▼
♂ Difficult breathing with continuous stridor or retractions after at least 20 minutes of steam treatment (see below)
♂ Signs of severe or moderate difficult breathing , constant noisy breathing
♂ Signs of severe dehydration
♂ Has excess drooling, spitting or difficulty swallowing
♂ Lips turn bluish with coughing episodes
♂ Unable to bend the neck forward
♂ Unable to lie down comfortably
♂ Is appearing listless, lethargic or difficult to arouse or acting sick

▽Call during office hours if:▼
♂ Coughing spasms are worsening or becoming more frequent
♂ Refusing fluids or vomiting and is appearing well-hydrated or only mildly dehydrated
♂ Fever more than 104
♂ Signs of secondary infection - ear infection, pneumonia

▽Home treatment▼
1. Humidifier.
Run a humidifier in the child*s room. Cool mist humidifiers are safer to use than the steam vaporizers because of the risk of curious toddlers burning themselves with the steam. Humidifiers must be kept clean and if possibe, distilled water is recommended.

2. Steamy bathroom.
If the child is having frequent croupy cough or becoming stridorous and has constant noisy breathing, take him into the bathroom and run a hot shower. Sit in the steamy bathroom with him for 10 to 20 minutes. Another alternative is to bundle your child up and take him outside in the cool night air if the episode is occurring at night.

3. Medicines.
Antibiotics do not treat viral croup, although secondary infections which may accompany croup, such as an ear infection, pneumonia or strep throat do need antibiotics. Bacterial tracheitis as mentioned above does require antibiotics, but these children are usually hospitalized. Acetaminophen or ibuprofen may be used for fever. Over-the-counter cough medicines are usually not very helpful for croup. If a child is having a lot of difficult breathing, the physician may prescribe oral or injected steroids or give a breathing treatment with a medication called racemic epinephrine.

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Asthma/wheezing(祄霪, 揚霪)

Wheezing is caused by narrowed airways (bronchioles) in the lung. There are many causes of wheezing. It sounds like a high-pitched whistle when the child breathes out, but may also occur with breathing in when the child is having more problems. Sometimes, wheezing can only be heard with the doctor's stethoscope. There may be rapid breathing (over 40 breaths per minute), tight, difficult breathing and a cough.

♂ The main concern is noting how much difficulty breathing is present. If you feel your child's breathing is so difficult that you do not have time to call the doctor, call for emergency rescue (911).
♂ Wheezing with symptoms of a cold (congestion, cough and sometimes a fever) in infants under one year of age is often caused by a virus called respiratory syncytial virus (RSV). It occurs in epidemics during the winter months. This is called bronchiolitis (not the same as bronchitis). About 1 to 2% of these children will need to be hospitalized for dehydration or because they need oxygen. About 30% of children who develop bronchiolitis may go on the have asthma later in life. Bronchiolitis may occur in children as old as 3 years old, but babies under 6 months are at highest risk for complications and severe symptoms.
♂ Asthma is defined as recurrent episodes of wheezing. Most children who develop this have a family history of asthma, hay fever and/or eczema. Situations that may aggravate asthma include: pollens (note seasonal occurrences), dusty environments, smoke from tobacco or fires, animal danders, feathers, flowers, paint, perfumes, aerosol sprays, live Christmas tress, or dust from turning on a furnace. Also colds due to viruses and secondary bacterial infections such as an ear infection, pneumonia, sinusitis, and strep throat may cause a child to wheeze. Some children will develop exercise-induced asthma, where one sees that when they run or play hard, they start to cough or wheeze.
♂ Aspiration of a foreign body may also produce sudden onset of wheezing. If you suspect your child may have had a choking episode on some hard food or foreign object and is wheezing, alert your physician immediately.
♂ Anaphylaxis is a potentially life-threatening allergic reaction to a food or medication that may be associated with hives (itchy welt-like rash) and a sudden difficulty in breathing. If breathing is extremely labored, call 911 immediately.
♂ "Spitting up" in babies is called gastroesophageal reflux and this may cause wheezing because the child will spit up and aspirate some of the fluid into the lungs. This causes irritation in the lungs and then the baby may start wheezing.

▽Call the doctor immediately if:▼
♂ Moderate or severe difficult breathing
♂ Lips become bluish
♂ History of a choking episode on food or object
♂ Associated hives and suspicion of an allergic reaction to food or medication and having difficult breathing or coughing
♂ Signs of dehydration
♂ Infant less than 2 or 3 months of age

▽Call during office hours if:▼
♂ First episode of wheezing without any signs of difficult breathing
♂ The child has a history of asthma and the usual medications do not seem to be helping and is having mild difficulty breathing
♂ Signs of secondary infection - earache, sore throat
♂ Fever more than 72 hours
♂ Is unable to sleep because of wheezing

▽Home treatment▼
1. Medications.
Medications for asthma require prescription drugs that are called bronchodialators. Bronchodialators come in oral syrups or tablets, inhalers that are puffed into the lungs or may be provided by using a nebulizer that delivers a mist of medication to the child over 5 to 15 minutes. If your child has a history of asthma and you have used these medications in the past, you may use these as needed when attacks occur as guided by your physician. Steroids for serious asthma attacks should only be used after discussion with the physician, unless they have already established guidelines for you to use these.

2. Bronchiolitis in the infant.
Fluids need to be encouraged to avoid dehydration. Bulb syringing and clearing the nose of mucous, especially before eating is helpful (see colds for how to use the bulb syringe) in younger infants. Using a humidifier will also help breathing for an infant. Prescription medications, like the bronchodialators, may be prescribed by your doctor depending on the severity of the illness.

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Sore throat

An older child complaining of a sore throat, pain with swallowing.

A younger child may have a sore throat if they refuse to eat or cry with feedings.

When examined with a light, the throat may be red.

♂ Most sore throats are caused by a virus and may be part of a cold.
♂ Tonsillitis means any swelling or redness of the tonsils and may be caused by a virus or a bacteria. Viruses are more common in children under a year.
♂ About 10% of sore throats are caused by the strep (streptococcus Group A) bacteria. This does need treatment with antibiotics because of rare complications of an untreated strep bacteria such as rheumatic fever (which can lead to heart damage) or post-streptococcal glomerulonephritis ( a kidney complication where blood and protein are detected in the urine and causes a "coca-cola" colored urine). Strep throat may occur at any age, but is most common in children over 4 or 5 years of age. It is contracted by person-to-person contact and the incubation is 2 to 5 days. Strep rarely causes nasal congestion and cough. Symptoms of strep throat may include the following:
* fever
* sore throat with red spots or white spots on the tonsils
* swollen tender neck glands
* headaches
* stomachaches, nausea or vomiting
* fine, sandpaper-like rash may occur with strep called a scarletina rash or scarlet fever
♂ Children with congestion due to a cold or allergies may have a sore throat in the morning, that resolves later in the day and is secondary to mouth breathing and post-nasal drip.
♂ Infectious mononucleosis, commonly called mono is caused by the Epstein-Barr virus. See below under viral pharyngitis.

