Frequently asked questions

Fever

My child just had her shots and now has a fever, is this normal?


Yes, it is not uncommon for children to have a fever for up to two days after having their childhood vaccinations or shots. This is a normal and expected response to vaccines. In fact, children who develop a fever have been shown to make more antibodies (antibodies protect your child from disease)! Click here to get more information and recommendations about fever.




I gave Tylenol or Ibuprofen and my child’s temp did not come down to normal, is this ok?


Yes, if your child has a high fever, Tylenol or ibuprofen will most likely not bring it back down to a normal temperature. Remember, Tylenol or ibuprofen will bring the temp down by 1-2 degrees. In other words, a temperature of 103 will not come down to “normal” after one dose of medication. Click here to get more information and recommendations about fever.




If I give Tylenol or ibuprofen and it doesn’t “break” the fever, or bring it down, does that mean that the illness is serious?


Not necessarily. Fevers that don’t come down can be caused by viruses or bacteria. Remember, look at your child’s symptoms (is he or she comfortable after medication) rather than the number on the thermometer. Click here to get more information and recommendations about fever.




When my child gets a fever, should I alternate Tylenol and Ibuprofen?


We recommend starting with an appropriate dose of tylenol or ibuprofen and giving the medication time to work. Tylenol and ibuprofen are different types of medication and can safely be used together. However, we only recommend using them together for persistently high fevers or discomfort. If you are going to use both, alternate between tylenol and ibuprofen every 3 hours. For example: Tylenol at 12 noon, ibuprofen at 3 pm, tylenol at 6 pm and ibuprofen at 9 pm. Please remember to write down which medication you gave and when so that you don’t overdose one of the medications.
Click here to get more information and recommendations about fever.




My child has a fever, what do I do now?


The number one thing that we want parents to remember is the child’s symptoms are more important than what the number on the thermometer says. A child may have a temp of 104 but is drinking fluids and doing well. On the other hand, a child may have a temp of 101 but seem lethargic and dehydrated, this child is much more ill. This is why we ask you to pay attention to the symptoms rather than the number. Remember that fever is your child’s body’s way of fighting off infection, and it is a normal response. Click here to get more information and recommendations about fever.




What temperature is considered a fever?


A fever is a reading of 100.4 fahrenheit or greater. You do NOT need to add or subtract a degree when taking temp via any method (rectal, oral or tympanic). Simply take the temperature and tell your provider the number as well as the method used to take the temperature. Click here to get more information and recommendations about fever.




My child’s temperature has been between 98.7 and 100, does this mean my child has a “low grade” temperature?


No, a temperature under 100F is a normal variation of your child’s body temperature and is not a fever. Body temperature usually peaks in the afternoon to evening. Click here to get more information and recommendations about fever.




Is fever dangerous? Can it damage my child’s brain?


No, a fever is actually good because it helps the body kill off bacteria and viruses. Only body temperatures above 108 fahrenheit can cause brain damage and this level of body temperature can only be reached in by extreme environmental temperatures (for example, if a child is left in a hot car).




When can I wait until morning to call the office when my child has a fever?


You can generally wait until morning to call the office in the following instances:

  • Temperature is less than 100.4
  • Child has a temperature of greater than 100.4 but is otherwise doing well (not acting lethargic or showing signs or symptoms of dehydration). Your child may be more tired than usual, but this is normal.
  • Child has a temperature, but has received immunizations (shots) in the past two days. This is your child’s immune system doing what it should!
  • Fever lasting longer than 24 hours in a child 3 months or older
  • Fever lasting longer than 72 hours in a child 6 months or older
  • Burning or pain occurs with urination or you suspect that your child has an ear infection
The following signs are generally reassuring that the illness is not serious:
  • Child wants to play
  • Child is alert and smiling at you
  • Drinking fluids well (it is normal not to be hungry with a fever)
  • Is comfortable after fever reducing medication is given
  • Normal skin color




If my child has a fever, what things should I call about right away?


You should call our after hours number (or office during regular business hours) in the following instances:

  • An infant younger than 3 months of age has a fever greater than 100.4F - this is a medical emergency.
  • You child’s fever is greater than 104 and is NOT coming down with Tylenol or Ibuprofen. It may not go all the way down to normal, but it should drop at least 1 degree after medication.
  • You child is acting odd or lethargic (being tired is normal, but being difficult to arouse is not).
  • Your child is showing signs or symptoms of dehydration (dry/cracked lips and a dry mouth, no urine for 8-12 hours, sunken eyes or soft spot on baby’s head, lethargic).
  • Your child has a fever, rash and stiff neck.
  • Your child appears very ill even after giving fever reducing medication.
If you are concerned about your child, you should give us a call.




When can I give my child medication for his or her fever and what is the dose?


If your child is uncomfortable, you can give them a dose of fever reducer. However, if your child does not seem uncomfortable you do not have to give medication. Remember, fever is not something to be feared, and is actually helping your child fight infection. Always dose medication by WEIGHT and not by age. Click here to see what dose your child needs. Click here for more information about fever




What other things can I do to help my child feel better when he has a fever?


First and foremost, make sure you are keeping your child hydrated! Offer them fluids frequently. They might not be very hungry, that's ok, as long as they are drinking well. There is a myth that children should not have milk if they have a fever or cold. Milk is a great fluid to give your child when they have a fever, especially if they are not eating well! Milk has calories and the nutrition your child needs to get well. You can also try other fluids such as watered down juice or gatorade, jello, popsicles or pedialyte. It doesn’t really matter what your child is drinking, as long as they are staying hydrated. When you child has a fever, resist the urge to bundle them in warm clothes and blankets. Do not let your child become chilled, but dress the child in light clothing so that they can get rid of some of the heat of the fever. Don’t fear the fever! Remember that fever is fighting off your child’s infection. And of course, if you have any questions, please give us a call! Click here for more information about fever





Cough/Cold

How long is "too long" for a cough?


Most parents are surprised to find out that colds often linger for at least 2 weeks, and coughing can last for up to 4 weeks (with a small percentage of children taking a full 6-8 weeks to recover fully from cough)! Your child may have a fever for the first 3-5 days of the illness (this is also when the symptoms such as runny nose, sore throat and coughing will be most severe). Also remember that most young children get six to twelve colds per year – it may seem like your child is sick all winter! We recommend that if could lasts longer than 2-3 weeks, is getting worse rather than better after the first week, fever returns after being normal for 1-2 days, or new symptoms arise you should be seen in the office. If your child is not having any shortness of breath or difficulty breathing you can wait to be seen in the office rather than being seen in Urgent Care or the ER. If they are lethargic, having difficulty breathing or are dehydrated, you should bring the child in to be seen immediately.




My child has a cough, do I need to take them to Urgent Care or the ER?


If your child has a cough and has any of the following sympotms, you should take them in to be seen right away:

  • Difficulty breathing
  • Retractions (A retraction is a medical term for when the area between the ribs and/or in the neck sinks in when a person with asthma attempts to inhale. Retractions are a sign someone is working hard to breathe)
  • Wheezing (this is a high pitched, whistling sound when the child breaths out)
  • Very lethargic (this does not mean your child is simply "tired". It means that they are hard to arouse, even to take fluids or use the bathroom)
  • You think that your child has an urgent need to be seen.
If they have a cough, but are otherwise doing well (drinking fluids, not having difficutly breathing), you can wait until the next clinic day to be seen in our office.




I think my child might have croup, what should I do?


Croup is common in children and is often caused by a virus. Children will croup have a distinct “barky” cough that many parents compare to the sound a seal makes when it is “barking”. Although croup can be scary for both parents and the child, it can often be managed at home until you can be seen in the office the next day. If the child is not experiencing shortness of breath, retractions (skin between ribs and below the neck sinking in or getting sucked inwards), wheezing or stridor (see video below for example of stridor) you can monitor your child at home. If your child is experiencing trouble breathing, retractions, wheezing or stridor, you should have them seen right away. Example of what stridor sounds like:




What can I do to help my child when they have a cough and/or cold?


Not all coughs and colds need treatment. If symptoms aren't bothering your child, they don't need medicine or any treatment. Many children with a cough or cold are happy, play fine and sleep well. Only treat symptoms if they cause discomfort or wake your child up. Treat a cough if it's hacking and really bothers your child. Also, remember that fevers are helpful. Only treat them if they slow your child down or cause them some discomfort. That usually does not occur until 102° F (39° C) or higher. Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be given. Use to treat higher fever or pain. Click here to see dosing charts.




