This page has general advice. For urgent health questions or issues, please call our nurses at (925) 254-9203 & choose option 3.
IllnessNewborn Constipation
Frequency of stools varies greatly. Many breast-fed babies have a stool after each feeding and some may go several days without having a stool. Formula-fed babies often have fewer stools than breast-fed babies. You should be concerned if your newborn has not had a stool in five days, if there is blood in the stool, or if the stools are rock hard. Straining, turning red and grunting does not necessarily mean constipation. If your child is constipated, you may wish to try one or more of the following: 1. Prune juice. 2. Pediatric glycerine suppository. 3. Gentle insertion of a lubricated thermometer into the rectum (1 inch). How to measure your Child's temperature
There are several different types of thermometers on the market, and deciding which to purchase can be a tricky decision. Depending on the age of your child, it matters which thermometer you use. The three main types of thermometers are (1) a digital thermometer, (2) an ear thermometer, and (3) a temporal artery thermometer. You should not use the old mercury thermometers anymore, if you still have one in your home. A fever is a temperature over 100.4 degrees F, or 38 degrees C. For newborn infants under 3 months of age Use a digital thermometer and measure a rectal temperature. Any digital thermometer can be used rectally; there is not a specific “rectal” thermometer. This is the most accurate way to measure core body temperature, and it is important to have an accurate temperature in this age group. Measure your baby’s temperature if he/she feels warm or is acting sick. Signs of illness in this age group may include lethargy, poor feeding, or irritability. For infants over 3 months of age and older children You may use any type of thermometer you prefer. While a rectal temperature is still the most accurate, fevers in this older age group are not as potentially serious and it is not necessary to continue taking rectal temps. Digital thermometers may be used orally, in the armpit, or rectally. Ear thermometers measure temperature in the ear, and temporal artery thermometers measure temperature on the forehead. For more instructions on how to take your child's temperature, please check out this article on BabyCenter.com Fever Reducing Medications
Acetaminophen (the medication in Tylenol and other brands) and Ibuprofen (the medication in Ibuprofen, Advil, Motrin and other brands) are commonly used fever and pain medications. Dosing varies by child weight. Please see the medication table to determine how much to give your child. Vomiting
Vomiting is quite common in childhood, usually as part of gastroenteritis (stomach flu). Vomiting usually lasts one to three days, and may be accompanied by fever and diarrhea. The main concern with vomiting is that children are more susceptible to dehydration than adults. It is much easier to prevent dehydration than to treat it; treating it sometimes involves a stay in the hospital for intravenous fluids. To prevent this from happening, keep your child from getting dehydrated in the first place. If your child has thrown up more than one or two times, it is best to stop giving any milk or solid foods. Wait about an hour, then start offering very small amounts of clear liquid (Pedialyte®, Gatorade, apple or white grape juice, or flat coke or 7-Up) every 15 to 20 minutes for the next few hours. Once your child has been able to keep that fluid down without vomiting, then start offering larger amounts, about two ounces. Do not offer milk or food until your child can keep down clear liquids, even if your child is complaining about being hungry – if you do, your child will likely throw it and all the clear liquids up. Do not continue an all clear liquid diet for more than 24 hours without consulting the doctor. If your child has dark green or dark yellow vomit (bile), call the office. See the section on diarrhea for signs of dehydration. Fever
Fever is usually indicative of an underlying infection (most commonly a virus) and is usually self-limiting. The specific degree of temperature is less important than other signs and symptoms of your child’s illness. Rectal temperatures are most reliable for infants. In older children, ear thermometers can be used for screening but oral thermometers are more accurate.
