Illness in the first two months of life is unusual. However, babies at this age may not fight infections well. Therefore, your baby should not have contact with people known to have an infectious illness. All people should wash their hands before holding the baby, especially in the first few months of life.

If your baby has any of the following symptoms in the first 2 months of life, we should be contacted:

• Fever greater than 100.5 taken rectally or under the arm.
• Refusal of 2 or more feedings in a row
• Forceful vomiting of 2 or more feedings in a row
• Excessive irritability or lethargy

Chicken Pox

Chicken pox is a viral infection caused by the Varicella virus. Symptoms include fever for 2-3 days, a blister-like itchy rash, and a runny nose. The rash begins as small red spots that rapidly progress to white blisters, then scab in several days. Treatment includes antihistamine such as Benadryl, Tylenol for fever, and comfort measures such as Aveeno baths. There is an antiviral prescription medication available if the infection is found early. The rash is contagious until all lesions are scabbed. The incubation period is 14-21 days. The Varivax vaccine prevents chicken pox in 80% of kids vaccinated.

If your child has an underlying chronic condition, please call the office as soon as symptoms appear. If through the course of the illness, one pox looks markedly different than the surrounding lesions, please call the office. This may be a sign of a secondary infection.

Colds / Upper Respiratory Infections

Colds (URI) are caused by viruses. The typical child has 10-12 URIs in one year. They are the most frequent infection in childhood. Symptoms of URI include runny nose (first, a clear discharge, later, a thicker, colored discharge), sneezing, fever (101-103) initially for 2-3 days, decreased appetite, red eyes, mild sore throat, cough, slightly swollen glands, and decreased activity. Colds typically last 1-2 weeks. Sinus infections are rare in young children and are unlikely to develop before 14 days of cold symptoms. Green nasal discharge does not necessarily indicate a bacterial infection.

Treatment of colds is aimed at improving symptoms to make your child feel better. Fever may be treated with Tylenol or Motrin. Runny nose may be treated with over the counter decongestants for children older than 3 months (for dosages see the charts in the end of the booklet.) Also, encourage your child to drink.

Please call the office if your child has:

• A fever for more than 3 days
• Trouble sleeping at night
• Ear pain
• Trouble breathing
• Poor drinking and decreasing urination
• Symptoms lasting greater than 2 weeks

Constipation

A child’s stool pattern will vary throughout her life. Normal stool pattern may vary from several stools per day to one per week as long as the stools are soft. Periods of constipation may occur at any age. Constipation means the stools are hard, often like balls. Many babies will grunt and turn red in the face when having a stool. This is normal if the stools aren’t hard and the abdomen is soft when not crying. If your infant is younger than 2 weeks and seems constipated, please call the office during office hours. If your baby is older and constipated, you may try giving an extra ounce of water several times a day between feedings or 2 ounces of baby juice diluted half and half with water one or two times a day. If these methods do not help, please call the office.

Older children may also develop constipation. Sometimes, this develops after a period of illness when the child’s fluid intake has decreased or after a child has eaten many constipating foods for several days. Children may also learn to resist stooling if they have had a painful stool in the past. When an older child develops constipation, the first things to try are diet changes. Try to encourage your child to eat high fiber foods such as bran, Cheerios, oatmeal, popcorn, fresh fruits (except bananas), vegetables, and 100% fruit juices such as prune, apple, and grape. Fiber may be added by giving ½-1 Metamucil per day with 8oz of juice or water. Also encourage your child to drink extra fluids but limit milk and cheese to 3 servings per day. Call us during office hours if diet changes make no change in you child’s stools in one week or if your child becomes very uncomfortable.

Croup

Croup is a viral illness seen most commonly in infants and young children. Symptoms are caused by swelling of the upper airway (trachea). Symptoms include low grade fever, barky seal-like cough, and runny nose. Symptoms are usually worse in the evening and nighttime. The abrupt barky cough may awaken the child. The child may appear to be short of breath. The barky cough may last 3 or 4 nights. A looser cough may follow the barky cough for several more days. Treatment for coughing episodes includes elevating the head of the bed, cool mist humidifier, and steam from the shower or cold humid night air. Tylenol or Motrin may be given for fever.