My child has a cough/cold, should I give them over the counter medciation?


Over the counter cold medications are not recommended for children under the age of 4. Studies have consistently shown that they do not work in this age group, but they do have the potential to cause serious side effects. You can use honey as noted above if the child is older than 1 year. For children older than age 4 you may try giving them an over the counter cold medication, but keep in mind that even in this age group, they have not been shown to be effective. You can give fever medication if needed. Remember that fevers are helpful. Only treat them if they slow your child down or cause them some discomfort. That usually does not occur until 102° F (39° C) or higher. Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be given. Use to treat higher fever or pain. Click here to see dosing charts.




My child has a cough and is also having trouble breathing, what should I do?


If your child has a cough, along with difficulty breathing, you need to take them in to be seen right away. If it during office hours, please call our office for an appointment. If it is after hours, bring them directly to the nearest urgent care or emergency department.





Sore throat

My child has a sore throat, how do I know if it is strep throat?


It is important to remember that viruses are by far the most common cause of a sore throat. Antibiotics will NOT work to treat a virus. Viral sore throats can feel just as bad if not worse than strep throat. Symptoms of true strep throat include the following:

  • No other symptoms besides a sore throat and fever (and sometimes upset stomach) - If your child has a sore throat and cough, runny nose, sneezing or congestion, the sore throat is less likely to be caused by strep and more likely to be due to a virus.
  • Very red throat with red spots and/or pus on the tonsils (although some viruses can also look this way).
  • Fine pink rash on the chest, abdomen, and back which feel like sandpaper when you run your fingers over it. It may look like a sunburn.
  • Known close exposure to someone with strep throat.
Symptoms of a viral sore throat
  • Throat pain only when coughing but not when swallowing
  • Multiple cold or flu symptoms such as a cough, runny nose, watery eyes, sore muscles and sneezing
  • The child is not acting very sick overall
Click here for more information about strep/sore throat




If my child has strep throat, does he/she need to start antibiotics right away (do I need to bring the child to urgent care/ER right now)


Many parents worry that if they don't start antibiotics right away it will cause harm to their child in the long or short term. However, studies have shown that it is safe to wait several days before starting antibiotic therapy without any increased risk for complications. Although there is no harm in taking your child to urgent care, it is safe to wait until the next day to call the office and see your regular pediatrician for a throat swab. However, it is important to remember that if your child seems severely ill you need to bring them to the ER or Urgent Care right away. If you notice the following signs or symptoms, you need to bring your child to care urgently:

  • Trouble breathing
  • Can't swallow fluids or has new onset of drooling
  • Stiff neck or can't move neck like normal
  • Purple or blood-colored spots on the skin
  • You suspect your child may be dehydrated (No urine in over 8 hours, dry mouth, no tears, dark urine)
  • Child is lethargic
  • Fever over 104
Click here for more information about strep/sore throat




If my child has a sore throat or strep throat, what can I do at home to help my child feel better?


There are many things you can do at home to help your child feel better either before or after your child has seen their provider.

  • The best way to treat throat pain is to give the child ibuprofen or Tylenol. In our experience, ibuprofen often works the best (do not give ibuprofen to a child under 6 months of age).
  • Sip on warms fluids such as chicken broth.
  • If the child is old enough to gargle and spit you can add a little table salt to warm water and have them gargle with this mixture.
  • Make sure your child stays hydrated by drinking adequate fluids. Foods like popsicles, slushes, sherbet, and ice cream also contain fluids and can soothe a sore throat.
Click here for more information about strep/sore throat





Rash & Hives

My child has a rash, should I worry?


Rashes are very common in childhood and are usually not cause for concern. Many times, in children, the rash may be associated with an illness. How the child looks overall (happy, playing, not dehydrated) is more important than how the rash looks. If your child has a rash and seems very ill, is dehydrated, or is having difficulty breathing they should be seen in the clinic or in urgent care/ER if it is after hours. If they have a rash but otherwise seem to be doing fine, you can call us the next morning to make an appointment to be seen in our office. Sometimes a child will have a fever and cold symptoms followed by a rash. This is called Roseola and is a common cause of rash in children. Once the rash breaks out, the child is usually feeling much better. You don't need to bring your child in to be seen by a provider as long as they are playful, alert and drinking fluids.




My child developed a rash after having a fever, is this normal?


Fever followed by a rash is common in children. The most common cause is a viral illness called Roseola. What is Roseola? It is a viral illness which commonly affects children between 6 months of age and 3 years (although it can affect children both younger and older). What are the signs of Roseola? Initial signs:

  • Fever (sometimes higher than 103 degrees F) from 24 hours up to one week.
  • Mild respiratory symptoms such as runny nose, watery eyes and cough.
  • Fussy/irritable and may not want to eat well
  • Once the fever is gone:
  • Once the fever is gone (it often ends abruptly) a pinkish-red flat or raised rash appears on the trunk
  • The red spots of the rash may have a white "halo" around them
  • The spots turn white when pressure is applied
  • The rash usually then spreads to the face, neck, arms, and legs
Do I need to bring my child to be seen by a doctor if they have Roseola? No, if your child is otherwise doing well (not dehydrated, lethargic or severely ill) you can monitor them at home. If they are very ill or have a rash which is not like the one described above, they should be seen. Is Roseola Contagious? Yes, it is contagious. However, once the rash has broken out on your child's body, they are no longer contagious. Once the rash appears, they can go back to daycare or school as well as their normal activities. How long does it last? The fever of roseola lasts on average from 3-7 days and the rash can last from hours to a few days. Once the child has broken out in the rash, they usually feel better.




My child has hives, what could be causing this?


Hives are actually very common in children, and often, we don't know what causes them. Hives can be caused by viruses, bactera, foods and medications. If your child has hives but is otherwise happy, drinking fluids well, acting normal and not having any difficutly breathing, you can monitor them at home. If hives last longer than 4-5 days, you should be seen in the office. You can give benadryl to help keep your child comfortable if they are bothered by itching. Click here for benadryl dosing chart. Remember, this medication may make your child tired, so you may want to reserve this for before bedtime or nap or if hives are really bothering your child during the day. Call 911 right away if your child has hives and:

  • history of a life-threatening allergic reaction to similar substance in the past and exposure less than 2 hours ago
  • Trouble breathing or wheezing
  • Very hoarse voice or severe cough which started all of a sudden
  • Trouble swallowing, drooling or slurred speech which started all of a sudden
  • You think your child has a life-threatening emergency
Please call our office during office hours (8 am to 5 pm) if you think that your child needs to be seen, but the problem is not urgent. We are happy to see them!




My child has hives, can I give them something to help?


If they are having trouble breathing or are coughing/wheezing CALL 911 If they don't seem to be bothered by the hives and are not itching at them, you don't have to give them anything if you don't want to. However, if you would like to give your child something to help, you can give them Benadryl. Click here for a benadryl dosing chart. Other measures to help with hives:

  • To help with the itching, give a cool bath. Do this for 10 minutes. Caution: Avoid causing a chill.
  • Can also rub very itchy spots with an ice cube for up to 10 minutes.




How can I tell hives from a different type of rash?


Hives are lightly raised, pink or red swellings. They can appear alone or in a group, or connect over a large area. Often the hives subside or go away within 24 hours at one spot but may appear at another spot. These are pictures of hives:




What is a "viral rash"?


Many parents are surprised to find out that in infants and children, may viruses may also cause their child to break out in a rash. While a viral rash can look alarming, they usually aren’t cause for concern. How do I know if the rash is caused by a virus? Viral rashes can vary widey in appearance. However, most look like splotchy red spots or dots. These spots/dots might come on suddenly or appear gradually over several days. They can also appear in a small section or cover multiple areas of the body. A child may have a fever, cough, runny nose and/or sore throat before or during the time they have the rash. How is a viral rash treated? Viral infections and viral rashes often have to run their course. Unlike bacterial infections, they don’t respond to antibiotics, so treatment usually focuses on relieving your child's symptoms. If your child is itching at the rash, you can use cold compresses, an oatmeal bath or calamine lotion to relieve the itching. Here are some pictures of viral rashes:




My child was on an antibiotic (such as Amoxicillin) and now has a rash, is he allergic?


