Allergies

What are the signs of allergic problems?

That immune system response causes the troublesome symptoms that can range from any to all of the following – redness, swelling, fluid discharge, itching, discomfort, cough and difficulty breathing. The area(s) affected and the strength of the response determines any one person’s symptoms. These allergic problems can start at any time in someone’s life from infancy to old age. The symptoms usually start (and stop) suddenly and wax and wane over time. Allergic problems can last a few months never to return or can come and go over a lifetime.

Some people are bothered only infrequently to an insignificant degree and some people have frequent severe allergic problems. Most people with allergies that seek help fall between these extremes.

Is there a cure for allergies?

There are no proven treatments (except avoidance) that prevent allergies and there are no proven treatments that cure (or help people “outgrow”) allergies (including allergy shots). Allergy shots are simply another (in addition to nose drops, eye drops, inhaled medications and oral medications) treatment option. They help decrease allergy symptoms for as long as they are administered. They are usually reserved for people that have done all they can do to avoid offending substances, have “maxed-out” on drops, sprays and oral medications and are still miserable.

What about allergy treatments?

There are treatments that decrease the severity of symptoms and decrease the frequency of allergic episodes. But all treatments (except avoidance) may have undesirable side-effects. These side-effects range from insignificant problems to problems greater than the original allergic problem. In addition, side-effects vary not only by treatment but also by person. That is, a given treatment may cause few problems in one person, but cause major problems in another person. And to further complicate things, a given treatment may work well in one person, but not work at all in another. Except for avoidance, which works for everyone while the side-effects are limited to inconvenience, finding a treatment that works well for a particular person and has minimal side-effects for that person is largely a trial and error process. So, before deciding about a particular treatment for a particular person, it’s important to determine if the severity of the symptoms justify the search for a treatment. This is especially important when you realize that most people with allergy problems are going to have symptoms for at least a few years and if you’re going to recommend medication to someone, you must recognize they are probably going to be using medications for several years.

What about allergy testing?

Allergy testing is reasonable for those children with significant problems that have not been helped after taking steps to avoid the most common causes of allergy problems including

• dust and dust mites
• feathered and furry animals
• cigarette smoke
• perfumes and air freshners

When should you make an appointment to be seen?

First, you should try avoiding the allergy causing substance. If you don’t know what is causing the allergy problems, you should drop by our office to get an information sheet with helpful tips on avoiding the common allergy causing substances. If after instituting those avoidance measures, your child still has significant problems meriting treatment or testing, you should make an appointment to be seen in the office.

Colds

Illnesses limited to chest and nose congestion (or coughing and sneezing in older children and adults) – the most common of all pediatric infections – are commonly called “colds”. These infections are caused by viruses.

Treatment

No treatment (allopathic, homeopathic, chiropractic etc.) has been shown to help anyone clear symptoms quicker than with chicken soup. Not that we’re pushing chicken soup, but we’re definitely not advocating drugs to cure colds. Fortunately, having a normal
immune systems is all that is needed to clear a cold. The only purpose in treating someone with a cold is to make them feel more comfortable while they are ill. This may be important if that person is feeling ill and is unimportant if that person is only slightly bothered by their cold symptoms.
Most children are not bothered by cold symptoms except when they are trying to sleep, especially at night. The congestion can interfere with nose breathing and interfere with sleeping. For this problem a cool (it’s safer than the hot ones, but both work well) mist machine works best. Do not put any medication into the machine – use water, only.
If the amount of mist is not sufficient to ease the nose breathing, taking a bed sheet and (safely) draping it over the head of the crib (or bed) and fashioning a canopy and then aiming the mist so it blows into the canopy will usually loosen the mucus and ease the breathing.

How long should a cold last?

Colds last anywhere from several days (in a young healthy adult) to 6 weeks (in an healthy infant). The nose and chest congestion should start to decrease (slowly in infants) after the first 3-5 days of the cold. After the first week of the cold the amount of congestion should decrease week by week. Significant nose congestion that lingers more than 10 days without improving is suspicious for being a sinus infection.

Complications

Colds can lead to ear infections (especially in children who are prone to them), sinus infections (especially in children who are prone), asthma episodes (in anyone who has asthma) etc.. But for most children and adults colds don’t cause anything more than a temporary bother. The color of your mucous that comes from your child’s nose is not helpful in determining whether you child’s cold is something more than a cold or even different from a cold.

When to take your child to the doctor

If your child is breathing without problem through the nose and they are still uncomfortable, then a doctor visit is reasonable. Of course, there’s nothing we can do to cure that cold but you start becoming suspicious of a complication when the nose is clear and the child is still unhappy. And we can help with most complications.
Again, there are no over-the-counter medications that will help alleviate the nose and chest symptoms. Further, there are no over-the-counter medications that will help give even temporary relief from the symptoms. Because of potential side-effects, including rare deaths, it is recommended that NO over-the-counter cold medication be given to any child at any time.

