There will be no evening hours on November 28 or the week of December 26 to allow our physicians and staff to spend time with their families. Click below to see the hours.

Wednesday,November 23                                              8:00-12:00
Thursday, November 24                                                 Closed
Friday, November 25                                                       8:00-12:00

Friday, December 23                                                        8:00-5:00
Saturday, December 24                                                   8:00-12:00
Mon-Thursday, December 26 -29                               8:00-5:00
Friday, December 30                                                       8:00-2:00
Saturday, December 31                                                   8:00-12:00

If your child is vomiting, stop all food and drink for at least one hour. After an hour, give one teaspoon ONLY of clear liquid (Pedialyte preferred, but Gatorade may be used if the child is over a year of age). Try this every five minutes. If there is no vomiting after thirty minutes, you may give one ounce of clear liquid. Continue to give small amounts of fluids very slowly until the child has been without vomiting for at least four hours. Do not give solids or more than three ounces of fluids at a time until the child has not vomited for eight hours. Then resume bland foods (toast, applesauce, bread) slowly. The vomiting should stop within twenty-four hours. Call the office if it does not, if there is any blood in the vomit, or if your child cannot tolerate small amounts of fluids.

Diarrhea is also common. If your child has diarrhea without vomiting, there are no diet restrictions, although fruit juice may make the diarrhea worse. Feed your child a regular diet. Diarrhea can last for up to ten days. Call the office if there is blood in the diarrhea, your child refuses to drink, or if the diarrhea lasts more than ten days.

Because vomiting and diarrhea are generally caused by viruses, your child should be considered contagious until the symptoms resolve. Be sure to wash your hands thoroughly when cleaning either vomit or diarrhea, and sanitize any soiled areas. Your child should not attend daycare or school while vomiting. Many child care centers will not allow your child to attend if there is diarrhea, either.

We do not recommend the use of medications such as Phenergen or Immodium.

Dehydration

Signs of Dehydration that require evaluation

• Lack of tears
• Lack of any urine output in 24 hours
• Dry mouth and lips
• Listlessness—Acting Weak

Hand-foot-mouth disease (HFM) is a common illness that we see in children. The disease is most common in toddlers and school age children but can be seen rarely in adolescents. It is caused by a VIRUS known as the coxsackie virus, so antibiotics will NOT treat this illness.

What are the signs and symptoms of HFM?

HFM disease may start with the child simply feeling a bit under the weather for a few days after they were exposed to the disease. They will often begin to refuse to eat solid foods and sometimes liquids because their throat hurts a lot. These children may develop high fevers.

The distinguishing part of this disease is that they will develop red spots on the throat that may become blisters or ulcers. The kids also get small red spots which may blister on their hands, feet and even the buttocks. The rash is often found on the soles and palms which is usually for other viral rashes. It may also be painful but it usually does not itch.

How do we diagnose/treat HFM?

Diagnosis is made by history and exam of the body that shows us the rash.

Treatment is only supportive. This is a virus so antibiotics do not help. It is important to control the child’s pain with Tylenol and/or Motrin. It is also important to keep the child well hydrated by pushing fluids such as water, formula or pedialyte. You can also use jello or Popsicles as alternatives to fluid. Drinks such as orange juice should be avoided as the acidic nature may hurt the throat.

When do I call the doctor?

• If your child has no urine in 24 hours, dry mouth or a sunken soft spot (all signs of dehydration) the doctor should be called.
• If the fever lasts for more than 5 days or if the child has other signs of illness such as an ear infection.

How can I prevent HFM?

The virus is spread via particles in the stool and your respiratory secretions (AKA snot). You can also get this from objects such as changing tables and toys. You should wash hands frequently. Children should also not attend daycare for several days.

Basically, otitis externa is an infection of the skin that lines the ear canal. When water repeatedly gets trapped in the ear canal, the lining becomes wet and swollen. This makes it prone to superficial infections. It causes an itchy, painful ear, sometimes with drainage. There may be a sensation that the ear is plugged. Generally there is pain when the outer ear is moved up and down.

If it’s a mild case, you can try a home remedy:

• Rinse the ear canals twice a day with ½-strength white vinegar (mixed with equal parts water).
• Fill the ear canal.
• After 5 minutes, remove it by turning the head to the side.

More significant cases usually require prescription ear drops, so you’ll need to make an appointment to see one of us. Give acetaminophen or ibuprofen for pain relief. You can also use a heating pad or hot water bottle to the outer ear for up to 20 minutes for pain relief. With treatment, symptoms should be better in about 3 days.

