Please be aware that the information presented is intended as a reference and is not a substitute for the advice of a healthcare provider. Please do not hesitate to call our office if you have any questions.
Newborns with colic have long-lasting periods of crying and fussing. The cause of colic is unknown but is probably related to the baby’s temperament. It occurs in infants from birth to age 3 months. Crying usually occurs around the same time each day, in the evening most often. Episodes may last up to three hours and are obviously very stressful for parents. The baby’s face may become red and flushed, the belly may seem tense, and he/she may pull the legs up over the belly. It may seem like nothing you do helps to stop the crying and the baby may simply continue crying until he or she falls asleep from exhaustion. Sometimes the crying finally stops when the baby passes gas or has a bowel movement.
Many conditions mimic colic including formula intolerance, formula allergy, swallowing excess air, gastroesophageal reflux, urinary tract infection, and many others. It is necessary for us to see your child in the office to determine what is causing the problem. If crying is severe, prolonged, or if accompanied by other symptoms such as fever, vomiting, diarrhea, or constipation we should evaluate the child right away.
There are several things to try which may soothe a crying baby. Avoid overstimulation, especially around feeding time. Try soothing techniques such as rocking or quiet music. Improve feeding techniques by burping your child well. Try not to get too upset yourself, even though this can be difficult. If you really need a break, there’s no harm in leaving your baby cry in the crib for a few minutes or with another caretaker.
A croupy cough is a tight barking (like a seal) sounding cough. The voice or cry is hoarse usually and sometimes there is a fever and congestion. If there is struggling to breathe or grunting the child should be evaluated immediately. Things that can be done at home are the warm steamy shower/fogged bathroom, or inhale cold air in front of an open freezer. Increasing fluids is also important.
Most diaper rashes are irritations to the wetness in the diaper. So most important is air-drying the area several times a day. Using an over the counter diaper ointment can be helpful when applied every diaper change. Call for an appointment if there is no improvement.
Eczema is a chronic, red, itchy skin disorder that is very common, affecting 10% of children. It is often seen in children who have allergies. The skin is usually dry and may also become thickened with time. In babies it often begins on the cheeks and forehead and then spreads to the body, arms, and legs. In older children, the rash commonly occurs in the elbow creases and behind the knees, wrists, and ankles.
The cause of eczema is unknown. When it is severe, there is often an allergy that is making it worse. Foods such as eggs and peanuts, pollens, and house dust mites are all common allergic triggers for eczema. Very hot/humid or very cold/dry weather can worsen eczema, as can wool clothing. Scratching of the itchy skin will aggravate eczema as well.
There is no cure for eczema, meaning no treatment that will make it go away and never come back. Fortunately, most children see their eczema improve or resolve as they get older. There are many treatments that can manage eczema very effectively. Most important is the use of moisturizers twice a day. (Eucerin and Aquaphor are popular choices) The best time to moisturize is after bathing with a moisturizing soap such as Dove. Apply the moisturizer within 3 minutes of drying your child off with a towel to trap moisture in the skin.
If your child’s eczema is triggered by a food allergy, avoid that food. If a dust mite allergy is the problem, special pillow and mattress covers may be helpful. Keep your child’s fingernails short to reduce the impact of scratching. Topical steroid ointments are an important part of treatment. Oral antihistamines can help eczema by relieving itching, especially at night. Since these medications can have side effects if not used properly, we will evaluate your child in the office and select the right amount of treatment for his/her eczema. We will also make any necessary referrals to allergists or dermatologists in the case of severe eczema.
Eczema can become infected, so call our office right away if there is redness, oozing crusting, and/or fever.
If the insect bites are itchy and swollen, it’s okay to apply hydrocortisone cream 1% (i.e. Cortaid or other brand) twice a day as needed for 5-7 days. You may also give Benadryl by mouth every 6-8 hours as needed. If there is a firm redness that’s spreading, if the area is painful, warm, or if there is crusty drainage that looks like pus make an appointment to have it evaluated.
For prevention, please wear long pants/sleeves and use insect repellant during the early morning/evening times when the insects are out. Insect repellant is fine for children if it contains Immunization Reaction.
Common side effects following vaccination include local reactions such as redness, swelling, or tenderness at the site of injection and fever less than 103 degrees F. It is okay to apply a cool soak to the area, give Tylenol or Ibuprofen (older than 6 months of age) if fussy or uncomfortable. If the symptoms persist more than 48 hours, call our office for advice or an appointment. Refer to your vaccine handouts for further information on side effects for each vaccine. For MMR and Chicken Pox, it is possible to have a delayed fever and possibly rash that starts 6-12 days after the vaccine. Call if this occurs or there are any concerns.
Gastroesophageal reflux occurs when the contents of the stomach, including stomach acid, move upward (reflux) into the esophagus (swallowing tube). In infants, reflux is a fairly common problem (spitting up) that usually clears up with time. Gastroesophageal reflux becomes a disease (GERD) when it occurs enough to cause heartburn pain, respiratory symptoms, and other problems.