Constipation

What is constipation?

Constipation can be defined as having hard stools that come out round often causing pain. Note, constipation is not infrequent stools. Skipping days between bowel movements is not a problem as long as the stools are soft and easily passed.

Why do hard stools hurt?

Having round hard stools means the anus may be stretched beyond capacity and this stretching is painful.

Treatment

Appropriate treatment depends on the age of the child (or adult).
First, if you have a newborn that has never had a soft stool within the first 24 hours after birth, you should have your baby checked in the office.
For everyone else treatment is divided between infants and non-infants.

• Infants (before solid foods introduced)
  • If your baby is breastfed and having hard stools, call the
    office. Remember skipping days between bowel movements is not a problem and is normal – especially in breast fed babies that are 3 months of age.
  • If your baby is formula fed, add a water feeding (about 4 ounces) to the daily diet. If your baby doesn’t like water, add just enough table sugar so your baby willing drinks this. If that doesn’t stop the hard stools, call the office. We may want to add some prune juice to the diet or change the formula.
• Everyone else older than infants
  • First, stop giving constipating foods (like bananas, apples or
    applesauce, rice or rice cereal and fatty foods).
  • Next, give prunes, peaches, pears, apricots and plums or
    those juices. Sometimes you have to be creative to get children to consume these. (Some parents mix prune juice with 7-up to make the prune juice more appealing.)
  • In addition to foods you can give 1 capful of over-the-counter Miralax powder in 8oz of (any) liquid. You can give as many times per day as needed to soften the stool.

How long should you treat?

Constipation is usually not a short term problem. It will persist until the situation that caused the constipation changes. Since the cause is usually some change in your child’s appetite/diet, the tendency towards constipation is going to be present at least until your child’s appetite/diet changes again.

What can happen if constipation is left untreated?

The biggest problem occurs when a child has had enough painful stools to fear the passage of the next stool. Then your child may try and hold the stool inside (to prevent the painful experience). This starts a vicious cycle. The longer the child holds the stool, the harder and bigger (and more painful) the stool will be when passed. That more painful passage reinforces the fear and the child tries (with more determination) to hold the stool inside longer the next time resulting in the stool being even more painful.

Further, it’s not unusual for this fear of passing a painful stool to lead to inability to relax and pass even a soft stool.

Consequently, children will try to hold soft stools when the memory of painful stools is recent. You can estimate that the length of time it will take for a child to begin to relax at stool, once they start having soft stools, is about twice the length of time that they had hard stools.

In older children (and adults) the desire to pass the hard stool will usually result in excess pushing. This increased pushing can lead to dilated blood vessels (hemorrhoids) around the anus that cause further pain (and swelling with blood clot formation) and bleeding.

When should you see the doctor for constipation problems?

If can’t quickly quickly control constipation using the above information, please call for an appointment.

Diarrhea & Vomiting

Treatment of a child with diarrhea or vomiting from an “intestinal flu” is similar to treatment for adults. An adult with an upset stomach restricts the diet to sips of water, seven-up or light juices. In time, the queasy stomach begins to settle and the diet is gradually advanced to normal.

The same principle applies to infants and children. To help you pick appropriate foods and liquids for your child, we have prepared the following list.

Generally, you’ll want to start with appropriate (for your child’s age) items in category 1 and remember, small amounts or sips are easier to tolerate than larger volumes. If things go well with category 1 items, you may progress to category 2. If these are tolerated, you may continue progressing through the categories until your child is healthy again and tolerating their usual diet.

Most diarrhea and vomiting illnesses will take 24 hours to 72 hours to progress through the categories. Go slowest early in the illness. You’ll usually spend more time in category 1 than in category 2 or 3. (If your baby has never tried some of the foods listed, we suggest you not give them during this illness.)

• CATEGORY 1: Pedialyte, Pedialyte RS, Lytren, Infalyte, 1/2 strength grape juice or Gatorade, flat 7-up, popsicles, Jello
• CATEGORY 2: bananas, rice or rice cereal, applesauce, toast, soda crackers, potatoes (mashed, boiled or baked), pasta, Cheerios
• CATEGORY 3: fruits, vegetables
• CATEGORY 4: dairy products, infant formula, meats

Dairy products (especially milk and formulas like Similac and Enfamil) are difficult to digest during and even after diarrhea and vomiting illnesses, so early use may aggravate and prolong the symptoms. Adult remedies like Pepto Bismol and Kaopectate should not be used.