▽Call the doctor immediately if:▼
♂ Child is drooling, spitting or having great difficulty swallowing
♂ Child with difficulty breathing, not due to a stuffy nose
♂ Child acting sick despite acetaminophen
♂ "Coca-Cola" colored urine or blood in the urine

▽Call during office hours if:▼
♂ Sore throat more than 3 days
♂ Accompanied by high fever
♂ Known recent contacts with strep throat
♂ Fine, red sandpapery rash usually starting in lower abdomen

▽Home treatment▼
1. Home Care.
Acetaminophen or ibuprofen are recommended for pain relief. Older children may gargle with warm salt water. Make sure the child is drinking fluids to stay hydrated and do not worry as much about food. Soft foods are usually better tolerated. A humidifier may help is sore throat is due to a dry throat from mouth breathing.

2. Viral pharyngitis.
Many viruses may cause a sore throat. Most of the time if your child has an accompanying cold with congestion and cough, they will be more likely have a virus rather than strep throat. One virus that may cause a severe sore throat is mono (infectious mononucleosis caused by the Epstein-Barr virus). Recognized frequently in adolescents ( the "kissing" disease), it may occur in young children. Mono usually is accompanied by fatigue, fever, very swollen tonsils with a white coating and possibly an enlarged spleen. A blood test is needed to diagnose mononucleosis and there is no real treatment. Steroids are occasionally used if tonsils are so large that the child has difficulty breathing.

3. Strep pharyngitis.
Strep does need treatment with antibiotics. The diagnosis is made with a throat swab and performing a rapid strep test (usually takes a few minutes to do in the office) or a throat culture (results after 24 to 48 hours from a lab). The scarlet fever rash that may occur with strep feels like a fine, sandpapery rash usually starting in the groin area, neck and then spreads. The child is contagious until they have been treated with antibiotics for at least 24 hours. They are usually feeling better after being on the antibiotics for at least 48 hours. Not everyone is prone to strep throat, so even though someone is exposed, they may not necessarily get the disease.

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Swimmer's Ear (蚔蚞俶嫉瓷;蚔蚞俶嫉朒)

The ear canal is the tube that ends at the eardrum. This is where wax build-up occurs. When the ear canal is exposed to water from baths or swimming, the ear canal which is simply skin, may become infected with bacteria. The canal may appear red and swollen. The main symptom is pain with movement of the ear or touching the ear or pushing on the area in front the ear. This is commonly called an outer ear infection, swimmer's ear or otitis externa.

Swimmer's ear does not usually require an urgent call to the doctor after-hours. Acetaminophen or ibuprofen can be used for pain in the middle of the night.

▽Home treatment▼
1. Antibiotic ear drops.
If your child has a swimmer's ear, presciption antibiotic drops with or without steriods in the drops are usually prescribed. If the case of a severe swimmer's ear, the physician may place a "wick" which is like a piece of cotton for a few days, so the drops will stay in the ear canal better and reach deeper into the ear canal. Occasionally, oral antibiotics will be used in severe cases or will be prescribed if there is an accompanying middle ear infection. Drops are usually used for 5 days and the child should not swim or get water in the ear during this time.

2. Prevention.
Some children are prone to swimmer's ear and there are over-the-counter drops that may be used after swimming to help prevent swimmer's ear. This helps to dry the ear canal and creates acidity where bacteria will not grow as easily. Drops may be made at home by combining half vinegar and half rubbing alcohol.

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Ear infection (OTITIS MEDIA)

Otitis media means inflammation of the middle ear. The middle ear is a small space located behind the eardrum. An acute otitis media may be caused by a bacterial infection behind the eardrum. It usually comes as a complication of a cold. Some ear infections are caused by viruses. It is not possible to tell which ear infections are bacterial or viral simply by looking at the eardrum. The reason ear infections are common in children is because the eustachian tube, which is the tube between the middle ear and the back of the nasal passage, is short and straight compared to adults. This tube becomes blocked and does not function well when congestion is present. Fluid then builds up in the middle ear and may become infected.

Most common in children from 6 months until 2 or 3 years old, but can occur at any age, even newborns.

Signs of an acute ear infection may include:
♂ Fussy babies who don't eat well or pull off the bottle or breast
♂ Not sleeping well
♂ Usually with a cold, but occasionally without signs of a cold
♂ May or may not have a fever
♂ Pulling on the ear (pulling on the ear in a happy, non-sick child may be a sign of teething)
♂ Not hearing well, talking loudly, ignoring normal voice tones, television volume increased
♂ Older child complaining of pain

Situations that will increase risk of ear infection include:
♂ Daycare
♂ Smoking environment
♂ Taking a bottle or nursing with the baby lying flat
♂ Family history of lots of ear infections or allergies (from foods, animals, dust, mold or pollens)
♂ Allergies in the child with chronic congestion (more than 3 weeks)
♂ Flying (especially with a cold)
♂ Swimming underwater and diving into the water
♂ Enlarged adenoids (see adenoids in the treatment section below).

Any of these risk factors may need to be addressed with your physician to see if there is something that may be done preventatively. Sometimes a trial off dairy products may be helpful if allergies are playing a role for ear infections.
♂ 5 to 10% of children may rupture the eardrum with an acute ear infection and yellow, thin possibly bloody fluid may be noted coming from the ear. These will usually heal within a couple weeks.
♂ When seen in the office, some children may have serous otitis, fluid in the middle ear that is not infected with bacteria and usually without symptoms of pain. This may accompany a cold or may be present after an acute infection has already been treated with antibiotics. Your doctor may elect not to treat this with antibiotics depending on the situation.
♂ Serious complications of a middle ear infection can include meningitis (an infection of the fluid surrounding the brain and spinal cord) and mastoiditis (an infection of the mastoid bone that is around the middle ear). Signs of a mastoiditis include an ear that protrudes out more from the head and tenderness and redness on the bone behind the ear.
♂ Another concern about ear infections involves hearing loss and language development. Fluid that stays in the middle air space for a long period of time may eventually cause hearing loss and may affect language development and behavior.
♂ Many young children (4 months to 18 months) may pull on their ears with teething. These children usually do not have a cold and sleep fine.
♂ Swimmer*s ear (otitis externa) is an infection of the skin of the ear canal. There is usually a history of swimming and pain with movement of the earlobe or when the ear is touched.
♂ Myths about ear infections: Getting water splashed in the ear, earwax, wind or being cold do not cause a middle ear infection.
♂ Ear infections are not contagious, but the viruses that cause a cold which leads to an ear infection are contagious.
♂ Home otoscopes to see the eardrum for parents to diagnose ear infections are not very useful. The lights on these are not strong and it takes a lot of training to see the eardrum and understand what it all means.
♂ At times a child is brought to the office with a cold for a day or two and the physician does not find an ear infection. If the cold continues, an ear infection may still develop and the child may return in 2 or 3 days with an obvious ear infection. Be alert to worsening of symptoms or if the cold does not seem to run its course in a week or so.