In babies, you may see milk or formula coming out of the mouth. Infants may be fussy, cry, arch their back, or refuse feedings. There may be slow weight gain. Symptoms occur commonly after meals. Older children may complain of a sour taste in their mouths, cough or clear their throats, or have a hoarse voice. Reflux may make asthma worse. Long-term problems that occur in adults such as esophagus damage are rare in children.
It can be difficult to diagnose reflux in children. Symptom history is most important. Tests such as X-rays (Upper GI Series), pH probe, and Endoscopy (flexible camera used to look down esophagus) are occasionally helpful. Usually a course of antacid medications is recommended. It is also helpful is to thicken feedings with rice cereal and elevate the head of the bed slightly.
Call our office if you think your child has symptoms of GERD, especially if your child has frequent vomiting, vomiting with weight loss, painful swallowing, difficulty swallowing, heartburn, chest or stomach pain, choking, gagging, or apnea (temporary interruptions of breathing during sleep).
If your child is verbal and complains of ear pain, or crying and tugging of the ear in a younger child, you may use a warm pack applied externally over the ear to help alleviate the pain. If this inconveniently happens at night, continue supportive care until the morning and call our office to make an appointment, or come to the walk-in sick clinic (Monday-Friday in both/ALL? offices from 7:30 a.m.- 8:30 a.m.).
If the pain is not improved with the above measures or there is drainage of fluid or blood from the ear, call the provider.
Ear infections are caused by viruses or bacteria that enters through the nose or mouth. This creates an upper respiratory infection where fluid enters the middle ear. This fluid may cause some pressure feeling or may get infected and cause inflammation of the eardrum. Your provider will be able to discuss with you antibiotic treatment versus “watchful waiting” after evaluation.
Pink Eye (Conjunctivitis)
Conjunctivitis, or Pink Eye, is caused by viruses, bacteria or allergies. Commonly this occurs with viral upper respiratory infections. In most cases it is a self-limited process and will resolve on its own after a few days. If there is any yellow or green mucoid discharge from the eye or eyelid swelling, call our office. Children should not be in school or daycare if there is colored discharge from the eye, otherwise they are allowed. Wash your hands carefully as these germs are spread by contact.
Allergic conjunctivitis will also cause redness of eye, watering, and itching of the eye. Cool compresses sometimes help alleviate the swelling and provide some comfort. Benadryl orally can help with the itching and swelling. If symptoms are not alleviated with the above measures, or if there is a lot of eyelid swelling or discomfort, call our office.
Keep the involved areas clean and use 1% hydrocortisone cream 3-4 times a day. You may also use oral Benadryl (over the counter) or Zyrtec (a prescription) to relieve the itching. If swelling occurs please call the office for an appointment.
If your child complains of a sore throat along with possibly fever, headache, stomachache, nausea or vomiting, call our office to make an appointment to have your child tested for strep. Your child will be swabbed by our nurse or medical assistant and we will run a quick test. If it is positive, a prescription for antibiotics will be written. If it is negative, a culture will be performed and you will be notified the next day only if it is positive. If your child’s strep test(s) are negative and sore throat persists after a few days or symptoms are worsening, call our office.
Provide hard, cold teething toys to chew on. Over the counter medication lasts only a minute or two. One homeopathic medication has a tiny amount of opiate in it and should not be used. It is important to note that teething does not cause significant fever, irritability, or illness symptoms.
Urinary Tract Infections
Urinary tract infections (UTIs) are infections of the bladder, kidneys, or both. They are caused by bacteria that spread from fecal (bowel movement) material. Without proper treatment, UTI’s may lead to kidney damage. It is important to call our office as soon as possible if you suspect your child may have a UTI.
The main symptoms of UTI’s are pain and/or burning with urination, frequent urination, wetting accidents, abnormal smelling urine, nausea and vomiting, and fever. Fever occurs when the infection has spread to the kidneys and may be the only symptom in an infant or young child. These fevers are usually high grade (over 104) but may be lower initially.
The risk of UTI is higher in girls than boys. Boys who get UTI are most often under 3 months of age and uncircumcised. Factors that increase the risk of UTI include constipation, poor hygiene, and urine-holding behaviors (waiting till the last minute to urinate and then rushing to the bathroom). UTI’s may be the result of a problem with the urinary system, such as reflux (backward flow of urine toward the kidney when the bladder squeezes at urination).
The diagnosis of UTI depends on a properly collected fresh urine sample, which we can collect and analyze immediately at our office. All children suspected of having UTI are treated with antibiotics right away. Please schedule an appointment if you suspect that your child may have a UTI.
Please note: The American Academy of Pediatrics does not recommend giving over-the-counter cough or cold medications to children under the age of 6 years