Rashes on Amoxicillin: When is it a True Allergy? Rash while taking Amoxicillin or Augmentin is common; 5-10% of children taking Amoxicillin or Augmentin will develop a skin rash at some point during the course of the medication. The majority of these are not a true allergic reaction, and most are caused by viruses. So, how can you tell the difference? A non-allergic rash occurring while taking Amoxicillin or Augmentin will:

  • Look like small (less than ½ inch) widespread pink spots in a symmetrical pattern or slightly raised pink bumps.
  • Usually appear on day 5-7 (but can be earlier or as late as the 16th day) from the start of the Amoxicillin or Augmentin, but can occur at any time during the course of the medication. It always appears on the chest, abdomen, or back and usually involves the face, arms, and legs.
  • Differ from hives in appearance (hives are always raised, itchy and change location).
  • Usually go away in 3 days, but can last from 1-6 days.
Your child probably won't develop it the next time she takes amoxicillin. The best part? It's not contagious, so he/she can go back to school! How is an "amoxicillin rash" treated? No treatment is necessary. The rash will disappear just a quickly whether or not you continue the medication. Even if you know it's not an allergic reaction, it may still feel wrong to continue giving the medication. There are several reasons why it is better to finish the course of Amoxicillin than stop or change to a different antibiotic:
  • Stopping the Amoxicillin or Augmentin it won't make the rash go away any faster.
  • You can avoid changing to a broader-spectrum antibiotic that may not be necessary and could cause other problems, such as diarrhea or vomiting.
  • Stopping the medication can incorrectly label your child as allergic to the penicillin family of antibiotics, which would limit future antibiotic choices.
If your child is on Amoxicillin or Augmentin and develops a rash, we always recommend calling the office so that we can go over your child's symptoms. You still may need to come in if there is anything about the rash that is worrisome or doesn't fit a non-allergic rash. Warning signs that is a true allergic reaction would be sudden onset of rash within two hours of the first dose, any breathing or swallowing difficulty, hives, or a very itchy rash. Call your provider if:
  • The rash changes to hives (raised, itchy, and change location)
  • The rash becomes very itchy
  • The rash becomes significantly worse or lasts more than 6 days





Diarrhea/Vomiting

What are the most common causes of diarrhea and/or vomiting?


  1. Viruses - the most common cause of vomiting with diarrhea is viruses. Other family members or schoolmates may have been or may become sick with the same symptoms. The most common type of viruses that cause vomiting and diarrhea are Norovirus and Rotavirus
  2. Food Poisoning - Your child may have rapid onset of vomiting and diarrhea just hours after eating a contaminated food. Often times, this is caused by germs growing in food which is left out too long. Others who ate the same food will also come down with the same symptoms.




How severe is my child's vomiting and/or diarrhea?


Vomiting

  • Mild = 1-2 times per day
  • Moderate = 3-7 times per day
  • Severe = vomits everything, 8 or more times per day
The severity of vomiting actually relates more to how long the vomiting goes on for. When you child first starts vomiting, it is very common for them to vomit everything for about 2-4 hours. Then, children often become more stable and vomiting decreases to mild severity. Diarrhea
  • Mild = 2-5 watery stools per day
  • Moderate = 6-10 watery stools per day
  • Severe = over 10 watery stools per day
It is important to remember that diarrhea is defined as watery stools. Loose or runny stools are not true diarrhea and they alone do not cause dehydration.




My child is breastfeeding, how do I know if they have diarrhea?


Diarrhea can be harder to detect in a breast fed infant as they normally have frequent, runny stools. However your breast fed infant might have diarrhea if:

  • Stools suddenly increase in number and looseness. If this lasts for more than 3 stools, your child has diarrhea.
  • Stools in breast fed infants are normally yellow, but can also be green, and runny stools can even look like they are boarded by a "water ring". These are all normal stools.
  • Other clues that suggest that the baby has diarrhea are poor eating, fever or acting sick.




How do I know if my breastfed child is vomiting or simply "spitting up"


Vomiting in a breastfed infant tends to be more forceful than normal spit up. The child may gag or retch before and after true vomiting. The child may seem upset or distressed if they are truly vomiting. In contrast, "spitting up" is a easy and free flow of stomach contents from the mouth that does not cause the child distress. A child who is acutally vomiting may have other signs of illness such as diarrhea, refusing bottle, fussiness or fever.




What do I need to worry about if my child is vomiting or has diarrhea.


The main complication from vomiting and diarrhea is dehydration. Signs of dehydration include:

  • No urine in more than 8 hours is an early sign of dehydration. Urine may be dark in color if your child is dehydrated. If your child's urine is light straw colored or clear, they are not dehydrated.
  • Dry mouth and tongue. Dry lips alone are not a sign of dehydration.
  • Dry eyes with decreased or absent tears
  • In babies, the soft spot on the top of the head may be sunken
  • If your child is lethargic and acting severely ill, they may be dehydrated. A child who is alert, happy and playful is not dehydrated.
  • Dizziness when standing, or too weak to stand.




What are the signs and symptoms of dehydration?


  • No urine in more than 8 hours is an early sign of dehydration. Urine may be dark in color if your child is dehydrated. If your child's urine is light straw colored or clear, they are not dehydrated.
  • Dry mouth and tongue. Dry lips alone are not a sign of dehydration.
  • Dry eyes with decreased or absent tears
  • In babies, the soft spot on the top of the head may be sunken
  • If your child is lethargic and acting severely ill, they may be dehydrated. A child who is alert, happy and playful is not dehydrated.
  • Dizziness when standing, or too weak to stand.




My child is vomiting and/or has diarrhea, do they need to see a doctor?


If your child has any of the following symptoms, you should call 911 now:

  • You can't wake your child up
  • You child is not moving or is too weak to stand up
  • You think that your child might be having a life-threatening emergency
If your child has any of the following symptoms, you should make an appointment for them to be seen in our office, ER, or Urgent Care now (if it is during office hours, we encouraged you to call our office before going to ER or Urgent Care as we can likely see your child in the office):
  • The child is hard to wake up (is very lethargic)
  • Your child seems confused or is acting "out of it"
  • Blood in your child's vomit that is not from a nosebleed
  • Your child has pain low on the right side, won't jump up and down when asked and wants to lie very still. This may mean that your child has appendicitis.
  • If you suspect that your child might have eaten or drunk something that would cause poisoning.
  • You suspect that your child is dehydrated (see question regarding dehydration)
  • Bloody stool
  • Stomach pain when the child is not vomiting (However, stomach pain before vomiting is common)
  • Your child is under 12 weeks of age and has vomited 2 or more times
  • Severe vomiting (vomiting everything) for more than 8 hours while getting clear fluids only
  • Fever over 104
  • Your child looks or acts very sick
  • Your child has been vomiting frequently for more than 24 hours




How do I keep my children hydrated when they are vomiting?


Formula Fed babies:

  • Stop all solid foods. You will give your child oral rehydration solution (commonly referred to as Pedialyte) to keep them hydrated while vomiting. This can be bought at any grocery or drug store. You do not need to give Pedialyte if the child only has diarrhea, you can continue with formula.
  • Do not give any over-the-counter medications for at least 8 hours, as some of these can make vomiting worse. Remember that mild fevers do not need to be treated with any drugs. For higher fevers which are greater than 102, you can use an acetaminophen suppository which is a form of Tylenol which is put in the rectum. Do not give your child ibuprofen as this can upset the stomach.
  • If your child has vomited more than one time, offer oral rehydration solution ("Pedialyte") for 8 hours. If you don't have any on hand, use formula until you can get some.
  • Give your child 1-2 teaspoons (5-10 mL) every 5 minutes. You can use a spoon or syringe to feed your child these small amounts. Do not let them gulp large amounts of fluid, or they will vomit it.
  • Double the amount to 2-4 ounces after 4 hours with no vomiting.
  • After a full 8 hours with no vomiting, go back to giving regular formula. You may also slowly add in solid foods. Start with foods which are easy to digest such as cereals, crackers, bananas, rice, and bread.
Breastfed babies:
  • You will reduce the amount per feeding to help your child keep the breast milk down. If your child is taking solids, stop all solid foods.
  • Do not give any over-the-counter medications for at least 8 hours, as some of these can make vomiting worse. Remember that mild fevers do not need to be treated with any drugs. For higher fevers which are greater than 102, you can use an acetaminophen suppository which is a form of Tylenol which is put in the rectum. Do not give your child ibuprofen as this can upset the stomach.
  • If your child has vomited more than one time, nurse for 5 minutes every 30 to 60 minutes.
  • Your child may want to nurse longer at the breast, however, if you let them nurse for a prolonged period of time, they are very likely to vomit all of the breast milk back up.
  • After four hours without vomiting, return to regular nursing
  • If the child continues to vomit despite decreasing the amount per feeding, switch them to an oral rehydration solution (known as Pedialyte). Give 1-2 teaspoons 5-10 mL every 5 minutes. Do this for 4 hours.
  • After 4 hours with no vomiting, return to feeding at the breast. Start with small feedings 5 minutes in duration every 30 minutes. As your baby keeps down these small amounts, slowly lengthen the duration of feeding. After breastfeeding without vomiting for 8 hours, may start to slowly reintroduce solids. Start with foods which are easy to digest such as cereals, crackers, bananas, rice, and bread.
Older Children (over 1 year of age):
  • If your child is having vomiting with watery diarrhea, they will need an oral rehydration solution (also known as Pedialyte). Some children do not like the taste and will refuse to drink this. You can use half-strength Gatorade (mix equal amounts of Gatorade and water).
  • Your child should not drink only water, this can cause an imbalance of electrolytes in the body and make the child sicker. They need calories when they have vomiting and/or diarrhea.
  • Stop all solid foods until 8 hours after vomiting has stopped.
  • Do not give any over-the-counter medications (except Emetrol if they are over 2 years of age, which is an over the counter medication for vomiting) for at least 8 hours, as some of these can make vomiting worse. Remember that mild fevers do not need to be treated with any drugs. For higher fevers over 102, you can give Tylenol. Avoid ibuprofen as this can upset the stomach.
  • You MUST limit the child to small amounts of fluid, if you allow the child to gulp large amounts they will most likely vomit it back up. Start with 2-3 teaspoons every 5 minutes.
  • After 4 hours without vomiting, may slowly increase the amount.
  • After 8 hours without vomiting, return to regular fluids.
  • Avoid giving fruit juice or soda as these can make diarrhea worse. However, if that is all that your child will take, let them drink it. Getting fluid is the most important part of avoiding dehydration.




What should I do if my child has diarrhea but no vomiting?


It can be easier to keep children hydrated if they don't have vomiting along with diarrhea. Most children with diarrhea can eat a normal diet, but you do want them to drink more fluids to stay hydrated.

  • For formula fed infants, you should keep giving normal formula but you should feed more often. Offer as much formula as your child will take. Mix formula the normal way, do not attempt to dilute or add more water to the formula. You do not need to give oral rehydration solution (pedialyte) if the child is taking formula well. If for some reason the child is not taking formula well, you can attempt to give oral rehydration solution; give as much as the child will take and offer it frequently.
  • In breast fed infants, offer the breast more frequently and allow the child to drink until they are satisfied. If you feel that the child is not getting enough breast milk, you can supplement with oral rehydration solution (pedialyte).
  • Older children should be offered fluids frequently and allowed to drink as much as possible.
  • All children who are eating solid foods should be allowed to continue solids. Offer easy to digest foods such as cereals, bread, crackers, rice and pasta.
IMPORTANT: if your child is not eating solid food, you need to ensure that you are offering them a fluid which has calories in it (such as Gatorade, milk or half strength apple juice).




Are there any over the counter medications I can give my child for vomiting and/or diarrhea?


There is an over-the-counter medication called Emetrol which can be used to decrease nausea and vomiting. This should not be used in children under the age of 2, or in any child with diabetes. You may also want to start a daily probiotic as this has been shown in studies to decrease the severity of diarrhea as well as how long your child has diarrhea. These are also over the counter. Two brands that we recommend are Culturelle and Florajen. You'll start by giving this twice daily for two weeks and then may decrease to once daily. You should not give your child ibuprofen or tylenol if they have vomiting and/or diarrhea unless they need it for discomfort or fever.




How long will diarrhea and/or vomiting last?


For the first 2-4 hours vomiting may be severe. Your child may vomit everything. However, vomiting usually decreases in frequency as the stomach settles For most children, a viral stomach bug lasts no more than 12-24 hours. However, mild vomiting (1-2 times per day) with diarrhea may actually last longer. It can continue on and off for up to a week! Occasionally, after having a viral stomach illness, your child will seem better for a day or two and then have another episode of vomiting. He or she will seem otherwise well. This is normal in children. If vomiting or diarrhea returns and is severe and your child vomits more than 1-2 times they should be seen in our office. For children with viral diarrhea, it is not uncommon for diarrhea to last anywhere from 5-14 days. Diarrhea is usually severe for the first one to two days, and then slows down. However, loose stools can last for 1-2 weeks. If diarrhea has been present for longer than 7-10 days and is not improving or getting worse, or your child also has fever or blood in the stool, you should contact our office during regular office hours.




My child had a "stomach bug" a few days ago and just vomited again, is this normal?


For most children, a viral stomach bug lasts no more than 12-24 hours. However, mild vomiting (1-2 times per day) with diarrhea may actually last longer. It can continue on and off for up to a week! Occasionally, after having a viral stomach illness, your child will seem better for a day or two and then have another episode of vomiting. He or she will seem otherwise well. This is normal in children. If vomiting or diarrhea returns and is severe and your child vomits more than 1-2 times they should be seen in our office.





Ear Problems

My child is having ear pain, what could be causing this?


The two most common causes of ear pain in children are ear infections and fluid behind the eardrum which is not infected. Ear pain may also be caused by an infection of the outer part of the ear (called swimmer's ear). Rarely, ear pain can be from a tooth or jaw problem, or if your child has something stuck in their ear canal. Sometimes, children complain of pain in the ear although there is no problem that a doctor can see. It's a very sensitive area, and sometimes children complain of pain for no particular reason.




My child is rubbing or touching at his ears, does this mean he has an infection?


Rubbing/touching the ears is very common in younger children. Simple ear pulling/tugging or touching without other symptoms such as crying or fever is harmless. These children rarely have an ear infection. If the child continues to rub or touch the ear frequently for greater than 3-5 days you should call our office during office hours at (715) 830-0732.




What are the signs of an ear infection?


  • Pain in the ear
  • Act fussy (babies or young children)
  • Pulling at ears (this alone is usually not a sign of ear infection, must be seen with other symptoms)
  • Fever
  • Drainage from ear(s)
  • Having trouble sleeping at night
It is important to remember that just because a baby is fussy and pulling at her ears does not mean it is an ear infection. The only way to diagnose an ear infection is to look in the ear, you cannot diagnose ear infections on symptoms alone.




What are the signs of swimmers ear?


Mild signs include:

  • Itching and/or slight discomfort in the ear canal
  • Redness of the ear canal
  • Drainage of clear fluid that does not smell
  • Pain which is made worse by pulling or pushing on the outer ear
Moderate signs include
  • More intense itching and pain
  • Increasing redness of the ear
  • Excessive fluid drainage, or drainage which is yellow/green (pus)
  • Decrease or muffled hearing
Severe signs include:
  • Severe pain which may radiate to the face, neck or side/top of the head
  • Complete blockage of the ear canal
  • Redness or swelling of the outer ear
  • Lymph node swelling in your child's neck
  • Fever
*If you note any severe signs, your child needs to be seen by a doctor right away.




If I suspect that my child has an ear infection, do they need to be seen by a doctor right away?


Not necessarily. Often times, ear infections are caused by viruses and will go away without treatment. Remember, antibiotics do not treat viruses and will not make an ear infection which is caused by a virus to get better. Studies have shown that anywhere from 60-80% of ear infections will clear without any medication or treatment. If your child has the following signs or symptoms, you should bring them to see their regular doctor (or Urgent care or emergency department if it is after office hours or on the weekend). If it is during regular office hours, we prefer that you call our office at 715-830-0732 to schedule an appointment to be seen:

  • Your child is under 6 months of age and you suspect that they have an ear infection.
  • Your child seems severely ill.
  • Pain is moderate to severe and a dose of ibuprofen/Tylenol does not decrease the pain.
  • Your child is lethargic (not easy to wake up, won't take a bottle or drink fluids)
  • Your child is dehydrated (no urine in 8 hours, dry mouth, no tears when she cries).
  • Your child has blood or pus coming out of his or her ear.
If you suspect that your child has an ear infection, is over the age of 6 months and is otherwise doing fine, you can give ibuprofen or Tylenol to control the pain and wait until you can be seen at OakLeaf Pediatrics on the next business day. Even if it the weekend, if your child is doing ok, you can continue to monitor your child and call us on Monday morning to make an appointment.




What should I do if I suspect that my child has swimmers ear but the office is not open?