For the majority of simple earaches the doctor does not need to be contacted in the middle of the night, unless the home remedies have not worked and the child is in extreme pain. In that case, the doctor may prescribe some ear drops for the pain and possibly some antibiotics until the child can be seen in the office. Note that even if your physician prescribes some antibiotics in the middle of the night, your child may still have ear pain for 24 to 48 hours after starting the antibiotics. Ibuprofen or acetaminophen are more helpful in relieving pain initially with the majority of ear infections. Also see fever, congestion, cough for other concerns that may need immediate attention.

▽Call the doctor immediately if:▼
♂ Severe pain that has not responded to any home treatments
♂ History of any penetrating ear trauma
♂ Stiff neck
♂ Redness, swelling and tenderness over the bone behind the ear (signs of mastoiditis)
♂ Acting sick

▽Call during office hours if:▼
Earache especially when accompanied by: fever, loss of sleep, fussiness, ear discharge, poor appetite, pulling off the bottle or breast,
History of swimming and pain with movement of the earlobe (swimmer*s ear)
Child on antibiotics for an ear infection that is still having significant pain symptoms after 48 hours

▽Home treatment▼
1. Pain.
Controlling the pain until the patient can be seen is the primary problem. The most severe pain occurs when an infection comes on rapidly, because of rapid stretching of the eardrum. The pain usually resolves if an eardrum ruptures and you will see fluid coming out of the ear. Give appropriate dosages of acetaminophen or ibuprofen (see fever for dosages). If you have prescription ear drops in the house for pain, these may be used as long as there is no discharge from the ear (an indication of a perforated eardrum). Your physician may prescribe these in the middle of the night if pain is severe. You may want to ask for a prescription at the office visit to have on hand if your child is prone to frequent ear infections. A warm compress over the ear may be helpful. Slightly warmed up cooking oil, garlic or mullein oil may also be helpful.

2. Antibiotics.
Your physician will probably prescribe antibiotics when your child is diagnosed with an acute ear infection. However, some ear infections may not need antibiotics depending on the situation. There is more concern about overuse of antibiotics, so please discuss these issues with your physician at the office visit. Make sure you keep the medicine refrigerated if instructed by the pharmacy. Some antibiotics are taken with food and others must be taken on a empty stomach and some can be taken either way. Antibiotics that may be taken with food, may be mixed in with food, like applesauce or pudding or drinks. However, you must make sure the child will take the full dosage, so mix it with a small amount of the food or drink. Symptoms of the earache should improve within 48 hours of starting the antibiotic. The congestion and cough do not necessarily improve with antibiotics. Antibiotics do have an expiration date, so be sure to discard after that date. Complete the entire course of antibiotics as directed, usually ten days, but some newer antibiotics only need to be taken for five days.

3. Over-the-counter medications.
Antihistamine and decongestant combinations have not been proven to prevent ear infections when used to treat cold symptoms. They may be helpful in relieving the cold symptoms.

4. Adenoids.
Adenoids are lymph tissue (related to the tonsillar lymph tissue) located behind the nasal passage and are not visible by physical exam to the physician. Because they are close to the eustachian tube, they may affect eustachian tube function and contribute to frequent ear infections when the adenoids are enlarged. Signs of large adenoids include snoring and open mouth breathing. If your physician suspects large adenoids may be contributing to frequent ear infections, they may recommend surgery to have them removed.

5. Flying with an ear infection.
It is generally not recommended to fly with a sick child with an acute painful ear. There is a small chance of triggering a perforation, although perforation of the eardrum may occur without flying. Many parents have inadvertently flown with children with an ear infection without any apparent problems and if the ear infection is mild or under treatment with antibiotics, the child may be able to fly. Discuss with your physician if you have any travel plans at the office visit. The decision may need to be based on the appearance of the eardrum and how sick the child is acting.

6. Ear wax.
Ear wax production is normal and healthy, with some people producing more wax than others. Color can vary from whitish to dark brown. It acts as protection for the ear canal. It naturally becomes pushed out, but occasionally some people produce so much that it may become impacted in the ear canal. If you see wax around the edge, you may remove it with a washcloth or cotton swab. However, never insert cotton swabs into an ear canal to clean the wax. This only packs the wax in deeper. Impacted wax may be painful. If your physician does note excess ear wax production, they may ask you to use an over-the-counter wax-softening agent and then some gentle irrigation with warm water.

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Eye infection

Causes - Redness of the whites of the eye (sclera) may have several causes with different types of presentations. Here are some common problems and their most usual cause, but there can be some variations:
♂ Red eye with yellow eye discharge - "pink eye" or bacterial conjunctivitis
♂ Red eye without discharge and with a cold - viral conjunctivitis
♂ Red eyes with itching, watery discharge - allergic conjunctivitis
♂ Red eye with history of trauma or chemical in the eye
♂ Red eye with pain, watery discharge - possible foreign body in the eye or corneal abrasion
♂ Eye with redness of the skin around the eye and swelling of the tissue around the eye - infection of the tissue around the eye (periorbital cellulitis)
♂ Eye discharge in a newborn baby - blocked tear duct (naso-lacrimal duct)
♂ Swollen lump near the lid margin - stye

▽Call the doctor immediately if:▼
♂ Eyelids very swollen with redness of the eyelid
♂ History of direct or blunt trauma
♂ Blurry vision, especially after any trauma
♂ Constant tearing, blinking or pain in the eye
♂ Possibility of foreign body in the eye

▽Call during office hours if:▼
♂ There is a yellow eye discharge
♂ Redness more than 3 days
♂ Constant itching, watery discharge

▽Home treatment▼
1. Periorbital cellulitis - This presents with very swollen and red tissue around the eye caused by a bacterial infection. It may occur as a complication of a cold or sinus infection or as a result of an insect bite or scratch near the eye. The eye itself may or may not be red and there may or may not be eye discharge. Fever and nasal congestion may also be present. This is considered an emergency because these children need to be seen quickly and started on antibiotics. If this infection progresses quickly, they may require hospitalization and even surgery to drain the infection.