Remember: This is meant to serve as a guideline. As long as you follow the general principles, you may deviate somewhat from these suggestions. Also, don’t be alarmed if your child’s diarrhea does not resolve within two or three days. Several mushy stools per day during the healing process are typical. In fact, it may take weeks before stools return to normal

Dehydration

The most worrisome complication of diarrhea and vomiting is dehydration. The signs of dehydration include:

• an energy level so low the child is too weak to drink,
• no urination for more than ten hours,
• eyes that appear dry, sunken or hollow and
• a dry mouth.

If you note signs of dehydration, please immediately call the office schedule an appointment to have your child checked.

Ear Infections

There are two common types of ear infections – external and middle ear infections.

• External ear infections start after irritation of the ear canal. These usually occur after frequent swimming and are commonly called “swimmer’s ear infections”.
  • For more information, please refer to the swimmer’s ear tab
• The second type is the middle ear infection. This usually occurs after the eustachian (or drainage) tube from the middle ear becomes blocked and the fluid which collects behind the eardrum becomes infected.
  • Since young (under 9 years of age) children usually do not spend enough time in water to have problems with external ear infections, it is the middle ear infection which causes the most problems in young children.
  • For the rest of this section we will discuss middle ear infections.
  • Middle ear infections are more common than all other infections in children except “colds”. While most ear infections begin as colds, most colds do not progress to ear infections. If an ear infection is going to occur, it usually takes several days to develop after the cold starts.

Ear pain and fever usually mean an ear infection is present. However, ear infections can be present when one or both of these signs are absent.
Even when ear pain is present it may be difficult to detect, especially in young children.
Often the only signs of ear pain are crankiness or eating and sleeping problems.
Sometimes there are no signs, at all.
Ear pulling is not a reliable sign of ear infection in infants.
Most infants older than three months pull, scratch or play with their ears when no infection is present, and most children with an ear infection do not manipulate their ears.

Complications

Mild hearing loss or distorted hearing is a frequent complication of ear infections. These hearing problems are almost always temporary. However, even mild hearing problems can interfere with
your child’s learning and development, especially speech development. Therefore, appropriate treatment and follow-up ear rechecks are important for young children. Serious infections rarely complicate ear infections

Treatment

Ear infections are usually caused by bacteria. Because antibiotics (like amoxicillin) are medicines which kill bacteria, they are the mainstay of treatment. However, over 80% of ear infections resolve just as quickly (or slowly) with antibiotics as without any antibiotic. In other words, antibiotics do not help over 80% of children with ear infections and most children get well quickly without any medication.

Since problems may result from the use of antibiotics, there are many situations when it is best to NOT treat an ear infection with antibiotics. For example, if your child has minimal symptoms (ie, is only slightly bothered by ear discomfort) it is not necessary to treat with antibiotics.

For many children (especially under age 3 years) with ear pain and/or fever in this country, an antibiotic is prescribed. You should always take the full course of antibiotics if one is prescribed. The most worrisome situation occurs when a child is “partially treated”, or given less than the full prescription. Even if your child seems completely well within a few days after starting an antibiotic, always finish the antibiotic.

In children older than 3 years of age, a common treatment strategy is to use pain medication for several days, and reserve antibiotic treatment for those children who do not get better during that time. Please feel free to discuss middle ear infection treatment with our physicians.

Middle ear pain can be relieved with Tylenol (Panadol, Tempra etc) or Motrin/Advil. The correct dose and frequency is the same as the dose and frequency used for fever control. Warmth (from a hot water bottle or heating pad) applied to the outside of the ear will also help soothe the discomfort. These measures are especially helpful when the pain arises at night. Ear infections are not serious medical problems and need not cause you to seek care in an emergency room or urgent care center.

Does your child get frequent ear infections?

There are several reasons that might explain why your child gets more ear infections than other children.

• Ear infections may run in your family because of an eustachian tube that frequently malfunctions.
• Smoking in the household irritates the eustachian tube and increases the likelihood of middle ear fluid accumulating.
• Children who drink from a bottle while lying flat on the back are prone to ear infections.
• Allergies can cause the eustachian tube to malfunction
• Frequent colds (brought home by an older brother or sister,
  or contracted from other children at the daycare center or
  pre-school) can predispose a child to frequent ear infections.
• Children that use a pacifier and attend daycare are at the
  highest risk for contracting ear infections.

Prevention of ear infections and helping your child clear ear fluid

Many parents wonder if getting water in the ear when bathing or swimming can increase middle ear infections. Or, some parents wonder if cold wind blowing on the ear is related to ear infections. In fact, neither water from the bath or pool nor drafts are related to ear infections. Keeping the ears dry and using ear muffs will not decrease ear infections nor speed recovery if one is already present.

There are a few things you may be able to do to help prevent middle ear fluid and ear infections.