If your child’s cough or shortness of breath is not relieved by the above treatment, you will need to call us. Special aerosol treatments and steroids are sometimes needed. Rarely, children need to be hospitalized.

DiarrheaStool patterns for children vary with age and diet. An occasional loose stool is not cause for alarm. If, however, the bowel pattern changes suddenly to loose, watery stools that occur more frequently than usual, your child has diarrhea.

Causes:

• Viruses - the most frequent cause in children
• Bacteria
• Parasitic infections (Giardia)
• Food or milk allergy
• Side effects of medications (most commonly antibiotics)
• Food poisoning

Treatment

There is no effective medication for viral intestinal infections. Antibiotics are only used to treat certain types of bacterial or parasitic infections. Treating these types of infections would be done after a stool culture shows bacteria or parasites.

We do not recommend over the counter medications for diarrhea for children. Please call the office before beginning antidiarrheal medications.

The main stay of treatment is diet changes. If your child is not vomiting, we do not recommend a “clear liquid diet”. Instead, give your child bland, constipating foods such as potatoes, bananas, cereal, applesauce, rice, and toast. Stay away from high sugar foods such as Jell-O, fruit juices, Gatorade, or pop.

Diarrhea from viral infections can last 10-14 days.

Call the Office if Your Child Has:

• Fever lasting longer than 3 days
• Bloody stools
• Vomiting for greater than 24 hours
• Distended (swollen appearing) abdomen
• Severe abdominal pain
• Refusal to drink
• Diarrhea lasting longer than 10 days
• Signs of dehydration including no urination for 12 hours, dry mouth, or absent tears

Ear Infections

During your child’s first year of life, there is a significant chance that she will have an ear infection. This happens when fluid accumulates behind the ear drum during a cold or throat infection. If bacteria or viruses infect this fluid, the ear drum may become red and bulging, causing pain and fever in your child.

Two thirds of children have at least one ear infection prior to their second birthday. Some children are at higher risk for ear infections. Children exposed to “second hand smoke” have a higher incidence of ear infections. Because children cared for at day care centers are exposed to more viral illnesses, they are at risk for more ear infections. Bottle feeding while laying flat may also increase the chance of ear infections.

Signs and symptoms include:

• Ear pain
• Fever
• Waking up at night
• Ear drainage (blood tinged yellow fluid or pus drainage)
• Refusal to drink bottles
• Hearing loss
• Vomiting (occasionally)

Treatment

If your child has signs or symptoms of an ear infection, please call the office during office hours for an appointment. We need to examine your child if you feel they have an ear infection because there are other causes of ear pain.

Eye Infections

If the white of your child’s eye and the inside of her lower lid becomes red and the eyes are mattering, she probably has a condition called conjunctivitis. Also known as “pink eye,” this inflammation usually signals an eye infection but may also be due to other causes such as irritation, an allergic reaction, or (rarely) a more serious illness.

Call us during office hours if your child experiences these symptoms. If your child’s eyelid becomes swollen shut and purplish in color, or if your child complains of severe pain or blurred vision, please call us immediately.

If your child’s eye is mildly red with no mattering, then you can safely watch for several days or try Artificial Tears. If your child’s eye is draining yellow or green discharge and is matted shut upon awakening, then your child may need treatment for conjunctivitis. Most cases of conjunctivitis can easily be treated with eye drops or ointment. You should see improvement in the eye redness and mattering within several days of treatment. If the eye continues to be bothersome after 2-3 days, let us know. Also let us know if your child complains of ear pain because some of the bacteria that cause conjunctivitis can also cause ear infections.