2. Viral and bacterial conjunctivitis ("pink eye") - This is usually accompanied by a cold. It often starts with just redness without discharge and then yellow eye discharge appears, especially noted when the child wakes from sleep. When the yellow discharge appears, this usually responds to antibiotic eye drops. An ear infection may accompany this in about 40% of cases.

3. Allergic conjunctivitis - These children usually have a history of allergies and it may be triggerred by a contact to which the child is allergic (like a cat). The eye is itchy, watery and sneezing and clear runny nose may be present. Treatment with over-the-counter allergy eye drops and oral antihistamines may be helpful. If symptoms are persistent or severe, prescription allergy eye drops may be helpful.

4. Foreign body or chemical in the eye- A foreign body lodged in the eye or under the eyelids will cause irritation, redness and pain in the eye. It may sometimes be dislodged at home by gently flushing the eye with water. Chemicals may also be flushed. Consult your local poison control if chemicals are suspected. If pain persists after flushing or if poison control recommends it, the child should be seen by a physician. A corneal abrasion, which is a scratch on the cornea also needs to be ruled out. These cause persistent pain of the eye and a sensation like something is scratching the eye every time they blink.

5. Trauma - Any significant trauma to the eye, or possiblity of a penetrating injury (like a small metallic chip from striking metal on metal) should be seen immediately.

6. Stye - A stye is an acute infection of the glands located at the eyelid margin. There is swelling, pain, itching and redness in a small area at the lid margin. Treatment consists of using frequent warm compresses on the eye.

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Head Injuries

An injury caused by any blow to the head. A concussion is defined as a head injury which is followed immediately with a period of loss of consciousness (the child is not arousable).

♂ Toddlers who are learning to walk take many falls along the way. It is unusual for a child falling from their own height to have any serious head injury.
♂ If a child cries immediately after an injury to the head and has no loss of consciousness, this is most likely to be a minor head injury. A child may have nausea, vomiting, headache or dizziness in the first 24 to 48 hours after minor head injury. This is not cause for alarm, unless the symptoms appear to worsen over time and especially if associated with progressive lethargy. By lethargy, we mean the child may appear disoriented, or very sleepy when it is not bedtime, or be hard to awaken if it is their normal sleep time.
♂ With any head injury where the child does not cry immediately and appears to "pass out" for seconds or minutes after the event, the doctor should be contacted immediately.
♂ Often, a large bump or "goose egg" develops on the head after a head injury. The size of the bump or how quickly it appears does not tell us the seriousness of the injury. What is more important is if there was any loss of consciousness and how the child is acting.

▽Call the doctor immediately if:▼
♂ Any loss of consciousness where the child appears to "pass out" and is unarousable after the injury
♂ Vomiting 2 or 3 times after the injury, especially if the child is not acting normally
♂ Disoriented, confused behavior
♂ Pupils of the eyes appear unequal (this is usually a late sign for serious head injury)
♂ Extremely sleepy behavior during usual awake time
♂ Very difficult to awaken if during usual sleep time
♂ Mechanism of the head injury seems severe (for example, falling down several stairs onto tile or falling from a large height)
♂ There appears to be a slight depression of the skull bone at the point of injury

▽Call during office hours if:▼
♂ Headache, nausea or dizziness are not going away after 48 to 72 hours of the injury

▽Home treatment▼
1. Observation at home.
Most children with minor head injuries can be observed at home. During daytime hours, observe their behavior and also watch for vomiting. If a child normally naps, try to keep the child up for a short period, so that you may observe their behavior and then allow them to sleep. Awaken them when they have napped their usual amount of time. If it is bedtime, try to observe for a short period and then allow them to sleep. The child should be awakened every 3 to 6 hours, depending on how significant an injury occurred and how the child is acting before bedtime. The more concerned we are, the more often we will awaken the child.

2. Treatment of bumps and headaches.
Headaches can be managed with appropriate doses of acetaminophen or ibuprofen (see chart under fever). Place ice on bumps on the skull that swell up after the injury.

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Febrile Seizures (俶儐婽, ▽瓟▼俶騍豵楷釬)

These are usually harmless and occur most often from 6 months to 4 years, although they may occur up to 5 or 6 years of age.

There is often a family member who had febrile seizures as a child. They occur in about 3 to 5 % of the population. Typically, the seizure occurs when the fever is rapidly increasing. They are typically brief, lasting only 3-5 minutes.

They may occur with any type of infection that causes a fever. Any first febrile seizure should be evaluated by the doctor. The possibility of meningitis needs to be ruled out. Because a child has a history of febrile seizures does not mean they will go on to have epilepsy as an adult.

The treatment is based on controlling fever with acetaminophen or ibuprofen. Some children with complicated or frequent febrile seizures need prescription anti-seizure medicines. Febrile seizures generally do not cause brain damage unless they last for a long time (more than 5 0r 10 minutes) and the child is not getting enough oxygen.

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Vomiting

Bringing up a large amount of stomach contents through the mouth and sometimes the nose.

♂ The main concern is to watch for signs of dehydration.
♂ Vomiting is commonly seen with viral infections like the flu, stomach viruses (usually associated with diarrhea), and bacterial infections like strep throats, ear infections, and urinary tract infections. More serious infections like meningitis and bloodstream infections may also have vomiting symptoms.
♂ It may be triggered by a cough that causes the child to gag and then vomit.
♂ Newborns vomiting in the first few days of life after each feeding that is forceful, bright yellow or green may have an obstruction and need immediate evaluation.
♂ Blood in the vomitus with a nursing baby may occur when mother*s nipples are bleeding and the baby is swallowing blood. It is fine to continue to breast-feed in this situation.
♂ Babies under a year commonly spit up - this is usually a few mouthfuls of milk/food that is non-forceful usually with burping. The babies should be gaining weight and not be excessively irritable with feeding or after a feeding. If they are very fussy , discuss the possibility of gastroesophageal reflux with esophagitis with your doctor during office hours. This is a fancy name for what we commonly know as "heartburn" and makes for an uncomfortable baby. Your doctor may need to recommend medications like antacids.
♂ Pyloric stenosis is a problem that occurs in infants around 4 to 6 weeks of age because of an obstruction from the muscle at the outlet of the stomach. The baby will have projectile vomiting during or shortly after feeding. This needs immediate evaluation.
♂ Intussusception occurs typically in the 2 month to 6 year age range. This is caused by a "telescoping" of some small intestine within itself. There is an obstruction and the bowel will lose blood supply. The common finding is a bloody stool that looks like "red currant jelly". Other symptoms can include abdominal pain, and a very sleepy, hard to arouse child.
♂ Head injuries and abdominal injuries may cause vomiting.