If your child is having only mild symptoms and you are able to bring your child to our office the next day, you can give your child ibuprofen or Tylenol and call us the next day at 715-830-0732 to schedule an appointment (we open the phone lines at 8 am, call us as soon as you can). If symptoms are moderate to severe, you should bring your child in to be seen urgently (if it is not during office hours, you can bring your child to urgent care). If symptoms are mild, you can also use a vinegar rinse to restore the normal pH of the ear canal and reduce swelling. To make a vinegar rinse dilute equal parts white vinegar with warm water (ex 1/2 cup of vinegar diluted with 1/2 cup of white vinegar). Have your child lay on their side with the affected ear upward and fill the ear with canal with the diluted vinegar. Let the vinegar stay in the ear for 5 minutes before letting it drain out. Do this twice daily until the ear canal returns to normal. Do NOT do a vinegar rinse if your child has a hole in the eardrum or if he or she has tubes.




If my child has ear pain, what can I do at home to help her feel better?


  • Tylenol or ibuprofen dosed according to your child's weight. This is the most helpful in decreasing pain. Click here for dosing chart.
  • Cool or warm compresses - soak a washcloth in either cool or warm water, wring it out and then put it over the ear that bothers the child. Try both temperatures and see which one your child likes best.
  • Sleep upright - prop your child up in bed with pillows or sleep with them in an armchair that's slightly reclined. This may help to decrease pain and encouraged fluid in the ear to drain out.




My child is saying that her ears feel "plugged" - what should I do?


The sensation of a "plugged" ear can be cause by earwax blocking the ear canal or fluid behind the ear drum. Please call us on the next business day to have your child seen in the office.




My child has fluid/discharge coming out of his ear, what could this be?


If the discharge is light brown, orange-brown, or dark brown it is earwax. You can wipe the visible earwax out with a soft washcloth - do NOT use a q-tip as this could push the earwax further into the ear or damage the ear drum.

If the fluid is clear, it’s most likely water from a bath/shower or from swimming. If the discharge occurs for more than 24 hours, your child should be seen in the office. If your child has recently had a head injury and has clear discharge from the ear they need to be seen in the ER immediately.

If the discharge is cloudy, yellow, or green they should be seen in the office the next morning. If the office is not open the next day, they should be seen in urgent care.

Always remember that no matter what type of drainage you see, if your child appears very ill or is in significant pain, they should be seen immediately.





Tick Bite/Lyme

There is a tick on my child's body, what should I do?


  • Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.
  • Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth parts or head easily with clean tweezers, leave it alone and let the skin heal.
  • After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.
  • Never crush a tick with your fingers. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet.




The head of the tick is stuck in my child's skin, what should I do?


Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth parts or head easily with clean tweezers, leave it alone and let the skin heal. Trying to dig out the head/mouth parts will only irritate the area more. The body will expel the tick over time if you leave the area alone. If you notice redness (although a small amount of redness surrounding the mouth parts is normal), drainage or significant swelling around the mouth parts, please call our office to have your child seen.




Will my child get Lyme disease from this tick bite?


The tick must be attached and feeding for at least 48 hours in order to transmit Lyme disease. A small, non-engorged tick that is walking on the surface of the skin, or is easily removed is not capable of giving your child Lyme disease. Try to think about the last time your child was outside and may have possibly come into contact with a tick. It is important to remember that Lyme disease is much less likely because removal of the tick within two to three days of attachment usually prevents transmission of Lyme disease. More commonly, Lyme disease is transmitted by the unrecognized tick that feeds to repletion (about four to five days) and then falls off without the person knowing that he or she has been bitten.




Does my child need antibitoics after a tick bite?


Usually, your child will NOT need antibiotics to prevent Lyme disease. Your provider may consider a single dose of antibiotics to prevent Lyme disease if he/she meets ALL of the following criteria:

  • Attached tick identified as a deer tick
  • Tick is estimated to have been attached for ≥36 hours
  • The antibiotic can be given within 72 hours of the tick bite
  • The child is older than 8 years of age and can take the antibiotic doxycycline
Even if your child meets all of the above criteria, he/she may still not need antibiotics. You and your child's provider may decide to simply observe the child for signs or symptoms of Lyme disease and treat with antibiotics only if these develop. If your child meets all of the above criteria and you would like to talk with your provider about a dose of antibiotics, please call our office during regular business hours at (715) 830-0732.




How do I know if the tick that I removed from my child is a deer tick?


Deer ticks are brown and approximately the size of a poppy seed or pencil point. Dog ticks are brown with a white collar and about the size of a pencil eraser (larger than a deer tick). Deer tick (above) Dog Tick (above)




Should my child get tested for Lyme disease right away after a bite?


There is no reason to test your child's blood for Lyme disease at the time of the tick bite because even people who become infected will not have a positive blood test until approximately two to six weeks after the bite.




What are the signs and symptoms of lyme disease?


Observe the site of the bite for a red rash that is expanding. It will develop into a spot which often looks like a "bullseye". If you see this rash on your child, please call our office during regular business hours at (715) 830-0732 to make an appointment for your child to be seen. You do not need to bring your child to urgent care unless he/she is significantly ill along with having the rash. "Bulls-Eye Rash" The rash is seen in early Lyme disease, later signs and symptoms include:

  • Headaches
  • Joint swelling/pain
  • Drooping of one side of the face
  • Dizziness
  • Shortness of breath





Eye Problem

I think that my child has pink eye, should I bring them to Urgent Care?


Pink eye is extremely common, and is something that you usually don't need to go to urgent care for. Rather, you can wait until the next morning and be seen in the office. Many cases of pink eye are viral and don't require antibiotics at all. There are three different types of pink eye. Here's how to tell them apart: Viral (most common) - Symptoms can include watery eyes and is often times seen along with a cold, flu, or sore throat. Often eyelids are crusted upon waking from sleeping. However, after the crusts are clean out, the drainage does not accumulate. Allergic - Symptoms include itchy eyes, swollen eyelids, and a runny or itchy nose. This type of pink eye is common in people with allergies to pollen or animal dander (although there are many causes). Bacterial - Symptoms include a red eye or eyes and a thick, often yellow-green discharge that lasts all day (usually not with a cold or flu). Eyes will be crusted shut upon waking; however, unlike viral, when you clean out the crusts the yellow-green discharge reappears within minutes. If you child is experiencing any of the following, please bring them to care urgently:

  • Severe eye pain, child cannot keep eye open, or sensitivity to light
  • A change in vision (blurry vision or can't see as well)
  • History of recent injury to the eye
  • Significant swelling and redness around the eye (it is normal to have minor redness and swelling, and redness of the eyeball)
  • You child has a history of eye surgery




How can I tell bacterial from viral pink eye?





I think my child has bacterial pink eye, what should I do?


Even if your child has bacterial pink eye, you may NOT need antibiotics. Mild bacterial pink eye almost always goes away within 10 days without treatment (antibacterial drops). It is usually not necessary to go to urgent care after hours or on the weekends for simple pink eye. However, we do recommend that you be seen in the office on the next business day so drops can be started if needed, which may help you child get better faster (may need drops in order to be able to return to daycare). If you child is experiencing any of the following, please bring them to care urgently:

  • Severe eye pain, child cannot keep eye open, or sensitivity to light
  • A change in vision (blurry vision or can't see as well)
  • History of recent injury to the eye
  • Significant swelling and redness around the eye (it is normal to have minor redness and swelling, and redness of the eyeball)
  • You child has a history of eye surgery




I think my child has viral pink eye, what should I do?


Antibiotic drops will NOT work for viral pink eye, and may actually make the redness and discharge worse! You can put a cool compress on the eyes to help soothe the eye. Cooled artificial tears (which can be found over the counter) may also help, but don't overuse them as they can cause more irritation if overused.




I think my infant might have a blocked tear duct, what should I do?


Blocked tear ducts are common in newborns and infants. Parents usually start noticing that the duct is blocked somewhere between 2-4 weeks of age.

  • Signs of a blocked tear duct:
  • One or both eyes are excessively watering
  • Tears fill the eye and even run down the face even when the child is not crying
  • The white part of the eye is not red
  • The eyelid is not swollen
  • There may be a small amount of green discharge on the inner corner of the eye
  • There may be some crusting in the lashes when the child wakes up

If your child has the above symptoms and are otheriwse healthy, they can be seen in the office for evaluation on the next clinic day. However if your infant has a fever, swelling or redness around or in the eye, a red/blue/purple lump at the inner corner of the eye, or a lot of pus coming out of the eye they should be seen in the office/urgent care/emergency department now.