• Stop your child’s exposure to cigarette smoke.
• Do not to allow your child to lie flat on the back and drink
  (from a bottle). If your child likes to lie down with the bottle,
  then you should use a pillow to prevent lying flat.
• Stop using a pacifier.
• Try to decrease your child’s exposure to other children with
  colds.

Feeding Infants

SOLID FOODS

There are many reasonable ways to introduce solid foods to infants. With just a few guidelines that are listed below, you should be able to relax and enjoy mealtimes with your child.

Why do you start solid foods?

The main reason you’re introducing solid foods is to increase the pleasure in your child’s life. With few exceptions you are not introducing solids because breast milk or infant formula is lacking in some important nutrient. Now, please re-read the first two sentences in this paragraph because you’ll spare yourself worry and aggravation if you understand those two facts.

When should you start solid foods?

For most people, introducing solids when their infant around 6 months of age is reasonable.

What are good choices for first foods?

Start with foods high in iron because breast milk is low in iron (but it’s easily absorbed by the baby) and high-iron formula has iron that’s difficult to absorb. So, it makes sense to start with an iron fortified baby food – usually cereal in United States.

Next, you can add a new simple food (a cereal, a fruit or a vegetable – unmixed) to your infant’s menu about every 3 days. This means at any given time there is, at most, one “new” food on your child’s menu. That way if some “new” problem arises, like constipation, diarrhea, rash or vomiting, you’ll have a good idea what “new” food may have caused that problem.

Give foods that appeal to you and that you think your child might enjoy. There’s no good rationale to support giving green vegetables before yellow, or yellow vegetables before greens, or fruits before vegetables, or vegetables before fruits etc. Some parents think their children eat vegetables better if they’re offered before fruits and some parents like to give fruits first because they know they can treat stooling problems with certain fruits.

Give whichever you want first. It probably won’t make much difference in the long run. There is a fair chance your child will become a “picky” eater by two years of age, no matter what you do with the first foods.

On the other hand, there are reactions to certain foods that are consistent. If you’re like most parents you’ll find that bananas and apple sauce thicken the stools (or may even cause constipation) while pears, peaches, prunes, apricots and plums loosen the stools.

So, if your child has a tendency towards constipation, avoid bananas and applesauce and give pears, peaches etc.. If you want to thicken your child’s stools avoid the stool softening fruits and give more bananas and applesauce.

Meats are best started after 7 or 8 months of age, if you want to offer meats. Most children don’t care for meats until well past their first birthday so don’t expect much meat eating and don’t expect your infant to eat any baby food meats because they taste and smell awful. Further, it is not important that a child eat a minimum of meat. Little or no meat works very well for most children.

When can you give “real” food to your child?

After 2 or 3 months of introducing 1 new food every 3 days you will have given about 20 different foods; some cereals, some fruits and some vegetables.

If you are like most parents, you will have found that your child has no significant problem with any of those first 20 foods. You can then stop giving 1 new food every 3 days and start giving mixtures of food which may contain quite a few “new” dietary items. For example, you can give pizza and lasagna and enchiladas and whatever foods your family normally eats – with only a two exceptions; honey and Karo Syrup.

Of course, everything has to be soft and swallow-sized for an infant, so you’ll need to use your fork or spoon to mash these foods.

You can give foods that contain spices and that are not especially “baby” foods and you can give finger foods, like Cheerios at this time. This is the best time to introduce meats, but you’ll have to shred the meat into baby-sized bites and you still wouldn’t expect your child to show much interest.

How can you be sure your child is getting the correct amount of calories, protein, calcium, other minerals, fats and vitamins?

The core of your child’s nutrition will usually be breast milk or formula or, when a child’s 1 year of age, whole milk – even if they’re eating cereals, fruits, vegetables and meats.

A nursing child should nurse, at least, 4 times/day and a child drinking formula or milk should consume, at least, 20 oz’s/day to ensure they are getting adequate calories, protein, calcium and most vitamins.

The quantity of starches, fruits or vegetables a child eats, beyond this core nutrition, is not crucial. Again, the breast milk, formula or milk will usually supply the most important parts of your child’s nutrition.

As you give more solid foods, your child will decrease the amount of breast milk or formula or milk. As long as your child is nursing 4 times/day and/or drinking 20oz/day of formula or milk, you are probably not giving too many solids. If you find your child’s consuming less than the minimum core nutrition, decrease the solids until the core nutrition increases to meet the above guidelines.

You don’t have to worry about giving too few solid foods. Even if your child eats no starches and no fruits and no vegetables and no meats, but is doing well with their core nutrition, it is unlikely that you’ll have a significant nutrition problem.

With no solids it’s possible that your child could develop a mild anemia (that’s easily corrected and routinely monitored in our office at the 9 month check-up). And if you’re only breast-feeding beyond 6 months of age, we may choose to start a vitamin supplement for a child that’s eating no solid foods. Otherwise, you should have no problems.