▽Call the doctor immediately if:▼
♂ Blood in the vomited material (unless you have a breast-fed newborn and you are sure you have bleeding nipples)
♂ Yellow or green vomitus
♂ Abdominal distention
♂ Constant abdominal pain over 1 to 2 hours
♂ Signs of severe dehydration
♂ Mottled, pale skin with cool hands and feet
♂ History of recent abdominal injury
♂ Is difficult to arouse, confused or delirious or acting sick
♂ Unable to keep down important medicines like anti-seizure or heart medications
♂ History of significant head injury, especially with other symptoms like severe headache, unsteady gait, weakness, change in behavior
♂ Possibility of accidental ingestion of a poison (plant, medicine, chemical)
♂ Choking episode or ingestion of a coin or other foreign object
♂ Projectile, very forceful vomiting more than 2 or 3 times, especially in an infant under 6 months of age
♂ Blood in the stool, any stool that looks like "red currant jelly"
♂ See fever, abdominal pain, diarrhea for other associated symptoms

▽Call during office hours if:▼
♂ If the child on medicine that may be making him vomit and has missed more than one dose
♂ Signs of mild dehydration
♂ If the child less than 6 months and vomiting more than 12 hours
♂ If the child more than 6 months and vomiting more than 24 hours
♂ Associated symptoms that need evaluation such as an earache, sore throat, pain with urination, diarrhea
♂ Needing to use Pedialtye for more than 12 hours in an infant under 1 year of age

▽Home treatment▼
1. Dehydration.
The key to treating vomiting at home is to avoid dehydration. Unfortunately, it is impossible to give an exact number of times of vomiting that will cause dehydration. It depends on the size of the child, how much they are vomiting and if they are keeping some fluids down.

♂ Signs of severe dehydration include listlessness (very weak with no energy), dry tongue and mouth that is sticky or tacky, absent tears with crying, sunken eyes, mottled skin, no urination for more than 8 to 10 hours, and in babies a sunken fontanel (soft spot on top of the head). Sometimes, in quiet, healthy baby, the fontanel does appear slightly sunken, especially if the baby is in an upright position. If any of these symptoms of severe dehydration are occurring, the doctor should be contacted immediately.
♂ Signs of mild dehydration may include dry lips with a moist mouth inside, fussy behavior, but the child should be able to interact, babble or talk or intermittently play, and less urine when the child does urinate. It is often difficult to check urination when a child is having diarrhea. Children who are mildly dehydrated need to be watched closely and if they can keep some fluids down, tend to do well.

3. Medications.
If the child is on any medications, they should be temporarily stopped, unless they are critical like anti-seizure or heart medications. The doctor should be contacted if the child is unable to keep down these type of medications. Antibiotics may need to be skipped with alot of vomiting, but call the doctor if more than one dose of medicine is missed. Acetaminophen may be given as a suppository to control fever if the child can not keep down oral acetminophen and this is available over-the-counter. Medications to stop vomiting should not be used unless specifically instructed by your doctor.

4. Fluids.
If the child is vomiting frequently, wait one hour after the last vomiting episode and then start with clear fluids in small, frequent amounts. Choices such as Pedialyte, Infalyte and Ricelyte in young infants and Gatorade in older children are preferable. Flat cola, ginger ale or 7-up may be given to older children. Popsicles or ice chips may also be used. Start with 1 teaspoon to 1 tablespoon every 15 to 20 minutes. Do not let the child take more initially even though they may feel thirsty. Too much fluids given too fast will often worsen the vomiting. The amounts may be increased every hour, if the child is tolerating what is offered.

If you are breast-feeding, try to nurse small amounts of time, like 3 to 4 minutes and then increase the time. If the baby is still vomiting with breast milk, pedialyte may need to be offered instead for a few hours.

For bottle-fed infants under one year, use Pedialtye at first and if this is tolerated, you may switch to diluted formula (try starting with 1/4 strength) and then gradually increase the strength.

5. Solids.
In children who are on solids, do not offer any until they are tolerating fluids for at least 8 hours. Foods to start with include bananas, rice or rice cereal, applesauce, toast (BRAT diet); crackers, potatoes, bland soup. Do not worry if your child is not interested in solids for a few days as long as they are drinking and staying well hydrated.

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Diarrhea

The frequency and consistency of stools in children varies with age. Diarrhea is a sudden increase in frequency and looseness of the stool.

♂ The main concern with diarrhea is if the child is becoming dehydrated or is acting sick or if the diarrhea is lasting more than 1 to 2 weeks. A child with two or three watery stools who is happy and drinking well is not a concern.
♂ Breast-fed babies have watery stools with some mustard consistency curd-like material on top. They may also pass some intermittent green stools. They may have up to 10 to 12 stools per day. If a breast-fed baby is fussy and having persistent green and more watery stools than normal, this may indicate an infection. A brand new nursing baby should have 4 to 12 stools per day once mother's milk is "in". If the baby is only having one or two stools per day, this may mean your baby is not getting enough milk.
♂ The majority of diarrheal illnesses are caused by a virus. If there is blood or mucous in the stools, bacteria may be a source for the diarrhea. Parasites may also cause diarrhea. Stool cultures will often be obtained if the diarrhea is present more than one week, if there is a history of exposure to some bacteria or parasite, or if there is blood or mucous in the stools.
♂ Diarrhea may also be caused by excess fruit juices, food allergy/intolerance or medications (especially antibiotics).
♂ Alert your doctor if you have done any unusual travel, there is a possibility of food poisoning, there are other contacts with diarrhea, or the child has been on recent antibiotics.
♂ Diarrhea due to viruses may last up to a week or sometimes longer. At times, there can be fluctuation between diarrhea and almost normal stools for a few days.
♂ "Red currant jelly" stools are a sign of intussusception and require an immediate call to the physician. See intussusception under vomiting.
♂ When a child is drinking red colored liquids, the stools may be reddish. If you are not sure if this is blood or red fluids, your doctor can test this chemically in the office. Stop giving red fluids and the problem should go away.
♂ Food poisoning is classically caused by a bacteria called Staphylococcus aureus. Food, especially dairy and meat products left at room temperature become contaminated with this bacteria. There is sudden onset, within 1 to 6 hours, of alot of diarrhea, abdominal cramps and nausea or vomiting. The symptoms improve within 8 to 24 hours. There are other forms of food poisoning like E.coli O157 from undercooked meats where the child may become very ill and have severe, bloody diarrhea. These children need immediate medical evaluation and may need hospitalization.
♂ Children are contagious with diarrhea caused by viruses for a day or two before the onset of diarrhea, and as long as they have diarrhea. Hand washing is key to reduce passing it on to others.
♂ Severity of diarrhea varies with the age group. A younger infant will take less diarrhea production to get dehydrated. Remember that breast-fed infants are different and have a lot more stool production. Keep in mind that other fluid losses like vomiting and sweating from a fever will add to further fluid loss and increase the risks of dehydration. These are rough guidelines for severity of diarrhea:
* Mild diarrhea is present if the child is having 3 to 4 stools in 24 hours that are not particularly large in volume.
* Moderate diarrhea is present if the child is having 5 to 6 stools in 24 hours that are of medium volume (not leaking out of the diaper in massive amounts).
* Severe diarrhea is present if the child is having 7 to 8 or greater stools of large volume that are running down the legs and require a total clothing change.