Diarrhea
Most parents worry about their child’s bowel movements. From a medical standpoint, diarrhea (i.e., increased number of bowel movements or very liquid stools) is not dangerous. Aside from its being unpleasant and mildly uncomfortable for your child, diarrhea is a serious medical concern only when it is associated with repeated vomiting (i.e., dehydration) or other related symptoms (e.g., blood in the stool). If your child has diarrhea and is vomiting repeatedly, you should look for signs of dehydration that will require medical attention:
Medication is rarely needed to treat diarrhea. If you have any questions, please call our advice nurse. Colds
Colds are caused by viruses. During the first five years of life, children average nine colds per year. Antibiotics are not useful unless a complication occurs (such as ear infection, sinusitis, pneumonia). Colds usually last three to ten days. Symptomatic treatment includes:
InfectionVomiting
Vomiting is quite common in childhood, usually as part of gastroenteritis (stomach flu). Vomiting usually lasts one to three days, and may be accompanied by fever and diarrhea. The main concern with vomiting is that children are more susceptible to dehydration than adults. It is much easier to prevent dehydration than to treat it; treating it sometimes involves a stay in the hospital for intravenous fluids. To prevent this from happening, keep your child from getting dehydrated in the first place. If your child has thrown up more than one or two times, it is best to stop giving any milk or solid foods. Wait about an hour, then start offering very small amounts of clear liquid (Pedialyte®, Gatorade, apple or white grape juice, or flat coke or 7-Up) every 15 to 20 minutes for the next few hours. Once your child has been able to keep that fluid down without vomiting, then start offering larger amounts, about two ounces. Do not offer milk or food until your child can keep down clear liquids, even if your child is complaining about being hungry – if you do, your child will likely throw it and all the clear liquids up. Do not continue an all clear liquid diet for more than 24 hours without consulting the doctor. If your child has dark green or dark yellow vomit (bile), call the office. See the section on diarrhea for signs of dehydration. Pinworms
Pinworms are a common infestation of childhood. They cause intense itching in the anal area, especially at night. If your child is having difficulty sleeping because of an itchy bottom, test for pinworms. At night, stick clear tape on the anus and remove it. If you see small white objects on the tape, your child has pinworms. In the past, treatment required a prescription. Now treatment can be found over the counter with brand names such as PinX. We recommend treating all household members as the worms can spread easily. You may want to consider disinfecting your toilet and washing sheets in hot water. Do not allow children to bathe together when at least one child is infected with pinworms. For more information on pinworms, see Healthychildren.org Head Lice
Head lice is often resistant to standard treatments. Follow these guidelines to help rid your child of this itchy scalp infestation. Supplies:
Method:
Home Care:
IngestionsIngestions
Accidental poisoning most frequently occurs in children 1 to 4 years old. All poisons, medications, and other toxic substances should be kept out of sight and reach of children. Cabinets and drawers containing such substances should be securely locked. Ipecac is no longer recommended for poisonings. If you are worried that your child ingested a medication in error or overdosed on a medication, call the San Francisco Poison Control at 800-222-1222. Do not wait for symptoms to occur! Calling right away may prevent adverse outcomes. InjuryHead Injury
Head injury is the leading cause of childhood injury. A blow to the head or fall on the head my lead to scalp swelling, bruising, lacerations, skull fractures, concussions, or even brain injuries. If you child has a head injury look for the following signs, which may be indications that your child needs to be evaluated by a physician.