Try to avoid swimming until all the symptoms have resolved. If your child is on swim team, it’s OK to continue. Swimming may slow recovery, but causes no significant harm.

The key to prevention is keeping the ear canals dry. After swimming, hair washing, showers, etc, turn the head to let the water run out of the canals. If your child is on swim team, you can make a home remedy of ½ rubbing alcohol and ½ white vinegar to rinse your child’s ear canals with after practices to restore to normal acid balance to and dry the canals.

You should call a doctor if:

• your child is experiencing severe ear pain
• your child’s ear pain is accompanied by fever
• there is redness and swelling of the outer ear

(Must be 6 months or older)

Emergency Care
Quick reference guide:

Call us or seek emergency care if:

• Your Baby seems unable to latch to a bottle or breast due to cough and congestion
• Your infant or child is retracting– this means using their ribs, belly or neck muscles to assist in their breathing. You will see the belly and chest going up and down like a see-saw, or each individual rib as the muscles in between the ribs suck in and out .
• You notice your child’s nostrils flaring open with each inward breath.
• You notice a color change, such as a blueish tinge around the mouth, lips or tongue.

Most of you reading this will not be dealing with a child with the above level of distress and you are accessing our web site to learn if there is some way to get through the night. First, a bit about why we cough:

As it is with most “symptoms”, our bodies produce the cough as a means of protection. Coughing increases mucous clearance and speeds up the tiny hair cells in our airways that help protect our lower recpiratory tract from infection. So, think of a Cough as a good thing. This is why we don’t necessarily recommend suppressing it. A good example of how helpful our cough is comes from the experience in caring for children with cystic fibrosis. These children have much thicker mucous and have damage to their Cilia (the tiny Hair cells mentioned above) consequently, their cough is less effective. They suffer from recurrent bouts of pneumonia and need external assistance to bring up mucous. So, hopefully after reading this as you hear your child cough you may have less anxiety about it and actually welcome a bit of coughing.

Most coughs then, are a product of an upper respiratory infection (a cold or flu) that causes increased secretions. Mucous that an adult or older child would spit out or blow into a tissue is swallowed by the young ones. This post nasal drip is what accounts for the more severe sounding cough in our children. Cough without the post nasal drip can also be caused by irritation or mild inflammation to the upper respiratory tract, such as croup. Croup causes a dry dog or seal like barking cough that is worse at night. Most of these viral coughs last about 2 weeks, but some cause a prolonged (>3 week) cough. If your childs cough has lasted more than 2 weeks and is not improving or worsening we should see them in the office the next day. Prolonged cough without the above emergency symptoms does not need emergency care.

WHAT DO I DO???

If you think you are dealing with one of the viral coughs this is where the frustration comes in. First, calm yourself by re-reading how protective coughs are, then get a humidifier or vaporizer going in your childs room (unless they have a known allergy to dust mites or molds). This adds moisture to the air and may make the cough less disruptive to sleep–it DOES NOT stop the cough. Some menthol and camphor based products, like Vicks can either be put in the humidifier or rubbed on the chest if they are old enough not to touch it and might put it in their eyes.

There are now menthol products that can be plugged indo an outlet, but I am unsure of their safety with small children at this time. The menthol conctricts the blood vessels in the nasal passage and may indirectly reduce cough by reducing the amount of congestion.

Cough syrups are rarely helpful. Dextrometorphan is the DM added to the end of the brand name and it is foul tasting and not very effective. It is hard to justify the fight it takes to get this medication into your child when it may reduce the frequency of cough by 5 – 0%. Expectorants don’t help as children don’t expectorate, so skip this one in total. If sleep is disturbed (the childs, not just yours) a single dose of diphenhydramine, (Benadryl) may help your child cross over from drowsy to actually asleep .

Of course, one should not forget the tried and true concentration on pushing fluids during a cold, it helps clear the secretions, and provides some calories for the little ones who reduce their solid food intake during the illness.

If your child has a hictory of wheezing or asthma and has a significant cough it is never wrong to try the Albeterol or Xopenex and monitor for decreased cough as a result. Remember that for a few minutes after the treatment the Cough may worsen as the treatment opens up previously closed airways and secretions are mobilized.

Colic means excessive crying in an infant 2 to 12 weeks of age who is otherwise healthy. It is a very common occurrence among infants, and the cause is unknown. Because many physical problems can cause excessive crying in an infant, the diagnosis of colic should be made only by a doctor.