If the child is having 3 to 4 very large stools, this is probably more moderate diarrhea and so the volume of each stool is important.

▽Call the doctor immediately if:▼
♂ Signs of severe dehydration
♂ Bloody diarrhea, especially if more than just specks of blood
♂ Red, "currant jelly stools"
♂ Severe, constant abdominal pain
♂ Listless, lethargic, difficult to arouse or acting sick

▽Call during office hours if:▼
♂ The child is on medicine that may be causing diarrhea or recently completed a course of antibiotics
♂ Moderate or severe diarrhea without signs of dehydration
♂ Mucous or pus in the stool
♂ Fever for more than 3 days
♂ Diarrhea for more than 1 week that is mild
♂ Known ill contacts to bacterial or parasitic cause of diarrhea
♂ Concerns about food allergy, food poisoning
♂ Infants under 3 or 4 months
♂ Home dietary treatment is not helping after 24 hours

▽Home treatment▼
1. Dehydration.
When diarrhea and vomiting occur together, the treatment of vomiting takes priority. A child with both of these symptoms, must be watched closely for dehydration.

2. Breast-fed infants (under 1 year).
Most infants being breast-fed, may continue to nurse. They often have milder cases of diarrhea. Try to nurse more frequently. Diarrhea is present if there is an abrupt increase in stools and stools are more watery than normal. The baby may be offered extra fluids in the form of Pedialyte or Infalyte in between nursing. If diarrhea is severe, discuss with your doctor before discontinuing breast-feeding.

3. Bottle-fed infants (under 1 year).
If diarrhea is mild, formula or milk should be diluted with extra water or Pedialyte to make the formula 1/4 or 1/2 strength for a few feedings and then may be gradually increased in strength as the baby tolerates over 2 or 3 days. They may also be supplemented with extra fluids such as Pedialyte or Infalyte. If diarrhea is moderate, start with Pedialyte or Infalyte for 2 to 3 feedings, then go to 1/4 to 1/2 strength formula. Do not use Pedialyte alone for more than 24 hours without discussing with your doctor. Soy formulas or lactose-free formulas are often used instead of milk-based formulas temporarily to treat the diarrhea. There presently is one formula for infants with diarrhea called Isomil DF. This may be used as a temporary formula and when the child is better, you may return to using the child's usual formula. Avoid fruit juices or jello water. They often aggravate the diarrhea because of the high sugar content and they don't contain the right balance of salts to correct losses of salt in diarrhea. Also do not give water alone for rehydration, because it lacks salt and sugar that the child needs.

4. Children over 1 year.
Pedialyte may be used for fluids, but some children do not like the taste. Gatorade or other "sports" drinks are another alternative. Again, avoid fruit juices. Also avoid all dairy products when the child is having diarrhea. If the child is drinking well and tolerating some solids dairy is not necessary.

5. Solids.
For infants and children on solids, foods such as bananas, rice or rice cereal, applesauce, toast or crackers (the BRAT diet) are helpful. Other foods that won't aggravate the diarrhea include: plain noodles, bland soups, lean meats, potatoes, plain cooked vegetables. Do not be concerned if your child is not very hungry for solids, if they are drinking well and staying well-hydrated.

6. Diaper rash from diarrhea.
This is common with diarrhea and is best treated with ointments such as petroleum jelly or other diaper ointments.

7. Medications.
Never use any medications to treat diarrhea unless your doctor has specifically ordered it. In general, they may not help and may be dangerous in young children.

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Constipation

Constipation is the passage of hard stools, that is painful to pass and associated with infrequent bowel movements. Occasionlly, bright red blood may be passed with hard stools. This blood comes from a slight tear in the rectal area from the hard stool.

♂ Breast-fed babies rarely get constipated. They do commonly develop an infrequent stool pattern after 2 or 3 months of age. These older breast-fed babies may have one stool every 4 or 5 days, but they are soft and mushy and the babies do not seem uncomfortable.
♂ Newborns should pass their first meconium stool by 48 hours of age, if they do not, notify your physician. Once newborns who are a few days old are feeding well, they should be having 3 to 4 or more stools per day. If they are not, this may be a sign that they are not getting enough milk.
♂ Constipation is very common in infants starting on solids.
♂ Some toddlers who are toilet training may become constipated. They may then start to hold onto their stools and refuse to go to the bathroom and this will create further constipation problems.

▽Call the doctor immediately if:▼
♂ Severe, constant pain for more than 2 hours
♂ The child is acting sick
♂ You suspect your newborn is dehydrated and not getting enough milk

▽Call during office hours if:▼
♂ Your newborn under one or two months who is breastfeeding is not stooling at least 3 or 4 times a day and you suspect they are not getting enough milk or gaining weight
♂ You need direction in treatment because what you have tried is not working

▽Home treatment▼
1. Babies.
In babies under 3 or 4 months a rectal temperature will sometimes stimulate them to have a bowel movement. Prune juice, diluted 1:1 with water may be used to treat constipation in babies over a month or two. In babies on solids, try using prunes, apricots, pears, beans, plums and decrease foods like rice cereal, bananas, applesauce, or rice. Occasionally, a change of formula may be helpful, but talk to your physician before making a change.

2. Toddlers.
Toddlers who are resisting toilet training may become constipated. Sometimes, they do not like using the toilet for bowel movements, but will urinate in the toilet. This can become a behavioral issue and if they start to get scared that their bowel movements will hurt, they try to hold onto to the stool further. Try to keep the stools loose with diet and sometimes with medications. If you feel you have a behavior issue on your hands, discuss this with your physician.

