The following information is intended to assist you in caring for your child and is for informational purposes only. Parents should not rely on this web site as a sole source for care. You are advised to seek the advice of your medical health professional at any time. When contacting our office, we ask that you provide your child’s name, age, weight, medications, allergies and/or symptoms. Please have a paper and pen available at the time of your call. Holland Pediatric Associates, PLC is not responsible for errors or omissions. Reference to trademark products does not constitute an endorsement.

Acne

Most acne can be treated well right at HPA. If your child doesn’t respond to usual treatments, a Dermatology consult may be ordered.

Behavioral Issues

There are few areas that raise more concern among parents than their child’s behavior. Pediatricians are often asked about the best approach to “behavior problems” but the best approach is not always clear-cut. In fact, the many professionals that deal with children often do not agree on the best approach and often there are several approaches that seem to work.

Parents frequently have difficulty telling the difference between variations in normal behavior and behavioral problems because what is normal is often dependent on a child’s level of development. Children of the same age often vary in their level of development. Additionally, a child’s development can be uneven so that a child’s social, physical and intellectual development may not all be at the same level. Finally, each one of us has different behavior expectations for our children based on our own family, cultural and social values.

We hope that you find the information listed below helpful in determining whether a behavior is a problem. We feel that they present a reasonable approach to problems. For some families this information may be all that is needed. Others may want to make an office appointment to discuss the problem further. In a few instances we may refer you to a child behavioral specialist.

Colds and Cough

It is not unusual for children to have several colds each year. A cold is caused by a virus. Antibiotics will not help since colds are not caused by bacteria. Only time and tender, loving care will help. Most colds will last 1-2 weeks and some may persist longer. Nothing will shorten a cold. Your main concern is to make your child as comfortable as possible during this time.

Cough is a common symptom, often seen with a cold, in response to throat irritation or nasal drainage in the throat. Congested sounding coughs often come from a build-up of this nasal drainage in the throat. A cough is a natural response by the body to rid itself of something irritating. If your child is comfortable and can go about his or her daily activities, there is no reason to give something for the cough. Allowing him or her to cough helps move the secretions around and helps to prevent infections such as pneumonia.

We do not recommend using any cough or cold medicine for children under six years of age. The following are suggestions we do recommend:

Encourage fluids.
Elevate the head of the bed. Children under two years of age should not use a pillow.
Use a cool mist vaporizer. Avoid steam vaporizers due to the risk of serious burns.
Salt water (saline) nose drops (i.e. OCEAN NOSE DROPS™) may be used. Use these for your infant before feedings and bedtime along with a round tip nasal bulb syringe. Homemade salt water nose drops can be made by mixing 1/4 tsp. salt in one cup clean warm water. Put two drops in each side of the nose and use the bulb syringe.

Some reasons to call today:

Signs of labored breathing
- Faster breathing than usual
- Pale color or bluish color around nails or mouth
- Pulling in of skin under or between the ribs
- Wheezing sound heard when child breathes out
- Noise heard when child breathes in
- Grunting sound when child breathes out
- Anxious or fretful look with breathing
Fever more than 3 days
Fever that goes away for 24 hours and then returns
Cold not improving in 10-14 days
Coughing in infants under three months of age
Any non-stop cough
Coughs that last longer than 3 weeks
Cough that started after choking

Diarrhea

Diarrhea can be seen frequently in infants and children. Some of the causes of frequent watery stools can be viruses, bacteria, parasites, medications, food intolerances and allergies. One or two loose stools is NOT diarrhea. Do not use any of the diarrhea medications found in stores unless your doctor specifically orders it for your child. Use of these medications can be harmful. It is suggested that you purchase a bottle or packet of electrolyte rehydration solution (such as Pedialyte™) at your grocery or drugstore. Store brands are also available. This rehydration fluid is also available in popsicle form. A homemade recipe is found below for those times you are unable to get to the store. Use of this fluid is intended for the first twenty-four hour in children with mild symptoms of dehydration.

Children who have diarrhea, and are not dehydrated, should continue to be fed a diet appropriate for their age. It is no longer routinely recommended that all children have clear liquids for the first twenty-four hours. If your child does not appear to have any of the signs of dehydration, you should continue to feed a normal diet. Avoid fatty foods.

Some suggested foods for the older child are:

Rice, wheat, potatoes, bread
Lean meats
Yogurt
Fruits and vegetables

Infants may continue to breastfeed or bottle feed formula during periods of diarrhea. You may continue feeding solid food. Do not introduce any new food until the diarrhea has stopped. Results will not be seen instantly. A gradual lessening of the number of stools will occur over the next few days.