Fever

By itself, fever is not an illness. Fever is not dangerous; rather, it is a sign that your body is fighting an infection of some kind. We do not worry about brain damage until the fever reaches 107º-108º F. Temperatures may be taken under the arm or rectally in young children or orally in older children with a digital thermometer. Ear thermometers tend to be inaccurate in young children and should be double checked with a digital thermometer. There is no need to add/subtract degrees with any method.

We consider any temperature greater or equal to 100.5ºF (38ºC) a fever. If your child is under 2 months old and has a fever, you should call us. If your child is older than 2 months and is drinking and sleeping well and has playful or smiling moments, you may treat fever less than 105ºF with Tylenol using the dosages found here. If your child is 6 months or older, you may use Tylenol or Motrin (Ibuprofen dosages found here). Baths with lukewarm water may also make your child feel better. We do not recommend alcohol baths. These may raise the temperature and cause seizure.

Most fevers in children are caused by viruses. Fevers usually last for 2-3 days. If you would like your child to be seen sooner, please call the office for an appointment. If your child complains of earaches, sore throat, or burning with urination, please call for an appointment.

Hives

Hives are a skin rash caused by multiple different sources. Hives are reddish raised patches of itchy skin. Lesions vary in size from pencil eraser size to large patches. The rash comes and goes with new lesions reappearing each day. The rash may last 1-2 weeks. Potential causes include medications, viral illnesses, and other allergens. Treatment includes oral antihistamines such as Benadryl. If Benadryl is no help or your child is taking a medication, please call the office.

Sore Throats

Your child will probably experience several sore throats per year. Sore throats can be associated with colds and other viral illnesses. Sometimes bacterial infections, especially “strep throat” may occur.

The symptoms of strep throat include sore throat, difficulty swallowing, headache, nausea/vomiting, and usually fever. However, viral infections can cause similar symptoms. If a sore throat is accompanied by a runny nose or cough, it is more likely to be due to a viral infection or cold.

A strep test or throat culture is the easiest and most accurate way to differentiate the cause of your child’s sore throat. These tests can be done during normal office hours and are not an emergency. You may watch a sore throat for 24 hours to see of other symptoms suggesting a cold begin.

Treatment for strep throat includes antibiotics prescribed after test results confirm the diagnosis. Viral infections are not treated with antibiotics. Symptomatic treatment includes cold foods and drinks, Tylenol or Motrin for fever and discomfort, and salt water gargling or Chloraseptic spray in older children.

Children diagnosed with strep throat are contagious for 24 hours after antibiotics are begun. Viral infections are usually contagious during the fever phase of the illness.

Vomiting

Causes include:

The common causes of vomiting vary with age. During the first few months of life, most infants will spit up small amounts of formula or breast milk. This is a normal occurrence and will decrease with age. If young infants exhibit forceful vomiting that is projectile and associated with weight loss, an abnormality at the stomach exit may be present.

After the first few months of life, the most common cause of vomiting is viral infections of the stomach or intestine. The infection may cause fever, vomiting, diarrhea, and abdominal pain. Other more infrequent causes of vomiting include strep throat, ear infections, urinary tract infections, and appendicitis.

Call the office if:

• Blood or bile (a green colored substance) in the vomit
• Severe abdominal pain
• Severe irritability
• Signs or symptoms of dehydrating including no urination for greater than 12 hours, dry mouth, or absent tears
• Inability to drink any fluids for greater than 6 hours
• Burning with urination
• Earache
• Sore throat
• Severe cough or hard breathing

Treatment

1. Wait 1-2 hours after the last vomiting episode, then give small amounts (ie. ½ oz.) of clear fluids such as Pedialyte® every 15-20 minutes
2. If your child retains this amount for several hours, then slowly increase the amounts given until the child is tolerating clear liquids for 12 hours.
3. When your child is tolerating clear liquids, you may slowly advance the diet to formula and bland foods such as bananas, rice cereal, applesauce, and toast.
4. Call the office if your young infant has recurrent projectile vomiting.