3. Older children.
Over a year, increase fresh fruits and vegetables. Prune juice may be used. Increase bran and use bran cereals or muffins. Decrease constipating foods like milk, cheese, ice cream, rice, bananas and applesauce. Increase water intake. Constipation is very common in the summer months, when children are not keeping up fluid intake to compensate for increased fluid losses from sweating in the heat.

4. Medications.
A natural laxative is available over the counter called Maltsupex. Other laxatives, suppositories and enemas should be used only after your physician directs the usage.

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Abdominal Pain

There are numerous causes of abdominal pain and common causes vary with the age of the child.

Common causes listed below include:
♂ Abdominal cramps, usually comes and goes, often associated with diarrhea and may be caused by a virus, bacteria or parasite
♂ Constipation
♂ Appendicitis - rarely seen in children under 4 years. Typically, the child has constant, severe pain that often starts in the umbilical area and then may change to the classic, right lower area of the abdomen
♂ Medications, especially some antibiotics
♂ Urinary tract infections
♂ Often with strep throat
♂ Menstrual cramps
♂ Severe coughing or pneumonia
♂ Psychological
♂ Trauma
♂ Intussusception, which is a telescoping of the bowel with in itself causing obstruction, vomiting, severe pain and red, "currant-jelly" type stools
♂ Bowel obstructions
♂ Food poisoning - usually associated with eating spoiled foods (see diarrhea section for more information)
♂ Ulcers
♂ Pyloric stenosis - infants under 3 months presenting with projectile vomiting, caused by a spasm and thickening of the muscle where food exits the stomach
♂ Colic in babies is a term used for crying babies that are usually unconsolable for periods of a couple hours and may be caused by gassiness. This may be due to a formula intolerance or allergy to a formula. In breast-fed babies, food or drink that the mother is consuming may cause colic. Gassy foods like beans, broccoli, onions, cabbage or spicy foods may cause the baby to be gassy. Also caffeinated drinks, chocolate or red wine may create an irritable baby.
♂ "Spitting up" or gastroesophageal reflux in babies can sometimes cause a fussy baby with abdominal pains. A baby who spits up alot may develop "heartburn" or what is known as esophagitis. Signs of this include a baby who cries alot with feeding or arches with feeds. They may have a decreased appetite.

If your child is acting sick, the child may need immediate evaluation.. The doctor should be contacted immediately if a

▽Call the doctor immediately if:▼
♂ A baby is constantly crying, alternating with restless sleep; pale or mottled, blotchy skin or has other signs of acting sick
♂ An older child is doubled over with pain or crying with pain for more than a half to one hour or worsening pain in a two hour period
♂ Moderate or severe dehydration
♂ Unable to walk or walks bent over
♂ Blood in stool
♂ Possibility of poisoning with chemicals, plants or other toxic substances
♂ Recent injury to the abdomen
♂ Marked tenderness in any location or mild tenderness in the right lower quadrant when touched
♂ Urinary tract infection symptoms (frequent urination, pain with urination, blood in the urine, foul smell to the urine or urgency to urinate)
♂ Other concerning signs listed under vomiting or diarrhea

▽Call during office hours if:▼
♂ Recurrent abdominal pain - pain that comes and goes
♂ Abdominal pain associated with constipation
♂ Associated symptoms that may need evaluation like sore throat, earache, persistent cough

▽Home treatment▼
If pain is severe and worsening over a two hour period, the child will need to be evaluated immediately. A warm washcloth or hot water bottle over the abdomen may be soothing. Do not try to give solids, but try clear fluids first.

Psychological distress. Occasionally, with psychological distress, a child may complain of abdominal pain. You may suspect this if your child has no other physical symptoms and
♂ is unusually clingy, or having unusual aggressive or withdrawn behavior
♂ there has been some traumatic event, like a move, change at school, change in the home situation, marital discord, illness or death in the family, scary TV or movie show, disruption in friendships, or suspicion of sexual molestation
♂ rarely does this awaken a child at night

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Pinworms

A small white, thin worm about 1/4 inch in length that infects the intestinal tract. The main symptom is usually rectal itching, especially intense at night.

♂ They may seen with the naked eye and are best seen at night or early in the morning in the rectal area. To diagnose pinworms look with a flashlight in the rectal area a few hours after your child goes to bed or in the early morning. You should see the 1/4 inch threadlike worms moving. Occasionally they are seen with the bowel movement. They come out at night to lay eggs in the rectal area.
♂ They are extremely common in childhood and are usually contacted from other children. They become infected when they ingest the pinworm eggs. The swallowed egg matures to the adult pinworm after 3 to 4 weeks.
♂ This infection does not reflect uncleanliness or poor hygiene and frequently does recur.
♂ They are harmless and do not typically cause abdominal pain or diarrhea. Occasionally, if the child is heavily infected, abdominal pain may be a problem.
♂ A laboratory microscopic exam may be done if the diagnosis is uncertain. Discuss with your physician how to order this.

▽Home treatment▼
1. Treatment of pinworms.
Call your physician during office hours (it is not really a nighttime emergency) if you have identified the pinworms for prescription medication. Discuss if other family members need treatment also. Alert your physician if anyone in the family is pregnant.

2. Prevention of pinworms.
To prevent reinfection with pinworms, have the child use good handwashing techniques before meals. Vacuum your child's room once a week because any eggs on the floor are infectious for 1 to 2 weeks. Machine wash bedding and clothing will kill any eggs.

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Head Lice (芛坉)

Head lice are very common in childhood and are easily transmitted by using a hat, comb, headphones or brush of an infected person. They are also transmitted by close contact with an infected person. They do not indicate poor hygiene and have become very common epidemics among school children. They only live on humans and cannot live for more than 72 hours off the human body.

The findings of head lice include nits which are small white eggs that are firmly attached to the hairs closer to the scalp. They cannot be shaken off and are very difficult to pull off with your fingers. Sometimes, the lice themselves are seen which are gray bugs that move quickly. The scalp is very itchy and occasionally there is a rash. They tend to favor the back of the scalp or above the ears.

▽Call during office hours if:▼
♂ New eggs appear after recent treatment
♂ A rash is present that does not clear within a week of treatment
♂ Skin sores spread or look infected

▽Home treatment▼
1. Antilice shampoo.
There are a few over-the-counter products available, such as Nix or Rid. Use as directed on the package. Talk to your physician if these have failed to discuss other treatments.

2. Removing the nits.
This step is very important to help insure that they will not recur. After shampooing, you may use a special comb (usually comes with the shampoo) to remove the nits or they may be removed by hand. Check the hair daily after treatment and remove any nits that are found.