If you get stressed monitoring the number of green vegetables and yellow vegetables and orange vegetables that your child eats (or doesn’t eat), you are more likely to cause dietary problems than you are to help things. Remember, solid foods and meals should increase enjoyment in your child’s life. Mealtime is not the time to enforce your will upon your child.

On the other hand you are not expected to go out of your way to give junk foods. Once you are past the introductory baby food stage, you should be offering your child the kinds of (age appropriate) foods that the rest of your family eats. If your child wants some of the healthy choices you are offering, great. If your child doesn’t want some (or all) of the healthy foods you are offering, fine. Don’t worry about the foods your child doesn’t like – just stop offering those foods you know they don’t like and offer more of the healthy foods your child enjoys.

When to see the doctor

You should make an appointment if your child’s core nutrition is below recommended levels even after stopping other foods and you should make an appointment if you find yourself getting aggravated about your child’s eating habits.

Fever

What is fever?

Fever is a significantly elevated body temperature.
Unfortunately, because different people have differing “normal” body temperatures (and everyone’s body temperature varies through the day) there is no universally agreed upon definition of fever.
For now let’s say a child has a fever when the axillary (armpit) temperature is over 99 F (37.2 C), oral temperature is over l00 F (37.8 C), or rectal temperature is over l0l F (38 C).

Is fever dangerous?

Fever itself is not dangerous until the temperature exceeds 107 F (rectally) and remains at that extreme level for at least a few hours. Even fever as high as 106 does not cause any brain damage.
In fact, fever may actually help to fight an infection. Increased temperature is our “natural” defense and enhances our ability to fight infection.
Nevertheless, fever is important.
If fever is present it usually is a sign of illness. The higher the fever the more serious the illness may be, so it is often necessary for us to see a child with fever.
Guidelines to help you know when we should see your child are listed below under “When Should a Parent Call”.

How long should a fever last?

Most fevers in children are caused by viral illnesses.
Usually with these illnesses the temperature rises quickly at the beginning and starts to drop after 72 hours.
Sometimes, however, the fever will persist for the entire illness. Treating with fever reducers like Tylenol usually lowers the temperature, but does not normalize it.

What about your child’s appetite?

Children (and adults) have little or no appetite when they have a fever. However, while it is normal to refuse solid foods when feeling sick, your child should be able to drink liquids.
In fact, a child with fever can benefit from extra fluids, so encourage your child to drink.
A child may lose weight when ill, but will regain it once the illness resolves and the appetite returns.

What about convulsions from fever?

Some children may have a seizure or convulsion that is caused by fever. These seizures are called febrile seizures. They are frightening to parents and create much concern.
A febrile seizure lasting less than l5 minutes causes no harm or damage.
Remember, most children never have a seizure and febrile seizures are harmless. Nevertheless, you should call us if your child has a seizure. We need to check that it is a harmless febrile seizure.

How should you measure your child’s temperature?

The safest way to take a temperature is to measure the axillary (or armpit) temperature:

• Place the tip of thermometer in dry armpit.
• Close armpit by holding elbow against the side of the chest for 4 minutes.

For older children (usually 5 years and older), you can also measure the oral temperature:

• Be sure your child has not had a very hot or cold beverage within l5 minutes prior to inserting the thermometer.
• Place the thermometer tip beside the tongue or inside the cheek.
• Have your child hold the thermometer in place with lips and fingers (not teeth).
• Have your child breath through his nose with his mouth closed.
• Leave thermometer in place for 3 minutes, and then remove.

Why treat a fever?

Treating the fever will not treat the illness and so does not shorten the duration of the illness. The only reason for treating a fever is to increase your child’s comfort and appetite. If your child is active, playful, and drinking plenty of fluids, you especially do not need to treat the fever. However, if your feverish child is cranky, it is helpful to lower the temperature.

How do you treat a fever?

The following suggestions will make your child with fever (that is not complaining of feeling cold and is not shivering) more comfortable:

• Offer frequent liquids.
• Dress your child lightly to promote heat loss.
• A cool compress to the forehead may bring some relief to your child’s discomfort. It is not necessary to place your child in a tub of water to lower the temperature, but it does work (for a short time). Do not use cold baths or rubbing alcohol.
• Tylenol, Tempra or Panadol every 4 hours or Motrin or Advil every 6 hours. These medications can be safely taken with any other medication (that contains no fever reducer) your child is taking. They can be mixed in any liquid drink or given without mixing.
  • Use the recommended doses for child age and weight on the packages or call the office for advice on dosing.

When to call the doctor?

