Frequently Asked Questions
FAQ's

WHAT IS THE BEST MEDICATION FOR A COLD AND COUGH?
WHAT IS THE DOSE OF IBUPROFEN (MORTIN, ADVIL)?
WHAT PROBLEMS MAY ARISE WITH FEVER, AND HOW CAN IT GO BEFORE IT IS CONSIDERED DANGEROUS?
WHEN SHOULD MY CHILD BE SEEN FOR EITHER VOMITING OR DIARRHEA?WHAT TREATMENT OPTIONS ARE AVAILABLE?
WHAT IS CONJUNCTIVITIS AND HOW SHOULD IT BE TREATED?
HOW SHOULD I TREAT MY CHILD'S RASH?
HOW SHOULD I KEEP MY CHILD'S SKIN HEALTHY?
AT WHAT AGE CAN I USE SUNSCREENS, AND WHICH ONES ARE BEST?
HOW CAN I PREVENT AND/OR TREAT INSECT BITES, ESPECIALLY TICK BITES?
HOW DO I KNOW IF MY CHILD HAS SUFFERED A DANGEROUS OR SERIOUS HEAD INJURY?
WHAT IS CONSTIPATION AND HOW SHOULD IT BEST BE TREATED?
WHAT IS OPTIMUM NUTRITION FOR MY CHILD?

MEDICATION FOR COLD AND COUGH
There really is no effective OTC treatment for a cold and cough. Parents can try them and safely use them if they want (following the dosage instruction on the label), but there is no firm evidence that they work. Benadryl is inexpensive and commonly used and may help night sleeping. After age 2, dosing is half tsp every 6 hours (if 24-48 lbs) and 1 tsp every 6 hours if >than 48 lbs. For children 6 years or older, parents should follow
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WHAT IS THE DOSE OF IBUPROFEN (MORTIN, ADVIL)?
Motrin and Advil can only be used in infants 6 months and above
     For under 25 lbs use only Infant Motrin Drops (50mg/1.25ml).
     12-17lbs – 1.2 ml every 6 hours
      18-24 lbs – 1.875 ml every 6 hours
      For above 25 lbs use Children’s Motrin or Advil Suspension (100mg/5ml) or chewables (50 or 100mg) and follow advice on label.
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WHAT PROBLEMS MAY ARISE WITH FEVER, AND HOW CAN IT GO BEFORE IT IS CONSIDERED DANGEROUS?
A fever is a body temperature that is higher than normal. Your child's normal body temperature varies with his age, general health, activity level, the time of day and how much clothing he is wearing. Everyone's temperature tends to be lower early in the morning and higher between late afternoon and early evening. Body temperature also will be slightly higher with strenuous exercise.

Most pediatricians consider any thermometer reading above 100.4 degrees Fahrenheit (38 degrees Celsius) a sign of a fever. This number may vary depending on the method used for taking your child's temperature. If you call your pediatrician, say which method you used. If your child has a fever, it is probably a sign that her body is fighting an infection. When your child becomes ill because of a virus or bacteria, her body may respond by increasing body temperature. It is important to remember that, except in the case of heat stroke, fever itself is not an illness - only a symptom of one. Fever itself also is not a sign that your child needs an antibiotic.

Many conditions, such as an ear infection, a common cold, the flu, a urinary tract infection or pneumonia, may cause a child to develop a fever. In some cases, medication, injury, poison or an extreme level of overactivity may produce a fever. An environment that is too hot may result in heat stroke, a potentially dangerous rise in body temperature. It is important to look for the cause of the fever. Fevers are generally harmless and help your child fight infection. They can be considered a good sign that your child's immune system is working and the body is trying to rid itself of the infection.