3. Cleaning the house.
After treatment, the house should be vacuumed, especially the area where the nits were removed and the child's bedroom. All sheets and bedding should be washed in hot water. Any items that cannot be washed may be tied up in a plastic bag for 2 weeks to insure that the nits will die. Combs and brushes should be soaked for 1 hour in a solution made from the antilice shampoo. Be sure to check all family members for nits and treat any with symptoms of itching scalp or visible nits.

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Diaper Rash

Any rash in the diaper area.

Almost every child will get a diaper rash sometime in their life no matter how clean we try to keep them. They may occur with cloth or disposable diapers.
Diarrhea is a common factor to trigger a diaper rash. It is typically caused by moisture, and skin irritation from bacteria in the stool or chemicals in the urine. This creates an irritant diaper rash that appears like a burn more predominately in the rectal area.
Yeast (candidal) diaper rashes are also common. This comes from a moist, heated environment and typically looks red, sometimes raw or raised with small bumps. The bumps that look like pimples around the edge of the rash are called "satellite lesions." Yeast rashes usually occur more towards the front of the genitals - on the labia in girls, on the testes and groin area of boys and can even spread down the thighs.

▽Call the doctor immediately if:▼
♂ Large blisters more than one inch
♂ Acting sick

▽Call during office hours if:▼
♂ Rash is worseining despite home treatment after 3 days
♂ Blisters, sores or crusting develops

▽Home treatment▼
1. Irritant diaper rash.
Change diapers frequently and immediately after bowel movements. Wash with warm water and mild soap or you may use Vaseline to clean the skin. Allow the diaper area to air dry whenever possible. Carefully use a blow dryer on a low setting to help dry the area. Avoid airtight plastic pants. A barrier ointment like Desitin, Dyprotex or A & D ointment are helpful to protect the skin. Powders are not generally recommended because of the risk of a baby aspirating the powder into their lungs when it is being used.

2. Yeast (candidal) rash.
Yeast infections are very common in babies. Yeast is present everywhere in our environment. It loves moist areas such as the diaper area. It can also be found in other areas like the creases under the arms and the neck of a chubby baby. It may also be present in the mouth and is called thrush when it occurs orally. If your baby has a yeast diaper rash, be sure to check the mouth also and call the doctor during office hours to receive a prescription for thrush. Thrush appears as white patches inside the cheeks, lips and on the tongue. Yeast diaper rashes needs an antifungal cream to cure it. These creams are available by prescription or over-the-counter. The over-the-counter cream contains clotrimazole and one brand of this is called Lotrimin.

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Chickenpox (阨飩)

Chickenpox is caused by a virus called varicella that usually starts with a fever. The rash develops a day or two after the start of the fever. The rash looks like a small, red bump that has a thin water blister surrounded by a small area of redness on the skin around the blister (the appearance has been described as a "dewdrop on a rose petal"). These blisters then become open sores that finally dry and crust. There are repeated crops of sores for 4 to 7 days. The first usually appear on the head and neck area. The arms and legs and then palms and soles appear with lesions near the end of the course of the disease.

♂ The incubation (time from exposure to time of the child having the disease) is anywhere from 10 to 21 days.
♂ Usually fever starts before the appearance of the bumps by 1 to 2 days.
♂ The contagious period starts 1 to 2 days before the appearance of the rash and ends when all the bumps are crusted, typically around 5 to 7 days.
♂ The most common season is late winter and early spring.
♂ A person is not contagious if they have been around someone with chickenpox, but have already had the disease or are not in the contagious period described above.
♂ Sores may also occur in the mouth, around or in the eyes and in the rectal and genital area.
♂ If you suspect your child has chickenpox and are making an appointment to be seen in the office, please alert the staff on the phone so they may make arrangements for your child to be seen without exposing other children in the office. Most uncomplicated cases of chickenpox do not need to be seen by a physician.

▽Call the doctor immediately if:▼
♂ The child is confused and delirious, difficult to arouse (try acetaminophen or ibuprofen if febrile) or acting sick
♂ Stiff neck or severe headache
♂ Difficulty breathing
♂ Vomiting with signs of dehydration
♂ Purplish spots on the skin
♂ Child develops trouble walking, losing balance
♂ You suspect your newborn under 2 months old has chickenpox
♂ There is evidence of a rapidly spreading skin infection - large, red area of skin with red streaks radiating from the red areas

▽Call during office hours if:▼
♂ Yellow discharge/pus draining from lesions or a large area of redness around a lesion
♂ Fever more than three days
♂ Intense sore throat
♂ Adults are exposed who have never had documented chickenpox
♂ You suspect a newborn (under 2 months old) in the household may have been exposed to chickenpox
♂ Your child is on a course of steroids for an underlying disease like asthma, arthritis and has been exposed to chickenpox
♂ Chickenpox near or in the eye

▽Home treatment▼
1. Relief of itching.
Oatmeal baths (preparations such as Aveeno are available over-the-counter) are helpful. Calamine lotion may be placed on the itchy lesions. Over-the-counter antihistamines, such as Benadryl may be used. Lesions may occur in the mouth, and the key is to make sure fluids are encouraged to avoid dehydration. A bland diet (avoid salty foods and citrus) and cold liquids or popsicles are best tolerated.

2. Fever control.
Never use aspirin with a child with chickenpox, because of the association with Reye's syndrome. Reye's syndrome is characterized by a child who is delirious and confused (out of proportion to the fever and despite fever control) and vomiting. See fever for guidelines on fever control.

3. Infected chickenpox (impetigo).
To prevent infection, keep the child's fingernails cut short and wash hands with an antibacterial soap frequently. If you suspect a minor skin infection starting, you may use an over-the-counter antibacterial ointment until you can call during office hours. If you see a rapidly spreading skin infection over a few hours, call the office immediately. Purplish spots on the skin may indicate a hemorrhagic or bleeding form of chickenpox and the doctor should be contacted immediately or taken to the emergency room.

4. Chickenpox vaccine (varivax).
There is new vaccine to prevent against chickenpox. Please discuss the details individually with your physician. Children may receive it after a year of age.

5. Acyclovir (Zovirax).
Oral medication with acyclovir, may shorten the course of chickenpox once the infection develops. It is not a cure for the disease. Please discuss this medication with your physician.

6. Shingles (湍袨婦淟).
Shingles is a localized case of chickenpox in a small area of the body. The outbreak of pox lesions follows a nerve root and occurs months or years after a primary infection with chickenpox. It occurs more frequently in adulthood. Some people develop this complication and some people do not. Discuss possible treatment with acyclovir with your physician.

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