Fever is only a symptom, not an illness. Fever by itself is not dangerous. Your child’s level of awareness and activity is more important than the amount or presence of fever. Does he play? Does she show interest in her toys, her surroundings, or her family? Will he drink? If so, then the likelihood that she has a serious illness is low.
However, if your child is unable to play (at least off and on), demonstrates little interest in his surroundings, or is difficult to arouse, then a serious illness may be present.

Your feverish child should be seen if he/she:

• is less than 2 months of age.
• Is crying non-stop for several hours.
• Is difficult to awake or is confused or delirious.
• Has had a seizure.
• Has a stiff neck.
• Has purple spots on his skin.
• Has labored or difficult breathing not due to a stuffed nose.

Allergies

What causes allergic symptoms?

One of the most helpful ways to think about allergic problems of the eyes, nose and chest is to view them as being caused by the immune system having gone astray. Specifically, the immune system of people with allergies responds to dust, for example, as if the dust were a germ or a threat to health.

What are the signs of allergic problems?

That immune system response causes the troublesome symptoms that can range from any to all of the following – redness, swelling, fluid discharge, itching, discomfort, cough and difficulty breathing. The area(s) affected and the strength of the response determines any one person’s symptoms. These allergic problems can start at any time in someone’s life from infancy to old age. The symptoms usually start (and stop) suddenly and wax and wane over time. Allergic problems can last a few months never to return or can come and go over a lifetime.

Some people are bothered only infrequently to an insignificant degree and some people have frequent severe allergic problems. Most people with allergies that seek help fall between these extremes.

Is there a cure for allergies?

There are no proven treatments (except avoidance) that prevent allergies and there are no proven treatments that cure (or help people “outgrow”) allergies (including allergy shots). Allergy shots are simply another (in addition to nose drops, eye drops, inhaled medications and oral medications) treatment option. They help decrease allergy symptoms for as long as they are administered. They are usually reserved for people that have done all they can do to avoid offending substances, have “maxed-out” on drops, sprays and oral medications and are still miserable.

What about allergy treatments?

There are treatments that decrease the severity of symptoms and decrease the frequency of allergic episodes. But all treatments (except avoidance) may have undesirable side-effects. These side-effects range from insignificant problems to problems greater than the original allergic problem. In addition, side-effects vary not only by treatment but also by person. That is, a given treatment may cause few problems in one person, but cause major problems in another person. And to further complicate things, a given treatment may work well in one person, but not work at all in another. Except for avoidance, which works for everyone while the side-effects are limited to inconvenience, finding a treatment that works well for a particular person and has minimal side-effects for that person is largely a trial and error process. So, before deciding about a particular treatment for a particular person, it’s important to determine if the severity of the symptoms justify the search for a treatment. This is especially important when you realize that most people with allergy problems are going to have symptoms for at least a few years and if you’re going to recommend medication to someone, you must recognize they are probably going to be using medications for several years.

What about allergy testing?

Allergy testing is reasonable for those children with significant problems that have not been helped after taking steps to avoid the most common causes of allergy problems including

• dust and dust mites
• feathered and furry animals
• cigarette smoke
• perfumes and air freshners

When should you make an appointment to be seen?

First, you should try avoiding the allergy causing substance. If you don’t know what is causing the allergy problems, you should drop by our office to get an information sheet with helpful tips on avoiding the common allergy causing substances. If after instituting those avoidance measures, your child still has significant problems meriting treatment or testing, you should make an appointment to be seen in the office.

Flu Vaccine

Every year infections caused by influenza (flu) viruses leave hundreds of thousands of children and adults ill with fever, fatigue, muscle aches and headaches. These infections are usually not life-threatening.

However, in the elderly and in children and adults that have some underlying serious illness (like heart disease, diabetes, kidney failure, liver failure, severe asthma etc.), flu infections can result in a worsening of the underlying illness and cause serious problems. For these high-risk people yearly flu vaccine is recommended. The flu vaccine is also recommended for household contacts of these high-risk people.

For everyone else the risk of serious complications from a flu infection is very small. However, with hundreds of thousands of children getting the flu each winter it is typical for scores of healthy children (who have no high risk factors) to die each year from influenza complications. These deaths are usually preventable if the flu vaccine is given.

Giving a child a flu vaccine can reduce the risk of being hospitalized, missing school, and parents missing work due to influenza illness.

Therefore, it is recommended that all children older than 6 months of age receive the flu shot every year.

There is no strong evidence that getting the flu vaccine can give flu symptoms. There is no live flu virus in the influenza vaccine.

Yes, children who get the flu vaccine can still get the influenza illness. However, getting the vaccine can reduce the intensity of symptoms and shorten the length of illness.

In the not distant future, it will probably be recommended that everyone in the U.S. receive an annual flu vaccination.