In order to prevent injuries, remind your child to wear a helmet when riding a bicycle, scooter, roller blades, skateboard, snowboard, downhill skis or other moving object. MedicationsFever Reducer Medications
Acetaminophen (the medication in Tylenol and other brands) and Ibuprofen (the medication in Ibuprofen, Advil, Motrin and other brands) are commonly used fever and pain medications. Dosing varies by child weight. Please see the medication table to determine how much to give your child. |
NewbornCare of Bottles and Formula Preparation
IT IS NOT NECESSARY TO STERILIZE YOUR BABY’S WATER, BOTTLE OR NIPPLES. Washing them in a dishwasher or in hot soapy water and rinsing them thoroughly is adequate. Several types of formulas are available on the market, including Similac Pro Advance. 1. Powdered formula is mixed like instant coffee. A scoop of powdered formula is added for each 2 ounces of water and stirred. Follow directions on the formula can to ensure that the right amount of water is added. 2. Ready-To-Use formula comes in small disposable bottles and quart cans. It needs no preparation and is very convenient, but more expensive than powdered formula. Most tap water is safe for mixing formula for your baby. If you use bottled water, we recommend that you buy water with fluoride added. Beginning Breast Feeding
Breastfeeding is a natural way for women to feed their babies, but it is a learning experience for both you and your baby. Be patient with yourself and your baby, relax and enjoy this time together. Find a comfortable place to feed your baby, allowing space for pillows to support your arms and to bring the baby level to your breasts. Position your baby so he/ she does not need to twist or strain to reach your breasts. Express some milk onto your nipple and touch your nipple to the baby’s lower lip. When your baby’s mouth opens wide, quickly pull your baby in to latch on. The nipple needs to be far back in the baby’s mouth. If you experience pain, break the suction by slipping your little finger in the corner of your baby's mouth between the gums and take the baby off the breast. Try again to latch the baby on, this may take several attempts. Whenever possible offer both breasts during each breastfeeding session. Begin the next feeding with the breast with which you finished the last time. During the newborn period, breastfeeding may take from 20-45 minutes. However, because newborn babies are often sleepy, this may require patience and persistence. Babies need to breast feed at least 8-12 times in 24 hours the first few weeks in order to gain weight appropriately and stimulate a plentiful milk supply. After the first few days, you know your baby is getting enough milk if: 1. There are 4-6 wet diapers in a 24 hour period. 2. The urine is pale in color. 3. Stools are loose and change from black to mustard yellow in the first 5 days. 4. Your breasts feel softer after feedings Continue to eat a well balanced diet high in protein and calcium. Drink whenever you are thirsty and rest when you can. If you have problems with breastfeeding, talk with your pediatrician about getting help. Breast milk may be expressed into a clean, non-sterilized container and stored for up to 6 months in your freezer. Rewarming frozen breast milk under warm tap water or by exposure to room temperature provides a nice supplement to nursing. Some medications are contraindicated (should not be taken) while a mother is breastfeeding. The list of these medications is frequently updated - please call our nurses or your obstetrician to ask whether your medication is safe with breastfeeding. In general, many seizure medications, all radioactive medications, stimulants, and illicit drugs should not be used while breastfeeding. Newborn Feeding
Although there are many unresolved questions about infant nutrition, current medical thinking suggests the following: 1. Breastmilk is the preferred nutritional source for a newborn; there is nothing wrong with formula feeding. For some families, formula feeding may be preferable. 2. Feed your baby on demand, which usually is about every 2 to 3 hours. You may want to wake your baby during the day if he or she sleeps more than 4 hours to maintain a modified on demand schedule. 3. The American Academy of Pediatrics (AAP) recommends that all infants receive a vitamin D supplement. Both multivitamin preparations (with vitamins A, C, and D) and vitamin D alone are available over the counter (OTC). The dose of vitamin D is 400IU per day until the baby reaches one year of age. 4. Infants do not need water or other fluids outside of breastmilk or formula. However, it is perfectly safe to offer your older baby (over 6 months of age) a small cup or bottle of tap water during or between meals if desired. 5. The age at which solid foods should be introduced varies with each family. From a medical standpoint, infants need only breastmilk or formula in the first year of life. Solid foods should not be given during the first month of life and are commonly introduced at 4 to 6 months of age. There is no proof that introducing solids will help babies sleep longer.Raw honey should not be given until after the first year of life because honey carries a risk of infant botulism ("floppy baby" syndrome). Cow's mlk should not replace formula or breastmilk in the first year because its negligible iron content can lead to anemia (low blood count). Infant Cradle Cap