Crying

My child has been crying for an hour or more straight, what should I do?


Prolonged crying without an obvious reason in infants and babies can be normal. Infants with colic may cry for hours at a time. However, when you pick them up and soothe/rock them they often times relax. If your child seem to be in pain or the crying actually gets worse when you pick your baby up or move your baby, this is more concerning than if you are able to console them. If this is the case, you should take off all of their clothes, including the diaper and inspect their body. You might find a hair wrapped around a finger, toes or penis (this is called a "hair tourniqute"). If you do discover this, gently try to unwrap the hair. If you are not able to easily remove the hair, bring your child in to be seen right away. If it is during office hours, please call our office and we will get you in immedialty, if it is after hours go directly to urgent care or the emergency department. If you do not see any immediate cause for the crying and your child has been non-stop crying and inconsolable for 2 hours or seems to be in pain, you should bring them to be seen by a healthcare provider. If you noticed any of the following, bring your child to be seen immediatly:

  • Age less than 1 month old and looks or acts abnormal in any way
  • Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
  • Bulging or swollen soft spot
  • Swollen scrotum or groin
  • Vomiting
  • Cries when you touch, move or hold your baby
  • Could be an injury
  • Nonstop crying lasts more than 2 hours. (Your baby can't be consoled using this Care Advice).
  • Will not drink or drinks very little for more than 8 hours
  • Not alert when awake ("out of it")
  • You are afraid someone might hurt or shake your baby
  • High-risk child (such as with heart or brain disease)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent




My baby is fussy/crying a lot, could it be caused by gas?


Gas passing through normal intestines does not cause pain or crying. All crying babies pass lots of gas. Their stomachs also make lots of gassy noises. The gas comes from swallowed air. The gas is normal. It does not become trapped nor cause any pains. That's why burping a baby doesn't help the crying. Blaming gas is a myth.




I can't figure out what is making my baby cry, what could it be caused by?


Causes of Unexplained Crying

  • Hungry Baby. The most common reason babies cry is because they are hungry. They stop crying at the onset of feeding. By the end of the feeding, they are happy.
  • Sleepy Baby. The second reason babies cry is they need sleep. They need their parent to put them in a comfortable position. It may be swaddled and on their back. Then they fuss a little and fall asleep.
  • Fed Too Much. Some babies cry because of a bloated stomach from overfeeding. Unlike gas, too much milk can cause discomfort that lasts a short time.
  • Caffeine. Caffeine is a stimulant that can cause increased crying and trouble falling asleep. Breastfeeding mothers need to limit their caffeine intake.
  • Clothing. Being too hot or too cold can make a baby cry. So can clothing that is too tight.
  • Dirty Diaper. Stool is very irritating to the skin. If not cleaned off, it can cause pain and burning.
  • Colic. Colic is the main cause of recurrent crying during the early months. All babies have some normal fussy crying every day. When this occurs over 3 hours per day, it's called colic. When they are not crying, they are happy.
  • Pain (Serious). Painful causes include an earache, mouth ulcers, or a raw diaper rash. An ulcer on tip of penis may also cause pain and crying. These babies cry a lot and are not happy when they are not crying. If you think that your baby is in pain, they need to see a healthcare provider.





Allergy

My child got a rash around her mouth after eating, what should I do?


This is common in children, the medical term for this is "Perioral contact dermatitis". This rash can be hives, redness and/or a rash around the mouth after eating certain foods. The rash is where contact with food has occurred and there usually is no itching.

Foods that commonly cause a rash:

  • Ketchup

  • Ranch dressing

  • Citrus fruits

  • Tomatoes

  • Berries

This rash is harmless and does NOT mean that your child is allergic to that food. If you see this rash, you should wash off the involved skin with soap and water. Benadryl is not needed for this type of reaction. It will fade away on its own over a couple of hours to a day (usually goes away in less than 6 hours).

Your child does not need to avoid the food that caused the rash, however, you should try to keep their face clean while they eat that particular food. Your child will eventually outgrow this rash.

Please note that if your child has the following symptoms after eating food you need to see emergency care immediatly:

  • severe or widespread hives on the face or body and/or major facial swelling (especially after eating high risk foods such as nuts, fish, shell-fish, eggs)

  • Sudden onset of wheezing

  • Noisy breathing (stridor)

  • Difficulty breathing

  • Difficulty swallowing

  • Drooling with rapid (fast) onset




My child has hives, is this an allergic reaction?


Hives do not necessarily mean that your child has an allergy. Viral illnesses often cause hives in children. However, if your child has any of the following symptoms, you should call 911 right now:

  • Difficulty breathing

  • Wheezing

  • Hoarseness or cough which started very quickly

  • Difficulty swallowing, drooling or slurred speech

  • Hives after exposure to a food or substance that caused an allergic reaction in the past

  • If you think your child is experiencing a life threatening emergency

If your child has hives, but is otherwise completely well and is not experiencing any of the above symptoms, it is ok to monitor them at home. You can give Benadryl as needed to help with itching or discomfort. Click here for a benadryl dosing chart. You should call our office the next day to make an appointment to be seen.





ingestion

My child swallowed a coin, magnets or other item(s), what should I do?


Call poison control at 1-800-222-1222 immediately.




My child got into a medication and I'm not sure what I should do?


Call poison control at 1-800-222-1222 immediately.




My child got bit or stung by an insect, what should I do?


Call poison control at 1-800-222-1222 immediately.




My child ate a plant or flower, what should I do?


Call poison control at 1-800-222-1222 immediately.




My child swallowed a battery, what should I do?


Call the battery ingestion hotline at 800-498-8666 immediately.





Spitting up

My baby spits up a lot, is this normal?


Yes! Babies spit up - a lot! Some babies will spit up 10-15 times a day or more and this can be completely normal. It is not important how much or how frequently your baby spits up, what matters the most is how the child is growing. If they are gaining weight well, spitting up is not a cause for concern unless they seem to be in pain when feeing or when spitting up. Your provider will check your baby’s weight, height and head circumference at every well visit to ensure that they are growing. Many parents may assume that spitting up is what is causing fussiness in their infant, but this is often not the cause. Many things cause fussiness in an infant, but reflux is usually not one of them.




My baby spits up a lot, can't I just give her medication for this?


No, anti-reflux medications are not needed for most babies. In fact, these medications have been shown in multiple studies to be ineffective and come with the possibility of serious side effects. The hydrochloric acid in your baby’s stomach plays an important role in immunity by providing an acidic environment that makes it hard for bacteria or virus to survive in. This stomach acid is very important to your baby’s overall health, preventing unwanted bacterial growth in the stomach and upper intestine and helping them break down the nutrients in their food and/or milk appropriately. Acid reducing mediations decrease the amount of acid in your infant's stomach. If your infant spits up a lot but otherwise growing well, medications are usually not needed. Click here to see the American Academy of Pediatric's statement regarding the use of acid blocking medications in infants.




What can I do to stop my child from spitting up?


While you most likely won't be able to stop your child from spitting up, you can sometimes decrease the frequency by doing the following:

  • Sit your baby upright for 30 minutes after feeding.
  • Ensure that your infant is latched on the breast well (if breast feeding)
  • If giving formula or breast milk via bottle, use a bottle that decreases the amount of swallowed air such as Playtex Drop-in nurser bottles which has a bag that collapses and empties more similar to the breast

If you don't want to do any of the above, that’s ok too! Remember, spitting up in babies is normal and shouldn't be thought of as a problem (although it does create more laundry!)

You might be wondering about burping your baby - and you might be surprised to find out that research found that burping your baby doesn't help decrease spit up! A 2015 study was conducted that enrolled 71 mother-newborn pairs to assess crying and spitting up associated with burping. Half agreed to burp their babies after every feeding and half agreed to keep their hands to themselves. The result? Both the burped and un-burped babies cried the same amount and the babies who were not burped actually spit up less than the ones who were burped. So, if your little one is clearly trying to burp, a quick pat on the back certainly won’t hurt and might even help. But ritualized burping after every feeding doesn’t seem to make infants more comfortable.





Bites/Sting

My child got bit by a dog or cat or other animal, what should I do?


First, make sure that your child and your family are no longer in danger. If your child is experiencing a life threatening emergency call 911 immediately. If your child was bit by an unknown dog, you should contact the police or animal control. If the bite did not break the skin, you can monitor the area at home and contact our office if any concerning symptoms arise.