Injuries & Accidents

HEAD INJURIES AND YOUNG CHILDREN

Most children under 5 years of age have many head injuries. Injuries that occur as a result of a child running and falling are seldom serious. For the most part, there’s no reason to see the doctor based on the size of the lump or the color of the lump or the sound of the head hitting cement/tile/marble/wood/brick etc.
Within 15 minutes following a head injury, you should expect your child to be acting normally. In this situation, it’s rarely helpful to see a doctor.

However, if your child has/had any of the following, see a doctor,

• crying more than 15 minutes after the accident
• more than 1 episode of vomiting
• loss of consciousness
• seizure
• change in personality

For information on head injuries in older children, and especially with sport-related concussions, please visit the sports medicine information tab and click on the concussion information section.

Burns

Damage to the skin caused by heat is classified as being

• 1st degree – reddening of the skin
• 2nd degree – blistering of the skin
• 3rd degree – charring of the skin

Third degree burns are a medical emergency. Very few people (including very few doctors) have ever seen a 3rd degree burn, but if you suspect your child has a 3rd degree burn, you should seek emergency medical help.

First and 2nd degree burns are relatively easy to treat and while uncomfortable, are usually not a serious medical problem. For these burns, you’ll note that immediately after the burn, the skin temperature will be elevated. This elevated temperature causes further skin damage that continues hours after the initial insult.

Nothing can be done to undo that damage caused by the initial insult. But the continuing skin damage can be minimized or stopped by cooling the skin. Therefore, as soon as possible, following skin injury, run cool water over the burned area.

For as long as the skin’s temperature is elevated, running cool water over the burned area is beneficial. (You can judge whether the skin’s temperature is elevated by licking you lips and putting them near the burned area. If you feel heat radiating, continue the cooling measures.)

Once you’ve normalized the skin temperature, the next task is to prevent the burned area from becoming infected. If there’s been no blistering (ie, 1st degree burn), there’s no risk of skin infection and no treatment is necessary. If the skin is blistered, leave the blisters alone. Don’t break or open them intentionally. The longer they stay intact, the more resistant (to infection) the skin beneath will be.

When the blisters rupture the skin beneath will be either dry (and resistant to infection) or wet (and prone to infection). If the skin is dry, nothing needs to be done beyond congratulating yourself on good care of burned skin. If the skin is wet (you’ll see the skin “glisten” when angling your line-of-sight around the burn), you should see the doctor. We will prescribe an antibiotic skin cream.

Never apply anything greasy to a burn. Grease tends to insulate heat, accelerating and increasing skin damage.

You should see the doctor if a 2nd degree burn is covering most of a limb or large area of the face or body. And, as discussed above, you should see a doctor if ruptured blisters reveal wet skin.

Cuts

Cut injuries to the skin are very common in adults and children. The main aims of treatment are to stop bleeding and prevent infection. The first is accomplished by applying pressure over the injured area (if you can).
Bleeding that persists beyond 20 minutes should be checked by the doctor. If the bleeding is from an accessible area you should be applying enough pressure to stem the bleeding while the pressure is being applied. If the bleeding is from an inaccessible area (like the mouth), the best you can do is to wait 20 minutes to see if the bleeding stops.
The second aim of treatment, preventing infection, is done by keeping the wound clean with soap and water. Use of antibiotic creams, ointments and salves is unnecessary and generally a waste of time. If you want to do more than wash with soap and water to
help ensure no infection will occur, wash again with soap and water. That is, washing 2 to 4 times per day with soap and water is about the best you can do to prevent wound infection.

When you need stitches

There are only 2 reasons to have a wound sutured. The first is to stop bleeding that cannot be (otherwise) stopped and the second is to minimize scar formation..
If the cut is in an area (like the face) for which cosmetic concerns exist, you should see the doctor. If the edges of the wound can be brought closer together (by sutures or some other means) during the healing process, the chances and the amount of scar formation are minimized.
You can always stop bleeding by applying pressure over the wound. However when pressure is released bleeding may restart. If after applying pressure for 20 minutes the bleeding restarts, see the doctor.

Muscle and Bone Injuries

From sprained ankles to twisted knees, from bruised tailbones to a fall on an outstretched arm, injuries to muscle and bone are a normal part of life, especially when we are young. In the pre-school aged child, these injuries are seldom much of a concern and seldom need any treatment except a parent’s reassurance that all is well.
However, if a pre-school aged child shows signs of injury (eg, limping) more than 24 hours after the initial injury, they should probably be checked by the doctor.
Injuries in older children/adults are also usually self-limited.
Sports injuries, however, can halt a vibrant young athlete right in his/her tracks. Careful initial evaluation is crucial in determining appropriate care and safe return to play. As a rule, the younger the athlete, the more cautious one should be. Early and complete evaluation can allow for more complete healing and less complication and risk for future injury.
Regardless of the joint injured- the following principles can help reduce swelling and pain.