The infant's scalp may show a yellow flaky rash which seems unrelated to temperature or bathing conditions. This cosmetic condition may be present from birth and is referred to as infant “seborrhea” or commonly called “cradle cap.” Baby oil or mineral oil may be applied to loosen the flakes prior to gentle brushing with a fine nylon baby brush. Simply washing thereafter with plain soap or baby shampoo once or twice per week will keep cradle cap under control until it disappears. Ill Contacts and Your Newborn
There is controversy in the medical community about how susceptible newborns are to colds and other common infectious illnesses. Prudently, when taken outside, infants should be dressed appropriately for the weather, and their heads should be covered when it is cold or rainy. Persons with obvious or known colds or other respiratory illnesses, should try to limit contact with the child. Everyone should wash their hands before handling an infant and avoid breathing on the child. Colic
Excessive fussiness, or colic, occurs in many babies. It usually begins when the baby is about 2 weeks old; it peaks at 6 to 8 weeks; and it usually resolves by 3 to 4 months of age. A colicky baby may cry an average of 3 hours a day. If your child is fussy, determine whether he or she is hungry, wet or ill. If these do not appear to be causing your baby’s fussiness, certain colic measures may be tried: 1. Motion techniques (rocking, walking in a snugli, wind-up swing, going for a ride in the car). 2. Noise (TV, stereo, dishwasher, vacuum cleaner or hair dryer). 3. Heat (heating pad on a low setting or warm water bottle). Caution: Newborns have thin, delicate skin. Use only low heat. Any combination of the above measures may help to comfort your infant. If your baby’s fussiness seems to be excessive or if you are worried about it, please call our advice nurse. NewBorn Sleep
Newborns sleep between 12 and 20 hours per day. The sleep pattern for each child varies. Day/Night sleep patterns do not become firmly established until about 4 to 6 months of age. Infants should sleep on their backs; they should not sleep on their bellies or sides. Your baby's crib or bassinet should have a firm mattress. The space between the slats of your crib should measure no more than 2 3/4 inches. Newborn Clothing
New clothing should be washed in a mild detergent before wearing. Avoid the use of fabric softeners. For taking baby home: diaper, shirt, hat, and blanket. As a general rule, dress your baby in the same weight clothing that you are wearing. Bathing Your Newborn
Frequency: 2-3 times a week; sponge bath only until cord has dried and fallen off Soap: mild, without perfume Lotion: usually unnecessary; fragrance-free mild baby lotion may be helpful for excessively dry skin Powder: none; talcum powder can be inhaled into your baby’s lungs and cause serious respiratory problems Newborn Cord Care
Keep the cord stump clean and dry; it will fall off about two weeks after birth. Cleaning/cleansing the base of the cord with alcohol or hydrogen peroxide is not necessary. Some bleeding or discharge commonly occurs at the site of the cord. Call us if the bleeding seems excessive or if redness develops in the skin around the cord. SafetyIngestions
Accidental poisoning most frequently occurs in children 1 to 4 years old. All poisons, medications, and other toxic substances should be kept out of sight and reach of children. Cabinets and drawers containing such substances should be securely locked. Ipecac is no longer recommended for poisonings. If you are worried that your child ingested a medication in error or overdosed on a medication, call the San Francisco Poison Control at 800-222-1222. Do not wait for symptoms to occur! Calling right away may prevent adverse outcomes. Head Injury
Head injury is the leading cause of childhood injury. A blow to the head or fall on the head my lead to scalp swelling, bruising, lacerations, skull fractures, concussions, or even brain injuries. If you child has a head injury look for the following signs, which may be indications that your child needs to be evaluated by a physician.