If the animal's bite did break the skin or cause injury, you should be seen in the office/urgent care/ER for evaluation. Some bites may have damaged underlying tissues and/or structures and some may need antibiotics due to high risk for infection. Also, it is important to determine if you need rabies prophylaxis or need a booster of your tetanus vaccination.




My child got stung by a bee, what should I do?


There are different types of reactions that your child can have to a bee sting. These include:

  • Local reaction – pain at site of the sting along with swelling, itching and redness. The area can become very swollen depending on where on the body your child was stung.
  • Widespread hives – these are itchy welts across large patches of your child’s skin. These may be an isolated reaction to the sting, or may be part of an anaphylactic reaction
  • Anaphylactic reaction – severe, life threatening allergic reaction to a sting

If your child has a stinger stuck in their skin, use a fingernail or credit card to scrape the stinger off. If the stinger is below the skin surface, leave it alone. It will be shed with normal skin healing.

Call 911 if:

You think your child is having an allergic reaction. Signs and symptoms of an allergic reaction include:

  • Difficulty breathing or wheezing
  • Cough or hoarse sounding/muffled voice
  • Feeling of a “tight” throat or chest
  • Difficulty swallowing, drooling or if speech is unclear
  • Thinking and/or speech is not making sense
  • Child passed out or is too weak to stand up on her own
  • Previous severe or anaphylactic reaction to a sting
  • Abdominal pain or vomiting

If your child is not having any of the above symptoms, but is having hives on a large portion of their body within 2 hours after being stung you should bring them to the emergency department now to make sure that the hives are not part of an anaphylactic reaction. You should also bring them to the emergency department right away if the child was stung on the tongue (could cause swelling and block the airway) or on the eyeball (can cause scarring). If your child was stung on the tongue and is having trouble breathing or taking, do not drive them to the emergency department yourself, call 911 immediately.

Remember that your child may experience redness and swelling at the site of the sting, this is a local reaction to the venom. However, if your child has swelling or redness that starts greater than 24 hours after the sting, or there are red streaks coming from the sting, they should be seen in the office/urgent care to determine if it is a bacterial infection (luckily, an infection after a bee sting is uncommon and usually doesn’t start until 24-48 hours after the sting. Any redness/swelling seen before the first 24 hours is due to the venom).




My child got stung by a bee, what can I do to make them more comfortable?


  1. Make a paste of meat tenderizer with a little bit of water and rub it on the sting. Let it sit on the area for 20 minutes to help neutralize the venom and reduce swelling and pain. Do NOT use this near the eye.
  2. If you don’t have meat tenderizer, you can apply a paste of baking soda with a little bit of water or aluminum containing deodorant to the area for 20 minutes
  3. You may also massage the area with an ice cube for 5-10 minutes to help relieve pain
  4. If pain persists, give Tylenol or ibuprofen – Click Here for a dosing chart
  5. If the area is itching, you can give a dose of Benadryl – Click Here for a dosing chart. Remember that Benadryl may make your tired sleepy/groggy.
  6. If the area is swollen and itching, you may also want to apply 1% over the counter hydrocortisone to the area 3 times daily.




My child got bit/stung by an insect or spider - what should I do?


Call poison control at 1-800-222-1222 immediately.





Skin

I think my child might have frostbite, what should I do?


Frostbite can range from mild to very severe. If your child has severe frostbite they need to be seen immediately in the emergency department.

Signs of severe frostbite:

  • Color and sensation don’t return to normal after 1 hour of attempting to rewarm the area
  • White, hard or completely numb skin (don’t attempt rewarming at home, bring the child to care right away)
  • Frostbitten part develops blisters, this may mean that the frostbite was very deep
  • Area looks infected (red area, red streaks in the area, fever)

Very mild frostbite (also referred to as “frost-nip”) can cause temporary cold, tingling and painful skin. This usually lasts less than 15 minutes after the child is removed from the cold environment and does not cause any tissue damage.

To rewarm mild (not moderate or severe, those children need to be seen by a doctor) frost bite, do the following:

  • Rewarm the area with wet heat. This means that you will put the frostbitten part in warm (not hot) water. The water should be between 105-110 degrees. Do not rewarm with dry heat (such as a lamp or heating pad) as frostbitten tissue cannot feel if the area is getting too hot or burning, so you could damage the skin further.
  • Keep the part under the water until a pink flush appears; this means that blood flow has returned to the area. The area should no longer feel numb.
  • For frostbite of the face and/or ears, apply warm washcloths.
  • DO NOT rub snow on the area, this is an old wives tail and can actually cause more damage to the tissues.




I think my child has eczema, what do I need to know?


These are some eczema tips that can help:

  1. Bathing and hydrating: “soak and smear” – warm (not hot) bath or shower once daily to once every other day. Should remain in the water for at least 10 minutes. I tell older children they should remain in the water until their fingers wrinkle. IMPORTANT: right after getting out of the shower or bath you should smear on a generous amount of moisturizer (non-scented and thick, such as Aquaphor, Vanicream or CeraVea) on the entire body. This step is VERY important as it seals in the moisturizer.
  2. Moisturize twice daily – a thick, non-scented moisturizer should be applied twice daily.
  3. Avoidance: Use “free and clear” detergents that do not have any fragrance or dye. May also want to avoid fabric softener and dryer sheets (use non-chemical dryer balls instead).
  4. Nails: Cut nails short and smooth them out so that if the child scratches, it decreases the amount of damage that is done.
  5. Wet Wraps – Wet wraps after the “soak and smear” can help eczema flares in young children. Bathe the child, apply moisturizer, put on diaper and then take a cotton footed sleeper pajama and run it under water. Wring it out until it is just damp and then put this on the child. Cover this footed sleeper with another dry one to lock in the moisture and prevent the child from getting cold.
  6. Touch Test: It is important to remember that eczema can heal with discoloration (healed skin may look different than surrounding skin, even though eczema is not active there). While this discolored skin may look abnormal, the eczema may actually be healed and topical eczema medications may no longer be needed (although moisturizer should ALWAYS be continued). You can tell if skin is healed by doing the “touch test”: touch the area that is discolored if it is smooth and not dry/bumpy and the child is not itching at it, it is simply discolored skin which needs to heal. However, if it is dry and itchy, you should continue your prescribed medications.
If your child's eczema is flaring or causing them discomfort, please call our office during clinic hours at 715-830-0732 to schedule an appointment to discuss this with your provider.




I think my child has impetigo, what does that look like and what should I do?


Impetigo is a bacterial infection of the surface of the skin and is common in children. Symptoms include multiple small sores which are covered by a yellow, soft scab or crust. The rash usually begins as red bumps which quickly change to cloudy blisters, then yellow colored open/moist sores that may weep.

If your child has the following signs or symptoms, here she should be seen in our office or at urgent care today:

  • Child is very ill/sick/weak
  • Child has red or dark, cola-colored urine
  • Red streaks run from the impetigo
  • The area surrounding the impetigo is tender and red

If your child is otherwise healthy, does not have a fever and is drinking fluids well, they can be seen the next day in our office.




I think my child has ringworm, what does it look like? What should I do?


Ringworm looks like a pink patch which will clear in the center as the patch grows, looking like a "ring". The edge of the ring is usually rough, scaly and raised. It is also usually somewhat itchy.

If your child has 1-2 isolated spots of ringworm you can treat at home. Purchase Lamisil, Micatin or Lotrimin cream over the counter and apply it to the rash 2 times per day. Make sure you cover the entire spot and spread the cream 1 inch beyond the boarder of the lesion. Be sure to continue to use the cream at least 7 days after the spot has cleared completely. Your child does NOT have to miss any daycare or school if they have ringworm. However, remember that ringworm is mildly contagious, so avoid direct skin-to-skin contact. 48 hours after starting the cream, ringworm is no longer contagious. If you are not sure if the lesions are actually ringworm, your child has multiple lesions, or your child is participating in a contact sport such as wrestling (skin-to-skin) contact you should contact our office on the next clinic day to make an appointment. In these cases, oral treatment may be needed.





Abdominal Pain

My child has abdominal pain, should I take him to the ER?


If your child is showing signs of shock (weak, limp, not moving, not breathing normal, skin is grey) you need to call 911 right now.