• R= Relative Rest (don’t increase pain or put region at risk for further injury)
• I= Ice (maybe helpful for 20 minutes on, 20 minutes off for the first hour, then every 2 hours afterward)
  Immobilization (splint, sling or brace can help in the initial healing process)
• C= Compression (Ace wrap, foam dressing) Crutches (for initial use if athlete cannot walk safely)
• E= Elevation (put the injured region above the level of the heart to reduce swelling) Exercises (can be recommended by a medical profession to start the healing process)

When to see the doctor

Children stumble and fall on a regular basis- and most of the time return to usual activity within a few minutes, often with nothing more than a supportive hug and adult reassurance. However, there are several conditions that require medical evaluation. If in doubt, come into the office for further evaluation.

• Seek immediate medical attention
  • Any obvious change in mental status or difficulty
    breathing deserves immediate medical attention
  • Any open fracture (bone penetrating through skin) or
    obvious bone deformity also deserves immediate
    medical attention
• Seek attention within the first 1-2 days after injury
  • Large swelling of a region- especially within 1-2 hours of an injury
  • Inability to walk off the playing surface (leg injuries) or inability to use the arms/hands for everyday activities
  • Any obvious change in the athlete’s ability to run or use the injured region
  • Inability to fully move an injured joint (bend, straighten)
  • Repeated injuries to the same region
  • Past history of serious injury to the same region
  • Immediate need to return to play and uncertainty over
    the nature of the injury
  • Pain that limits sleep or awakens from sleep

Night Terrors

Night terrors are characterized by episodes of awakening from sleep, screaming, crying and acting terrorized. It is usually very difficult to calm the terrorized child. Once the child calms and falls back asleep they generally have no further terrors that night and no memory of the episode the next day.

However, night terrors are a recurring problem, and in fact can be so regular that they occur like clockwork. If your child has clockwork night terror episodes, you can awaken your child 10 to 15 minutes before the terror is due to start. That will usually prevent the night terror on that night. Continue to do this each night for about 2 weeks and that will usually end the night terror episodes. If the terrors return after this 2 week program, try the awakening program for another 2 weeks.

If your child’s night terrors are not predictable there’s not much you can do beyond ensuring there’s enough light in your child’s room so they can recognize their surroundings and offering reassurance when the terrors recur.

There’s not much reason to see the doctor for night terrors. There’s nothing that we can do to help. However, if you think your child has an illness or behavior disorder, then an office appointment is reasonable.

Swimmer’s Ear

Swimmer’s ear infections (infections of the outer ear canal) are the most common ear infections in older (over 9 years of age) children. They usually, but do not necessarily, occur after water has been in the ear canal for several hours. Therefore, they are most common in anyone that’s exposing their ears to water for several hours per day.

How can you tell if your child has a swimmer’s ear infection?

Swimmer’s ear infection does not cause fever and pulling on the ear lobe and causes significant pain. Usually a child with a swimmer’s ear infection will do more than say, yes that hurts when you do gently pull and tug. Normally, they will wince and show pain in their face. Children that say it hurts to touch or pull their ear, but do not evidence any pain on their face usually do not have a swimmer’s ear.

How do you treat swimmer’s ear?

You can buy (prescription) antibiotic drops or make your own drops. To make your own, mix vinegar (most people prefer white because it is less odorous) with water (50-50). The drops (prescription or home-made) can be put directed into the ear canal, but treatment is more effective if you use a cotton ball to make a wick. To make a wick, pull a cotton ball in half and twirl the wisps of cotton into a strand (or wick) that’s about 1/2 to 3/4 inch in length. Then thread the wick into the affected ear canal and tuck the attached cotton ball into the outside (pinna) of the ear. Put the ear drops onto the cotton ball every few hours for about 2 days or until all pain is gone.

It’s not necessary to warm the drops, but it is a nice thing to do. It’s much more comfortable having warm drops put into your ear than having room temperature or cool drops put into your ear.

Complications

The most common and worrisome complication is spread of the infection to the bone behind the ear – mastoiditis. This is marked by pain over that bone and the outside ear (pinna) protruding away from the head. If you think your child might have this problem, your child needs to be seen by the doctor.

How can you prevent swimmer’s ear infections?

First, drying the ear canals after prolonged exposure to water will prevent most swimmer’s ear problems. (Water that gets into the ears from bathing and showering and swimming for less than 1 hour rarely would lead to swimmer’s ear infection, so it’s not necessary to do anything special to dry ear canals in these situations.) Drying the ear canals can be done by leaning to the side and pulling on the outside of the ear or with medicine. You can buy (over-the-counter) preventive medicine or make your own with rubbing alcohol and water mixed 50-50.