If your child is currently taking an antibiotic, the loose stools can be decreased or eliminated by adequately spacing apart the doses. For instance, three times a day should be 8 hours apart; two times a day should be 12 hours apart. Offering yogurt with active cultures to children over six months of age or giving probiotics in an age appropriate form can be helpful.

An adequate fluid intake should be encouraged! Your infant or child should be given additional fluid after each stool to replace the fluid lost in the stool.

Some reasons to call today:

1. Signs of dehydration

No wet diaper for 8 hours or more in infant under 1 year of age
No wet diaper/urination for 12 hours or longer in children 1 year or older
Sunken eyes or sunken soft spot on head
Dryness or stickiness inside of cheek or mouth
Increased thirst
Weight loss
“Washed out” or “weak-looking” infant or child

2. Blood in stool
3. Diarrhea persisting longer than 2 weeks
4. Persistent abdominal pain
5. Diarrhea plus fever

Recipe for oral rehydration solution:

1 quart water

1/2 teaspoon of salt

8 teaspoons of sugar

1 quart water

1/2 teaspoon salt

1 cup baby rice cereal

Use a measuring spoon and mix together in a clean container. Discard after twenty-four hours.

Ear Pain

Most earaches are caused by an accumulation of fluid in the child’s middle ear (behind the eardrum) that sometimes gets infected with bacteria or viruses. Usually this fluid occurs as a result of a cold or allergy. Some infants will tug at their ears, awaken frequently at night and act fussy especially when lying down. Although any of these symptoms might indicate an ear infection, it should be understood that not all infants who act like this have an ear infection. Some infants and children routinely play with their ears.

Treating ear pain:

If your child seems uncomfortable, use acetaminophen (i.e. Tylenol™) or ibuprofen (i.e. Advil™ or Motrin™) until you can call the office in the morning.
A warm water bottle or heating pad on LOW against the ear may make the child more comfortable. Never let a child sleep on a heating pad.
Rock the infant or child in a rocking chair.
Elevate the head of the bed. Do not use pillows with children under two years of age.

Some reasons to call today:

1. Child persistently complains of earache
2. Drainage from ears
3. Pain with the movement of the ear lobe, particularly if the child has been swimming
4. Recent cold symptoms with fussiness, not sleeping well and/or fever

Fever

Fever is probably one of the symptoms that parents worry about the most. Contrary to popular belief by parents, fever is rarely dangerous. It is simply the body’s NORMAL response to an infection, usually caused by a virus or bacteria. Fever is NOT the illness. Current research has shown that fever actually can help shorten the length of the illness. Most children tolerate fevers very well. However, since fever may be the only sign of serious infection in a very young infant under 3 months of age, children in this age group may need to be examined that same day. Please call our office to speak with our telephone medical staff if you have any questions about your child’s fever.

Treating Fever

The purpose of reducing fever is to make the child feel more comfortable during the illness. Reducing the fever does NOT shorten the illness. Generally, if the child’s temperature is under 102 degrees and he/she feels comfortable, there is no need to use acetaminophen or other fever reducing products. However, if the child looks uncomfortable, then use of these products may help. (See Dosage Charts here). Do not use any fever reducing product with an infant under 4 mos. of age without FIRST calling our office. There are things that every parent can do to reduce the fever and increase the comfort level of the child:

Dress lightly
Offer plenty of fluids
Use acetaminophen (Tylenol™, etc.) NEVER ASPIRIN. Ibuprofen (Motrin™, Advil™) can also be used to reduce fever in children 6 mos. and older. It is not recommended to alternate between acetaminophen and ibuprofen every few hours.
Sponge bathing with warm tepid water (NEVER ALCOHOL) is only recommended if the fever reaches 104 degrees. If the child begins to shiver or gets goose bumps, stop sponging. This is the body’s attempt to warm itself even further.

Some reasons to call today:

1. Infant under 3 mos. of age with a temperature of 100.4 degrees rectally or higher
2. Very irritable, pale or “sick looking” infant or child (even if no fever)
3. Fever over 101 lasting more than 3 days
4. Fever with any of these symptoms:

Stiff neck
Tiny purple dotted rash
Pain on urination
Breathing problems

5. Temperature of 105 degrees or above
6. Seizure
7. Fever that returns after being gone for 24 hours

Head Injury

Head injuries in childhood may occur as a result of falls, accidents or fights. Although most head injuries are not serious, they do have the potential to become a problem. Call 911 immediately if your child is unconscious.