In order to prevent injuries, remind your child to wear a helmet when riding a bicycle, scooter, roller blades, skateboard, snowboard, downhill skis or other moving object. Child Safety Seats
Auto accidents are one of the most common causes of childhood injury and death. Adherence to car seat safety guidelines may save your child in the event of an accident. In 2011, the guidelines for car seat safety have been updated to the following:
For more information from the American Academy of Pediatrics, read the Car Safety Guidlines from 2011. Skin and RashesPlantar Warts
Plantar warts are warts which are on the bottom (or sole) of the foot. They can be frustrating because they can last a long time and they can feel like you constantly have a rock in your shoe! Warts do not require urgent treatment in the office. If they are not painful or bothersome, they can be left alone and eventually (could be years) will resolve on their own. East Bay Pediatrics physicians recommend trying home treatment first. Then if desired, you can schedule an appointment at least two weeks later. Home treatment, at bedtime:
Eczema
Eczema, or atopic dermatitis, is a very common childhood rash. Symptoms can range from very mild to quite severe, and it is important to understand the nature of the rash in order to manage it well. Eczema often runs in families, and it is often seen in patients or families where there are seasonal allergies, food allergies and asthma. The most important thing to know about eczema is that it is a chronic condition, that comes and goes, no matter how well it is treated. Some children do outgrow eczema as they get older, but others continue to have symptoms throughout their life. Symptoms: Eczema usually causes an itchy, red, bumpy rash. Children with eczema usually have dry skin. Patches of eczema can be small or large, and are sometimes round or oval shaped. In babies, the rash is usually on cheeks, arms, legs and neck. It is usually not in the diaper area. In older children and adults, it is usually on the insides of elbows, backs of knees, wrists and ankles. Some people get it on their eyelids. In more severe cases, it can be widespread over their whole body. After eczema fades it sometimes leave pale spots (hypopigmentation) that are more noticeable in the summer time when the rest of the skin gets more tan. Causes: For most children, there is no one cause of eczema. A small percentage of children with eczema have food allergies. When that food is removed from the diet, the eczema may improve (though doesn't usually go away completely). Many parents find that there are triggers that worsen their child's eczema. These may include very cold or very hot weather, viral illnesses, and detergents, lotions or soaps that are scented. Minimizing these triggers can lessen the eczema, but it is important to know that even if all of these triggers are avoided, eczema can still flare up. Treatment: The most important element of treatment for eczema is moisturizing. Frequent moisturizing, particularly after baths, will help keep skin moist and prevent eczema from worsening. Most children with eczema do better with less frequent baths, maybe every 2 to 3 days. Some children need moisturizers applied several times a day, every day, and others only need it occasionally when the eczema is flaring up. If, despite good moisturizing, itchy patches of eczema remain, a topical steroid cream will help treat the eczema. Despite the worries of some parents, topical steroid creams are safe when used as directed. For mild eczema, over the counter 1% Hydrocortisone twice a day will help. If it is not helping after 1 week, call your doctor. For more severe eczema, a prescription strength topical steroid will be prescribed by your doctor. The goal is to use the lowest strength steroid for the shortest time needed to settle down the eczema flare. Eczema is very itchy, and controlling scratching can also help the rash. In babies, keeping nails cut short and covering hands with socks at bed time can help. In older children a dose of an anti-histamine can decrease itching and keep the child from scratching. Infant Cradle Cap
The infant's scalp may show a yellow flaky rash which seems unrelated to temperature or bathing conditions. This cosmetic condition may be present from birth and is referred to as infant “seborrhea” or commonly called “cradle cap.” Baby oil or mineral oil may be applied to loosen the flakes prior to gentle brushing with a fine nylon baby brush. Simply washing thereafter with plain soap or baby shampoo once or twice per week will keep cradle cap under control until it disappears. Newborn Jaundice
Jaundice is a yellow discoloration of the skin caused by a pigment called bilirubin. Bilirubin, a by-product of red blood cell breakdown, is processed by the liver. Due to immaturity of the liver in newborns, nearly all newborns experience some degree of yellowness which is usually seen at about Day 3. Sometimes the extent of jaundice may require measurement of bilirubin by heelstick blood test. If the bilirubin is elevated, additional tests and/or treatment may be required. For mild jaundice, more frequent feeding or exposing the baby to filtered sunlight at home may be useful. If additional fluids are needed, offer 1-2 ounces of formula after nursing two to three times per day. If you have any concerns about your baby's yellow appearance, call our advice nurse. The advice nurse may recommend an office visit and/or a bilirubin blood test. |
Other Excellent Resources
- American Academy of Pediatrics website for parents: www.healthychildren.org
- Parenting advice for children ages 0-5 & county based resources: First 5 California
- Poison Control: (800) 222-1222