Fevers are considered dangerous when the child appears sick and listless, lethargic, has had a seizure, or is very irritable with constant crying. Fevers in excess of 103 degrees or fevers in infants less than 3 months of age have greater association with bacterial infection, and require medical attention.
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WHEN SHOULD MY CHILD BE SEEN FOR EITHER VOMITING OR DIARRHEA? WHAT TREATMENT OPTIONS ARE AVAILABLE?
In most cases, vomiting will stop without specific medical treatment. You should never use over-the-counter or prescription remedies unless they've been specifically prescribed by your pediatrician for your child and this particular illness. When there is continued vomiting, you need to make certain that dehydration doesn't occur. (Dehydration is a term used when the body loses so much water that it can no longer function efficiently.) If allowed to reach a severe degree, it can be serious and life-threatening. To prevent this from happening, make sure your child consumes enough extra fluids to restore what has been lost through throwing up. The fluid to be given is pedialyte for the infant and young child, and Gatorade for the older child and adolescent. Hydration can still be maintained even when vomiting pedialyte or Gatorade as long as the amount given continually approximates the volume thrown up (some fluid absorption can happen in the mouth.) Signs of dehydration are dry mouth and infrequent urination (less than once every 6 hours.) Your child should be immediately evaluated if signs of dehydration.

Most children should continue to eat a normal diet including formula or milk while they have mild diarrhea. Breastfeeding should continue. Diarrhea that is moderate to severe, accompanied by blood or mucous, or by high fever requires medical evaluation. Mild diarrhea is generally less than 6 stools per day, and moderate diarrhea is generally 6-12 stools per day. Severe diarrhea involves very frequent stooling (>12 per day) and/or large volume stools.

Infants and children with mild to moderate diarrhea can be cared for easily at home with close supervision. A normal diet is still recommended but with supplemental fluid by way of pedialyte in the infant and child and Gatorade in the older individual. Similar to the treatment for vomiting, diarrhea treatment involves giving roughly the same amount of fluid by mouth that is lost in each diarrhea stool. Also, the same precautions for dehydration are needed-particularly watching for infrequent urination. Medications are generally not recommended or prescribed for common diarrhea illness.
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WHAT IS CONJUNCTIVITIS AND HOW SHOULD IT BE TREATED?
Conjunctivitis, or inflammation of the conjunctiva, usually occurs as a result of infection or allergy. The conjunctiva is the tissue covering the white part of the globe of the eye and extends into the eyelids. It is an exceedingly common occurrence, certainly the most common acute disease of the eye seen by primary care physicians of children. Inflammation can cause redness, mucous discharge, itchiness, and/or pain of the eyes. In mild cases, home management with gentle eyelid cleansing with either water or liquid tears is sufficient. Mild allergic conjunctivitis (recurrent, seasonal itchiness with little discharge) can be treated with over the counter Zaditor and/or liquid tears. Conjunctivitis that involves moderate to heavy mucous discharge or that involves significant eye pain, light sensitivity, or any visual disturbance requires same day medical evaluation.
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HOW SHOULD I TREAT MY CHILD'S RASH?
Eruptions of the skin have so many causes and are so variable that phone treatment is generally not practical. Rashes in children with fever require prompt evaluation, and any rash that appears to be like blood in the skin or hemorrhages requires emergency evaluation. Most acute rashes, however, in childhood will be related to contact irritants (diaper, stool, plants) or from viral illness. Chronic rashes are most commonly eczema, managed with skin lubricants or emollients and occasional hydrocortisone products.
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HOW SHOULD I KEEP MY CHILD'S SKIN HEALTHY?
Newborns require very little, if any, of skin care products, as they will tend to naturally peal and acquire stronger skin. Older infants and children may need moisturizers, if prone to dryness, and soaps that are not too drying such as Dove or Cetaphil. Commonly used moisturizers are Eucerin and Aquaphor-and at times, even Vaseline petroleum jelly. Bathing, especially if prolonged, can worsen dryness-this can be prevented by immediate application of moisturizer after towel drying.
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AT WHAT AGE CAN I USE SUNSCREENS, AND WHICH ONES ARE BEST?
Infant skin is damaged more by sunburn than older children, and any sunburn should be completely avoided. Water Babies is one sunscreen that can be used down to 6 months of age. Other common pediatric sunscreens are Banana Boat Baby and Hawaiian Tropic Kids. Effective sunscreens should protect against both UVA and UVB light (indicated on the label) and have an SPF (Solar Protection Factor) of at least 15.
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HOW CAN I PREVENT AND/OR TREAT INSECT BITES, ESPECIALLY TICK BITES?
Safe insect repellants for children should have labels with "Family" on them, such as Family Off or Family Cutter. The active ingredient is DEET, which is effective, but unsafe for kids at high doses (products without "Family" on them.) Tick bites that involve tick attachment under 24 hours are of very little risk of disease transmission i.e. Lyme disease, but ticks should be removed as quickly as possible. Rashes that might occur with tick bites, especially from ticks that have been attached for prolonged or unknown periods, should be medically evaluated in the office.
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HOW DO I KNOW IF MY CHILD HAS SUFFERED A DANGEROUS OR SERIOUS HEAD INJURY?
When children under the age of 2 years suffer blunt trauma to the head, they are at higher risk for brain injury and/or skull fracture, and should be promptly medically evaluated. Older children who either have loss of consciousness, loss of orientation, head swelling (that is not on the forehead), strong head pain, vomiting, or any amnesia of the event, should also be promptly medically evaluated. Head injuries that are from falls of less than 3 feet or occur with immediate crying, forehead swellings, and/or no loss of consciousness or vomiting can be generally managed at home without medical intervention. If imaging is necessary with head trauma, head CT is preferred. Note all children who have suffered head trauma are at greater risk of brain injury should they suffer another head trauma event during the ensuing 2-week period.
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WHAT IS CONSTIPATION AND HOW SHOULD IT BEST BE TREATED?
Constipation is defined as the infrequent passage of dry, hard painful stools. Note that the passage of infrequent, yet soft stools is not constipation. Both breast and bottle fed infants can have soft, normal yet infrequent stools (sometimes at 7 day intervals) and are not considered constipated. Typically, breast fed infants are the least likely to become constipated. Older toddlers and children can suffer constipation because of heavy dairy, fiber poor diets. They can also suffer fears of pain from passing hard stools and will consequently voluntarily withhold defecation. Treatment depends on the age of the child. Infants greater than 2 months can be given a mixture of prune juice and water (1 oz prune juice to 2 oz water). Infants older than 6 months can take a mixture of water and prune juice (1 oz prune juice to 1 oz water). They can also take Milk of Magnesia at the following doses:

15 lbs 3 ml daily

20 lbs 4 ml daily

25 lbs 5 ml daily

Children older than 18 months can take Miralax, a very effective stool softener that is over the counter.

22 lbs ½ capful or about 8 grams daily

33 lbs ¾ capful or about 12 grams daily

44 lbs 1 capful or about 17 grams daily

The Miralax should be dissolved in 6-8 oz of clear liquids (juice or water). Generally, constipation treatment is best treated by mouth and not per rectum (because of pain and subsequent fears about defecation that may be generated in the child's mind.) Older children can benefit from a higher fiber diet or diet with daily Metamucil powder or wafer (artificial fiber enrichment).
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WHAT IS OPTIMUM NUTRITION FOR MY CHILD?
An excellent web site that specifically describes a child's optimal diet per age can be found at http://www.mypyramid.gov/ . As for infants, they should be breast fed and receive 1ml daily of polyvisol or trivisol with iron. Formulas that are adequate are Enfamil lipil or Similac advance. LOW IRON FORMULAS ARE NOW NEVER RECOMMENDED. Infants with minor cow milk problems can be fed soy based formulas. Infants with formula intolerance or allergy may benefit from Gentlease initially, or, if unsuccessful, Alimentum or Nutramigen or Pregestamil. Infants with severe formula intolerance sometimes require Neocate or Elecare. Generally, solid foods are introduced around 6 months of age, and by 12 months of age all foods are generally tolerated with the exception of peanut products. Peanut products in non-allergy households can be introduced at age 18 months (3-5 years of age in allergic households.) Foods that are choking hazards, i.e. nuts, hard candy, popcorn, hot dogs, or any food that cannot be pulverized, should be avoided until at least age 3 years. Older children will benefit from the parent always choosing the menu, NOT THE CHILD. Children receive heavy advertisement, in our culture, of what foods to eat, and sound nutrition requires the parents to NEVER ASK THEIR CHILD WHAT THEY WANT TO EAT. Meals should be chosen for them and presented at breakfast, lunch, and dinner. Fast food restaurants should be avoided and not visited more than twice per month. Sodas should not be offered more than twice weekly. Grazing or multiple snacks should be avoided. Infant bottle use should be strongly discouraged after 18 months of age, because of tooth damage. Older children will benefit from 5 servings per day of fruit and vegetables, low fat dairy intake, whole grain cereals and breads and plenty of poultry, fish, and nuts, again as found on the web site http://www.mypyramid.gov/ .
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