Treating a head injury:

If there are no signs of concussion (see SOME REASONS TO CALL TODAY) you may observe your child at home. Children will often be sleepy after the injury. Try to keep your child awake or distracted long enough to console him or her to see appropriate behavior for a few minutes (i.e. walking, talking, eye contact). Wake your child in two hours and at least once during the night. Elevating the head of the bed and applying a cool washcloth to the bump or bruised area may increase comfort. Look for these things over the next three days:

Alertness. Does he or she recognize you, know where he or she is, remember what happened?
Increasing headache. Acetaminophen (i.e. Tylenol™) may be used for comfort. If this does not help be sure to contact the office.
Problems with walking, vision or speech. Any changes to your child’s usual pattern should be reported.
Occasionally children will vomit after a head injury. Therefore, for the first few hours immediately after the injury, do not offer anything to eat or drink. Call if your child continues to vomit.
CALL 911 for any child that is difficult to awaken or doesn’t recognize familiar surroundings.

Some reasons to call today:

1. Unable to remember what happened or any loss of consciousness
2. Repeatedly vomits more than 3 times
3. Problems with speech, vision, walking
4. Increasing or continuous headache
5. Extreme irritability or sleepiness
6. Fall from a height or down a flight of stairs
7. Child or infant seems in pain
8. Babies under 3 months of age who fall or hit their head

Lice

Head lice are tiny, gray bugs. They are 2 to 3 millimeters long. They move fast and are hard to see. Head lice live in the hair and bite the scalp to suck blood. They attach their white eggs, called nits, to the hair. Unlike dandruff, nits can’t be shaken off. The nits are easier to see than the lice because they are white and there are a lot of them. The back of the neck is the favorite area for lice and nits. Lice and nits cause your child’s scalp to itch and have a rash.

Head lice live only on human beings. They can be spread quickly by using the hat, comb, or brush of an infected person, or simply by close contact. Lice may crawl or fall onto clothing, bedding, towels, or furniture. Anyone can get lice despite good health habits and frequent hairwashing. The nits (eggs) normally hatch into lice in about 1 week.

Here’s more information from the AAP (American Academy of Pediatrics).

One head lice treatment is the Nuvo method, which involves smothering the lice with Cetaphil Gentle Cleanser.

Here are the steps:

Apply Cetaphil Skin Cleanser to dry hair, coating the head from scalp to hair tips
Wait 2 minutes
Comb out excess Cetaphil
Blow dry your child’s hair thoroughly
Leave the dry Cetaphil on the hair for at least 8 hours
Wash the hair with a regular shampoo
Repeat this process twice at 1 week intervals

Another alternative is over the counter Lice shampoo or rinses:

Follow the directions. Most products must be used on dry hair. Pour about 2 ounces of the anti-lice shampoo into the dry hair. Add a little warm water to work up a lather. Scrub the hair and scalp for 10 minutes, by the clock. Rinse the hair thoroughly and dry it with a towel. The shampoo kills both the lice and the nits. Repeat the anti-lice shampoo once after 7 days to prevent reinfection.

Removing nits:

To make sure the nits are dead, wait at least 8 hours after using the shampoo before removing them. Remove the nits by backcombing with a fine-tooth comb or pulling them out individually. The nits can be loosened using a mixture of half vinegar and half water. Apply the mixture to the hair and keep your child’s hair under a towel wrap for 30 minutes. Even though the nits are dead, most schools will not allow children to return if nits are present. The head does not need to be shaved to cure lice.

Lice in the eyelashes: If you see any lice or nits in the eyelashes, put plain petroleum jelly on the eyelashes twice a day for 8 days. The lice won’t survive.

Cleaning the house:

Head lice can’t live for more than 24 hours off the human body. Your child’s room should be vacuumed. Soak combs and brushes for 1 hour in a solution made from the anti-lice shampoo. Wash your child’s sheets, blankets, and pillowcases in hot water. Items that can’t be washed (hats or coats) can be sealed in plastic bags for 2 weeks (the longest that nits can survive). You do not need to use anti-lice room sprays.

Contagiousness:

Check the head of everyone else living in your home. If lice or nits are seen, or they start to get an itchy scalp rash, they should be treated with anti-lice shampoo. Bedmates of children with lice should also be treated. If in doubt, have the person checked. Your child can return to school after the first treatment with the shampoo. Remind your child not to share combs and hats.