If your child has any of the following symptoms, they need to be seen in ER immediately:

  • Vomiting blood (red or black – both colors can be caused by blood)
  • Could have been poisoned with a plant, medicine or chemical
  • Your child is have severe or excruciating pain
  • Your child is bent over at the waist or lying down and cannot walk
  • Your child is having pain in his penis, testicles or scrotum
  • There is a moderate to large amount of blood in your child’s stool (exception: if your child has constipation and there is only a small amount when he or she wipes)
  • If you suspect that your child has appendicitis (right sided abdominal pain, severe pain, unable to walk, bent over, pain lasts longer than 2 hours, jumping up and down makes pain worse)
  • Your child has recently had abdominal surgery
  • Your child has diabetes
  • If your child otherwise looks sick or weak
  • If your infant is vomiting green bile and seems to have abdominal pain/crying
  • Abdominal pain with fever

If your child is having very mild abdominal pain that comes and goes and the child seems otherwise well or if the abdominal pain has been present for longer than a week and is not getting worse, you can wait to be seen in the office the next morning. However, if you have any questions – please call us!




I think my child's abdominal pain is caused by constipation - what should I do?


A child with constipation might report mild to moderate abdominal pain, have intermittent vomiting, stools that are hard to pass, large or infrequent. If you feel that your child is constipated you should increase fiber containing foods and fluids (not milk, this can be constipating). Your child should be seen in our office to discuss constipation on the next clinic day. If they have severe constipation, or other concerning symptoms such as vomiting, fever or abdominal pain you should take your child to be seen at the ER or Urgent care right away.





Fall/Injury

My child fell, what should I do?


That depends on where or how your child fell. The greater the height of the fall, the more likely your child will be seriously injured. If your child fell or tumbled just a short distance and are acting otherwise normal you can monitor them at home. If a child under 2 years of age falls from a height greater than 3 feet or from greater than 5 feet over 2 years old these are considered “high risk” falls and your child should be seen.

If your child fell down the stairs or stairway, these accidents are not as high risk as a free fall. If a child has fallen down less than 6 stairs and are acting otherwise normal, you can continue to watch them at home. If they have fallen down more than 6 stairs and seem to be injured or confused in any way, they should be seen by a provider. Very steep stairs, or stairs that are made from concrete can be dangerous at any age.

If your child has fallen and is experiencing the following, you should call 911 immediately:

  • Your child fell and then began to have a seizure
  • Your child fell and they cannot walk, are very confused, or are slurring their speech
  • Your child fell and you suspect they have a neck or back injury – DO NOT move the child, wait for EMS to arrive, they will stabilize the spine and neck
  • Major bleeding that cannot be stopped
  • Child was knocked out (unconscious) for greater than 1 minute
  • You think your child may be experiencing a life threatening emergency

If your child has fallen and is experiencing the following, take them to the ED immediately:

  • Altered mental status or “acting weird” (ex: slow to respond, not answering questions appropriately)
  • Severe neck pain/stiffness within 24 hours of falling
  • Blurred vision that lasts longer than 3-5 minutes
  • A cut or wound which will not stop bleeding or is gaping open (if bleeding is severe call 911)
  • The child has a “dent” in the skull, this may be a skull fracture
  • A fall of over 3 feet in a child under 2 years of age
  • A fall of over 5 feet in a child over 2 years of age
  • Vomited 2+ times within 24 hours after the fall/injury
  • Your child is high risk (history of brain surgery, bleeding disorder or VP shunt).
Common Heights:
  • Countertop - 3 feet high
  • Shopping cart - over 3 feet
  • Parent's arms - usually over 3 feet
  • High chair - 2 feet (may vary if chair is adjustable height)
  • Washer/Dryer - over 3 feet
  • Table - 2 1/2 feet
  • Dining room chair - 1 1/2 feet




My child hit their head, what should I do?


Most importantly, if your child was severely injured do not attempt to transport them to the ED, call 911 immediately. You do not want to move a child who has had a spinal cord injury as this could cause irreversible injury.

If your child has a head injury and is experiencing the following, you should call 911 immediately:

  • Your child fell and then began to have a seizure
  • Your child fell and they cannot walk, are very confused, or are slurring their speech
  • Your child fell and you suspect they have a neck or back injury – DO NOT move the child, wait for EMS to arrive, they will stabilize the spine and neck
  • Major bleeding that cannot be stopped
  • Child was knocked out (unconscious) for greater than 1 minute
  • You think your child may be experiencing a life threatening emergency

If your child has a head injury and is experiencing the following, take them to the ED immediately:

  • Altered mental status or “acting weird” (ex: slow to respond, not answering questions appropriately)
  • Severe neck pain/stiffness
  • Blurred vision that lasts longer than 3-5 minutes
  • A cut or wound which will not stop bleeding or is gaping open (if bleeding is severe call 911)
  • The child has a “dent” in the skull, this may be a skull fracture
  • A fall of over 3 feet in a child under 2 years of age
  • A fall of over 5 feet in a child over 2 years of age
  • Vomited 2+ times within 24 hours after the fall/injury
  • Your child is high risk (history of brain surgery, bleeding disorder or VP shunt)




I think my child might have a concussion, do I need to bring them to the ER?


Concussion range in severity from mild to very severe. Most children with a mild concussion do not need to be seen in the emergency department (see below for when you do need to bring your child in urgently). However, we do recommended that they follow up in our office on the next clinic day regardless of whether or not they were seen in the ER.

If the concussion was sustained while the child was playing a sport, they need to be taken out of the sport immediately and should not return to practice or play until they are cleared by their provider for return to play.

If your child has had a head injury and has any of the following, you need to have them seen immediately:

  • A serious neck/back injury (DO NOT move the child, call 911)

  • A loss of consciousness, or level of consciousness that deteriorates over time

  • Vomiting more than twice after a head injury

  • Inability to recognize people or places

  • Numbness or tingling in the arms or legs

  • Symptoms that worsen dramatically in a short period of time

  • Seizure after a head injury

  • Your child cannot walk or are confused/slurring their speech

  • Your child has a depression or "dent" where he hit his head

  • Child had a high speed injury (such as a car crash)

  • You think that your child may be experiencing a medical emergency





Coronavirus

I'm worried about coronavirus - what should I do?


The Centers for Disease Control has the most up to date information regarding coronavirus (COVID-19) here. You can also find information regarding children and the coronavirus (COVID-19) here. Most importantly if you or your child has been exposed to a known case, traveled to an area where there is an outbreak, or is showing symptoms, you should stay home and avoid other people. If your child is not seriously ill, is not dehydrated and is not having difficulty breathing you can continue to monitor them at home as they recover. You do not need to take them to the emergency department or urgent care for minor symptoms, you can call our office the next morning and speak with a nurse or provider. We have the ability to test them in the office.




My child was exposed to coronavirus (COVID-19) - what do I do now?


First, don't panic! Most children will have mild to moderate symptoms as they might experience with a common cold or flu. There is no specific medication or treatment for COVID; you should monitor them closely and bring them to care right away if severe symptoms (such as difficulty breathing, lethargy, or dehydration) are noted. If your child appears severely ill, they need to be seen right away by a healthcare provider (Emergency department). Please isolate your child at home and call our office on the next business day. If you are not sure if you need to have your child seen, you can use the Coronavirus Self-Checker on the CDC's website. The purpose of the Coronavirus Self-Checker is to help you make decisions about seeking appropriate medical care. You should have your child tested. If it is during the weekday, please call our office and we can schedule a test, either in your car or in the office if you feel that your child also needs to be examined by your healthcare provider. If it is after hours or on the weekend, you can either be swabbed at a community testing site, or you can wait for the next business day to be swabbed in our office (there is no rush to be swabbed, so we would be happy to see you!). Prevea Health has a testing site that is open on the weekend - you can schedule a test by going to www.myprevea.com.




My child an/or I got tested for coronavirus and I'm looking for test results.


Please do not use the on call number for test results. We will release your test results to mychart when available. Click here to go to the mychart site. If you have questions about your test during normal business hours (8 am to 5 pm Monday through Friday) please feel free to call our office at (715) 830-0732.




I want to get my child tested, but it is the weekend - what do I do?


You can go to myprevea.com to schedule a test. You can also call (715)-717-4582.




I think my child was exposed to COVID-19, but is not showing symptoms - what should I do?


If you think that your child might have been exposed, you should follow the CDC's current guidelines which can be found here. Depending on who you were exposed to and how long you were exposed for, you may need to quarantine for 14 days. You should quarantine as directed by the CDC. You should also call us on the next business day to discuss whether or not your child needs to be tested for COVID-19. This can vary depending on the exposure, so please call us to discuss.





The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.