Symptoms of Colic:

Colic usually begins by 2 to 3 weeks of age and may last 3 or 4 months. Colicky infants usually cry at least 3 hours a day. The crying may or may not occur at the same time each day, but usually happens more often in the evening. The baby does not stop crying when usual ways of comforting, such as holding and feeding, are tried.

Signs of Colic:

• Crying
• Flailing of arms and legs
• Clenched fists
• Drawing up legs toward abdomen
• Bulging and tense abdomen
• Struggling and angry when held

Possible Causes of Colic:

No one really knows the real cause of colic, but some things that may be related include:

• Gas pains
• Exposure to Tobacco Smoke
• Stomach Spasms
• Immature nervous system
• Hormones out of balance
• Immature digestive system
• Intolerance or allergy to milk/ formula
• Tension or emotional stress in babys environment

Reflux (GERD) and constipation may also cause similar symptoms

Treatment:

There are a wide variety of things that may help, but very few that will work every time. Often, it is trial and error to find the ones that work best for your child. Suggestions that have helped babies with colic include:

• Rocking in a chair or recliner
• Cuddling or Swathing
• White noise such as a vacuum cleaner or hair dryer
• Burping your baby multiple times while feeding to alleviate excessive gas
• Sitting your baby up in a car seat
• Going for a ride in a car or stroller
• Giving your baby a pacifier
• Playing soft and light music

*Never shake your baby!

Important Points:

• Your babys crying is not your fault
• Your baby does not blame you
• Confusion and Anger or normal responses
• Even though your baby is crying, they are still healthy
• There is a light at the end of the tunnel, and most babies symptoms resolve by 3-6 months of life.

When to Call your Doctor:

• Respiratory distress
• Fever >100.5º
• Bile or blood in spitup
• Dehydration
• Hard stools
• Poor weight gain
• Blood in stools
• Or if you have further concerns

Signs of Constipation:

Infants:

• Straining
• Hard, pebble like stools
• Liquid stools (leakage around solid stools)
• Distended or swollen abdomen that improves after a BM
• Blood in stool
• Rectal tear

Children:

• Abdominal pain and cramping
• Very infrequent/ irregular bowel habits
• Soiling or accident in pants
• Distended abdomen

Treatment:

Infants:

• Juices–pear and prune
• If old enough, you may give fruits and vegetables
• Karo syrup
• Switching from rice cereal to oatmeal or barley cereal

Children: Goal of 1 soft BM per day

• Vegetables, fruits, whole grain cereals
• Bran cereal
• Extra water and liquids between meals
• Toilet–sitting to take advantage of the normal reflex to have a BM 15-30 minutes after each meal
• Rewards system–calendar, stickers, favorite tv show, special time

When to call the Doctor

• When your child is irritable and seems to be having abdominal or rectal pain
• If you see blood in the stools
• If symptoms last for longer than 4-5 days
• If the above therapy does not improve symptoms
• If there is fever >100.5º associated

Important points:

Try to stay calm, positive, and understanding. This is not something children decide to do, and therefore punishment is not recommended. Do not give enemas, suppositories, or laxatives unless you are told to do so by your Doctor. Call your Doctor with any further concerns or issues.

The steps outlined below should help an existing rash to heal. They are also good techniques for preventing rashes when your child has diarrhea, whether from a viral infection or as a side effect of antibiotic therapy.

• Change diapers frequently and be sure the skin is completely dry before closing the new diaper. Wet skin is more easily penetrated by the irritating substances in stool and urine. It is also more easily damaged by chaffing of the diaper against the skin.
• Clean the skin gently with water. Avoiding the chemicals in store-bought wipes can help rashes to heal more quickly. Instead, use soft paper towels or washcloths moistened with water (these can be stored in air-tight bags for travel). Clean the skin with a light patting motion. Brief soaks in the sink or tub provide another way to cleanse without rubbing the irritated skin. You might also try using a squirt bottle filled with water.
• Leave the area open to air. During naps and any other time that is practical, expose the skin to air by placing your child on a towel without a diaper. While this may be the most challenging suggestion to implement, it may also be the most helpful.
• Use a diaper cream. The main purpose of these creams is to provide a barrier between the baby’s skin and urine/stool. Zinc oxide creams are the best (brand names include Desitin and Balmex) but creams made from petroleum jelly are also acceptable (brand names include Vaseline and A&D Ointment). Do NOT use powders or cornstarch as these have been shown to cause breathing problems when inhaled by some infants.

If you have followed these steps for 3-4 days and the rash is not improving, your child should be seen by a doctor. It is possible that the skin has become infected with yeast or bacteria and that a prescription will be required to clear the rash.