After you use anti-lice shampoo all lice and nits will be killed. If the lice come back, it usually means your child has had contact with another infected person or the shampoo wasn’t left on for 10 minutes. There are no lasting problems from having lice and they do not carry other diseases.

Call during office hours if:

The rash and itching are not gone 1 week after treatment.
The sores start to spread or look infected.
The lice and nits return.
You have other questions or concerns.

Physicals

We cover much more in our full physicals given here in the office than those given at schools. A lot of information is shared and preventative care given during these physicals. It is an important evaluation of your child’s physical, emotional and social well being. This is one of the best tools that we have to see problems at the beginning and provide early intervention.

Sore Throat

Two types of infections may cause sore throats: viral and bacterial. Not all sore throats are caused by Strep. More commonly sore throats are caused by viruses. If it is due to this, you may see cold symptoms, such as coughing, congestion or hoarseness. Sore throats due to a virus usually get better all on their own within approximately a week or so. Antibiotics do not work on viruses. Sore throats due to the Strep bacteria usually do not have any cold symptoms at the same time and do need to be treated with an antibiotic.

Treating a sore throat:

Encourage fluids
Acetaminophen (i.e. Tylenol™) or Ibuprofen (Motrin™, Advil™) for pain
Salt water gargles for older children: Mix 1/2 tsp. salt in 8 ounces of warm water
Children over 4 years of age may suck on hard candies or throat lozenges
Increase the humidity level in the house during the winter season

Some reasons to call today:

1. Fever over 101 degrees lasting more than 3 days
2. Fever over 105 degrees
3. Rash
4. Difficulty breathing or swallowing
5. Drooling or unable to swallow saliva
6. Tender swelling in the neck area or stiff neck
7. Family member was diagnosed with Strep throat in the past seven days and now this child is complaining of same symptoms

Vomiting

Vomiting can be caused by many factors. There is a certain way our office would like you to treat your child at home. Depending on the age and condition of the child, the suggested treatment may vary. If there are any signs of dehydration call our office right away. If not, please find your child’s age and follow the directions carefully. Wait one hour from the last time your child vomited before you begin fluids for the first time.

Treating vomiting under one year of age:

Use Pedialyte™ or another oral rehydration solution. Flavored varieties or the frozen popsicle form can be used for the child over six months of age.

Breastfed Infants:

Offer rehydration solution (Pedialyte™) 1-2 tsp. every 10-15 minutes by bottle.
After 4 hours, you may slowly increase the amount as tolerated.
Call the office for further instructions if your infant cannot keep this solution down.
After 8 hours of Pedialyte™, you can resume breastfeeding every 1-2 hours. Alternate breasts for nursing. Shorter frequent feedings are best. Once your infant tolerates 3-4 feedings, you may slowly increase the nursing time as tolerated.
If the infant is on solid foods, these may be resumed in 24 hours. Do not introduce new foods.

Bottle Fed Infants:

Offer rehydration solution (Pedialyte™) 1-2 tsp. every 10-15 minutes by bottle.
After 4 hours of no vomiting, you may slowly increase the amount and interval between feedings.
Once vomiting has stopped for 8 hours, return to regular formula feeding.
Return to regular diet in 24 hours.

Treating Vomiting over one year of age:

Offer rehydration solution (Pedialyte™) 1/2 ounce every 10 to 15 minutes.
Solution also available in frozen popsicles and flavored varieties
After 4 hours of no vomiting, slowly increase the amount and interval between feedings
After 8 hours of no vomiting, may have saltines, rice or unbuttered toast
Return to bland diet in 24 hours: bananas, cooked carrots, applesauce, unbuttered toast and other non-spicy, non-fatty foods

Some reasons to call today:

1. Signs of dehydration

No wet diaper for 8 hours or more in infant under 1 year of age
No urination for 12 hours or longer in child 1 year or older
Sunken eyes or sunken soft spot on head
Dryness or stickiness inside of cheek or mouth
Increased thirst
Weight loss
“Washed out” or “Weak-looking” infant or child

2. Infant under one year of age that repeatedly vomits the rehydration solution
3. Irritable or fussy infant
4. Vomits medication
5. Appears to have lost weight
6. Infant under 3 months of age with projectile vomiting, yet still seems hungry
7. Head injury with vomiting more than three times
8. Vomiting lasting more than 24 hours in children over one year of age